An important outcome of the COCHS conference Exploring Health Reform and Criminal Justice: Re-thinking the Connection between Jails and Community Health (10/17/2010) was a call from participants for COCHS to convene smaller, more focused, topical discussions on the implications of the Patient Protection and Affordable Care Act (PPACA) on the jail-involved population.
In response, COCHS initiated the formation of two small working groups in 2011 that catalyzed the identification and analyses of issues pertinent to the development of policy regarding implementation of the PPACA.
COCHS also facilitated a working group organized and hosted by the National Association of Counties (NACo) in January and February 2012 regarding Medicaid expansion and potential coverage for individuals who are pending disposition of charges.
Health Reform and Criminal Justice:
Implications for the Delivery of Behavioral Health Services
to the Criminal Justice Population Cycling through Jails
This working group met four times in the Spring of 2011. These sessions revealed a tremendous opportunity to cross-fertilize expertise and experience from thought leaders and practitioners in the areas of behavioral health care and in Medicaid policy and finance; the discussions resulted in a set of findings and recommendations that are intended to help inform states and local jurisdictions as they explore new opportunities for serving the criminal justice population under the Patient Protection and Affordable Care Act.
The group was supported by the Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Robert Wood Johnson Foundation.
The working group engaged in a dialogue with behavioral health specialists and technical experts in health plan benefit design, rate setting, and contracting and performance standards. It examined the 2006 Massachusetts health reform initiative and a unique program in Washington State that offers substance abuse treatment to very low-income childless adults. Data from both suggest that there are potential cost savings to be achieved in reaching and treating low-income people with mental health and substance use disorders, characteristics that mirror the criminal justice population.
For more information, please see:
Behavioral Health Working Group Executive Report.
Health Reform and Criminal Justice: Re-Tooling the Relationship
This working group met in May, 2011 to address the implications of health care reform on the criminal justice system, with primary emphasis on addressing the health needs of the millions of individuals cycling through the jail system, many of whom will become eligible for Medicaid in 2014. The dialogue centered on local jurisdictions and the issues and opportunities that might arise for their local criminal justice systems with implementation of the PPACA in 2014. The group also focused on how to communicate the opportunities of the PPACA to key actors in criminal justice system. The Public Welfare Foundation and The Robert Wood Johnson Foundation co-sponsored the working group.
COCHS developed FAQs on health care reform for criminal justice stakeholders to set the stage for the working group meeting. The meeting opened with a “fishbowl” exercise, a semi-structured role play in which experts representing various components of a local criminal justice system discussed the opportunities and challenges presented by health care reform in a hypothetical community called Cassidy County. After this exercise, the working group discussed some of the messages that it believes could be communicated to various stakeholders in the criminal justice system regarding the opportunities created by health care reform.
For more information, please see:
Criminal Justice Working Group Executive Report.
NACo Working Group on Pending Disposition
COCHS was invited to facilitate a small working group that was convened by the National Association of Counties (NACo) in January and February 2012 to discuss with its members how jurisdictions may be able to make use of Medicaid funding for their criminal justice system-involved population under Health Reform.
When implemented, the PPACA could shift the current correctional health paradigm in two ways: expansion of Medicaid eligibility would allow coverage in the community for individuals who are jail-involved, and, potentially, Medicaid coverage may be allowed for childless adults while incarcerated pending disposition of charges.
The working group discussed technical challenges and the financial and other factors that might motivate local stakeholders to reengineer criminal justice and public and correctional health care systems to take advantage of new opportunities under PPACA.
One outcome of the meeting was the development of three flow charts depicting health care related processes in jails:
the intake process, sick call, and discharge planning in jails.
For more information, please view the webcasts of the three sessions posted in our online library: