Prison and jail leaders met last month at the 2023 Minnesota State of Reform Health Policy Conference to discuss the state’s opportunity to provide services addressing health-related social needs (HRSNs) for individuals transitioning out of carceral settings. In Minnesota, incarceration rates are 342 for every 100,000 people.
Paul Fleissner, managing principal for Health Management Associates (HMA), explained how other states like California have recently used 1115 demonstrations to implement Medicaid coverage for adults and juveniles 90 days prior to release.
“As part of the pre-release benefit packages, they call it case management for physical or behavioral health, MAT [medication assisted treatment], things like durable medical equipment, 30-day supply of prescription medications,” Fleissner said. “Imagine how we’ve released people in the past and what that’s meant for people as we’ve put them out in the community.”
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Fleissner told State of Reform that the Minnesota Department of Human Services has a request for proposal for the exploration of a reentry waiver, which HMA has responded to. If approved, pre-release services for individuals in state prisons, county jails, and youth correctional facilities would become available 90 days prior to release under the 1115 expenditure authority.
Allen Godfrey, director of field services for the Minnesota Department of Corrections (DOC), brought up the federal Medicaid Inmate Exclusion Policy from 1965, which limited care in carceral settings, and noted how the War on Drugs led to mass incarcerations of individuals with complex mental health and chemical dependency needs who did not have the same access to services as the general population.
“Our facility, every given year, we have about 4,000 persons that are released under the DOC facilities back into the community. Imagine this—36 percent of those releases are there less than six months,” Godfrey said. “They are rarely getting any type of treatment intervention, access, case planning, et cetera. They’ve pretty much come through the door and then are released back out into the community to try to then navigate SUD [substance use disorder], mental health, et cetera.”
Of those 4,000 individuals, approximately 1,000 are incarcerated for technical violations and a large percentage are there for 90 days, according to Godfrey. He said it’s crucial for the system to become active rather than reactive by addressing drivers that lead to incarceration. About 40 percent of Minnesotans incarcerated are BIPOC, highlighting major disparities. Godfrey is currently focused on the Minnesota Rehabilitation and Reinvestment Act, which allows individuals within the DOC to gain early release and earned supervision abatement by accomplishing goals identified in their individualized rehabilitation plan.
“It’s really built upon a model to say when you are invested, you are doing treatment, we are now going to release you early out of the DOC facility,” Godfrey said.
Tim Walsh, chief executive officer of NorthStar Regional—a rehabilitation center—explained a DOC Pilot Project that took place in 2017 where leaders identified the 11 counties in the state that saw the highest number of incarcerated individuals settle upon release. Walsh explained how those populations began to receive Medical Assistance and were signed up for benefits while they were still in the carceral setting. After several years, the impact of this initiative was studied.
“What they found was this: for those persons that were released that had the Medical Assistance signed up—we’re not even talking about services, folks, we’re just talking about signed up, ready to hit the door and able to then get public assistance, which helps them with housing and food, [and] at the same time, access to food and treatment services—and they found this: after the first year … simply by getting the application approved, ultimately the population was two-thirds less likely to return back to incarceration compared to the control study,” Walsh said.
Walsh added that there was a one-third reduction in homelessness for individuals released back into the community because they filled out applications. He noted that the Minnesota Department of Human Services is working with DOC to make direct access for incarcerated individuals a reality. About 10 percent of incarcerated individuals who are released have someone assisting them, or a release planner, Walsh said. He hopes the approval of pre-release services will allow individuals to be eligible for navigational services like case management.