At the 2023 Southern California State of Reform Health Policy Conference, a handful of health leaders met to discuss the status of healthcare coverage for the justice-involved population. This year, California became the first state in the nation to offer Medicaid coverage to incarcerated individuals for up to 90 days prior to release.
Autumn Boylan, deputy director of the Office of Strategic Partnerships of the California Department of Health Care Services (DHCS), explained how the Centers for Medicare and Medicaid Services (CMS) approved the state’s 1115 waiver, which did away with an exclusionary healthcare portion for the justice-involved population. Washington state also gained approval for a similar justice-involved coverage initiative. Boylan said DHCS requested coverage 90 days prior to release because CMS was likely to approve it.
“It’s important to have enough time to be able to manage the relationship building, and the trust building that’s necessary for the care managers and the individuals to be able to develop a relationship that will serve as that bridge to community-based care.”
— Boylan
The goal of California’s Justice-Involved Initiative is to provide pre-and-post release care management to individuals who are incarcerated, with a team to support their transition to community-based care. Overall, the state expects this initiative to improve the physical and behavioral health of this population.
“With this particular population, there are poorer health outcomes for individuals who have been, or who are, incarcerated: higher rates of mortality and lower life expectancy rates for individuals who [are] or [who] have previously been incarcerated. There’s also a disproportionate impact for individuals from Black communities, as well as LatinX, Asian Pacific Islander, [and] other communities where the population is disproportionately overrepresented.”
— Boylan
Earlier this year, CalAIM’s Providing Access and Transforming Health Initiative (PATH) started issuing funds to support the implementation of pre-release Medi-Cal enrollment and suspension processes, and the delivery of Medi-Cal services prior to release. Boylan said DHCS received $410 million from the federal government to support correctional facilities and county behavioral health departments with pre-release service programs, staffing support, IT infrastructure, and more.
“With the infusion of federal dollars that will be coming into these systems that haven’t been available previously, this is really just a starting place for building out what will be available through this program,” Boylan said.
Pre-release services will become available to all individuals eligible for Medi-Cal and CHIP (Children’s Health Insurance Program). Adults must meet additional criteria including having a mental illness, substance use disorders, chronic health conditions, traumatic brain injuries, HIV/AIDS, and/or being pregnant or postpartum. Youth in correctional facilities will not have to meet additional criteria, according to Boylan.
“Reentry case management services is really the backbone of what the waiver is providing—that transition from the carceral setting into the community. That’s the most important aspect of the work,” Boylan said.
Yvette Willock, chief of social services for the Los Angeles County Justice Care and Opportunities Department (JCOD), highlighted how the county implemented pre-arraignment release protocol on Oct. 1st, which came from the county’s superior court.
“There will be an adjustment to the requirements of someone needing to post bond, and under guarding that is an understanding that they’re individuals who are arrested and have certain charges that are before them, and that they are, for example, [in the] nonviolent felony category, misdemeanor category,” Willock said.
Individuals who are facing these potential charges oftentimes don’t have the financial resources to post bond, which leads to incarceration. The Los Angeles Superior Court is addressing this long standing process by addressing the basic needs of individuals, like housing and food access. Individuals are able to return to their communities with a scheduled court date, although Willock said numerous existing barriers may prevent individuals from maintaining their court date, leading to warrants.
“There’s some nonclinical efforts that can be implemented, activated, [and] developed to assist that individual as they wait for that court date, to get certain needs met, and successfully return to court.”
— Willock
Willock noted how JCOD has partnerships across the county for nonclinical efforts, like linkages to services. She said JCOD is focused on capacity building in communities with community-based organizations who are trusted community members.
Linda Henderson-Smith, senior project management director for Carelon Behavioral Health, added how her employer has a justice-connect program that notifies the plan when individuals are taken into jails, so that they can begin enhanced care management.
When describing what panelists are most excited about, Anders Corey, health deputy for the Los Angeles Board of Supervisors, said it’s the collaboration between the state, counties, healthcare plans, and providers. He said while those collaborations have always been there, the state is now at a point where infrastructure is beginning to catch up with the collaborations. Willock is excited about seeing an intentional shift of focus.
“Individuals who are incarcerated are human beings, and they’re human beings with needs,” Willock said. “Those needs ought not to be ignored because they engaged in an action that yes, there is a consequence for it, and they are living out that consequence. That ought not suspend their humanity.”