Because the justice-involved population is so large, has substantial behavioral healthcare needs associated with significant costs, and has relatively new access to health insurance coverage and care, building bridges to care between correctional and community settings warrants special focus by public safety and health leaders in both government and private sectors.

Each state has its own Medicaid program that articulates covered services and populations, along with other features and parameters. States can add, remove, and modify services via state plan amendments (SPAs) and using other tools. They can also apply for a Section 1115 waiver, allowing them to cover and receive federal reimbursement for services, settings, and/or populations not otherwise allowed under federal Medicaid rules.

By successfully connecting individuals released from jail or prison to Medicaid MCOs (managed care organizations) and their care management programs, large numbers of people with unmet behavioral health needs who cycle in and out of the criminal justice system can begin receiving treatment in the community. 

In addition to direct services, Medicaid pays for administrative costs incurred for the “proper and efficient administration of the State plan.” Through Medicaid administrative claiming (MAC), these expenditures are reimbursed to the state.

People released from jail and prison face increased risk of hospitalization and overdose death in the period immediately following release....Granting them immediate health insurance coverage helps ensure they can get connected to aftercare in the community during a time when they are most at risk for relapse, thus reducing the risk of overdose, hospitalizations, and death, along with the chances of further offending and contact with the justice system. 

Health homes offer enrollees access to providers that are able to expertly coordinate complex care for that portion of the Medicaid population. Health homes are responsible for facilitating access to and coordination of a full array of primary and acute physical health services, behavioral healthcare, and long-term community-based services and supports. 

A Home and Community-Based Services (HCBS) waiver—also known as a Section 1915(c) waiver—is an option in the federal Medicaid program that enables states to promote community-based alternatives to institutionalization.

The federal Medicaid reimbursement rate varies depending on a number of circumstances and variables. Federal matching funds made available to states through the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 are referred to as “90/10 funds.” HITECH authorized federal matching funds for activities to promote adoption of a health information exchange (HIE), a system facilitating shared access to electronic health records. 

Jurisdictions seeking ways to connect detained youth to care are likely to face a common barrier—the requirement for parental income information on a Medicaid application. This information can be very difficult to come by at all, and even more difficult to obtain in a timely manner. Often, by the time social workers are able to contact a parent and obtain the information, a youth already has been discharged, and the opportunity for enrollment in time to facilitate care during the transitional period has passed. Many youth are discharged without being enrolled in Medicaid.

Medicaid enrollment prior to release increases the likelihood of engagement in services upon return to the community. Increased continuity of care supports efforts to reduce recidivism and healthcare costs among this population.