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Improving the Health of Individuals Reentering Communities from the Criminal Justice System

The role of the Medi-Cal program in providing health care to Californians reentering the community from the criminal justice system expanded substantially in 2014. All citizens and legal permanent residents with incomes up to 138% FPL are now eligible,[1] and many individuals without minor dependent children in their households will become eligible for Medi-Cal when they are released from incarceration.[2] This population has a quite different health and social profile than the groups who have historically been enrolled in Medi-Cal. Individuals who are incarcerated in California are more likely to have HIV, hepatitis, tuberculosis, and hypertension. Around half have a mental illness, and roughly two thirds are engaged in substance use.[3] In fact, many inmates also do not receive needed treatment while they are in prison or jail.[4] Although managed care plans may be skilled at serving parents and children, the needs of many newly eligible adults call for new outreach, service delivery, and care management models that allow Medi-Cal providers and managed care plans to offer high-quality, cost-efficient care to all beneficiaries.[5]

At the same time, several other important policy changes to health and criminal justice programs in recent years make the present an ideal time to build strategies to serve newly eligible groups with special needs. The 2011 realignment of certain criminal justice responsibilities from the state to the counties creates a window of opportunity to improve and coordinate health and social services for this population at the local level. The State has also made, and continues to make, many changes to Medi-Cal behavioral health programs. Realignment in 2011 also transferred financial responsibility for the Drug Medi-Cal (DMC) program from the state to the counties. In addition, when California expanded eligibility for Medi-Cal through the ACA, the state included an expansion of mental heath and substance use disorder services in managed care plans. A DHCS initiative to further organize and improve the DMC program though a federal Medicaid waiver is also ongoing.

All of these policy changes have increased local control of a range of important services that the reentry population frequently needs. Individuals leaving county jails can now immediately enroll in Medi-Cal managed care plans. With greater alignment among criminal justice stakeholders, health plans, and county departments responsible for behavioral health and social services, counties and managed care plans could connect beneficiaries with a range of service providers right at the point of discharge. In particular, the substantial need for substance use and mental health services among the reentry population requires effective and coordinated delivery of these benefits. These linkages could enable many individuals to make large strides toward better health and quality of life, while also reducing recidivism.[6], [7] In sum, county departments and health plans should leverage their increased programmatic flexibility and funding streams to reach these aims. We recommend the following local policy actions:

  • Counties should station personnel in jails to assist individuals with enrollment in Medi-Cal at the point of discharge.
  • Sheriffs’ departments and Medi-Cal managed care plans should build partnerships to share information and ensure continuity of care after release.
  • County officials in sheriffs’ and probation departments and county departments responsible for behavioral health should also build strong, collaborative relationships to continue treatments and connect individuals with providers in the community.
  • Health stakeholders should collaborate with district attorneys to maximize the appropriate use of split sentencing to allow for more comprehensive rehabilitation and treatment in the community.
  • Counties should align AB 109 funds and Medi-Cal services to create more innovative and comprehensive community rehabilitation and reentry programs that incorporate a range of physical health, behavioral health, educational, employment, and other social services.
  • Counties should dedicate AB 109 funds and staff resources to data collection and evaluation of reentry, rehabilitation, and treatment programs.

[1] Around $16,000 for an individual and $32,000 for a family of four.

[2] Cuellar AE, Cheema J. 2012 As Roughly 700,000 Prisoners Are Released Annually, about Half Will Gain Health Coverage and Care under Federal Laws. Health Affairs 31(5): 931-8.

[3] Davis et al. 2009. Understanding the Public Health Implications of Prisoner Reentry in California. RAND Corporation

[4] Rich JD, Wakeman, SE, Dickman SL. 2011. Medicine and the Epidemic of Incarceration in the United States. New England Journal of Medicine 364(22): 2081-3.

[5] Boutwell AE, Freedman J. 2014. Coverage Expansion and the Criminal Justice-Involved Population: Implications for Plans Service Connectivity. Health Affairs 33(3): 482-86.

[6] Wallace D, Papachristos A. 2012. Recidivism and the Availability of Health Care Organizations. Justice Quarterly. First published online July 9. Available at: http://www.tandfonline.com/doi/full/10.1080/07418825.2012.696126#.U0IoNa1dVxE

[7] Morrissey JP et al. 2007. The Role of Medicaid Enrollment and Outpatient Service Use in Jail Recidivism among Persons with Severe Mental Illness. Psychiatric Services 58(6). Available at: http://ps.psychiatryonline.org/article.aspx?articleID=98119

The full report is available for download:

Serving Newly Eligible Beneficiaries with Special Needs: Individuals Reentering Communities from the Criminal Justice System Serving Newly Eligible Beneficiaries with Special Needs: Individuals Reentering Communities from the Criminal Justice System .pdf

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