A panel of policy experts advocated for improving the state’s delivery of healthcare to the justice-involved population at the 2023 Illinois State of Reform Health Policy Conference earlier this month.
As part of the Biden administration’s effort to improve care for the justice-involved population, the Centers for Medicare and Medicaid Services (CMS) released guidance in April for states to apply for a new Medicaid 1115 Demonstration to increase healthcare access for those departing prisons and jails.
Last week, Illinois submitted an extension request for its 1115 Medicaid waiver for Gov. JB Pritzker’s Healthcare Transformation Collaborative (HTC) to CMS.
Called the Illinois Healthcare Transformation Demonstration, the updated waiver extension seeks to address health-related social needs (HRSNs) by extending community reintegration services for justice-involved adults and youths for up to 90 days before their release from incarceration. It also would incorporate housing support for people who are experiencing or at risk of homelessness.
This pre-release incarcerated population would receive Medicaid benefits including employment, food, nutrition, violence prevention, health, and behavioral health services as well as justice-involved reintegration.
Victor Dickson, president and CEO of Safer Foundation, an organization providing reentry support for the HTC pilot program in Cook County, said that the organization has been lobbying for the Illinois Department of Healthcare and Family Services to incorporate the pilot’s successes statewide to help the justice-involved population successfully transition back into society.
“One of the key roles is a navigator across systems—a navigation role because you’re dealing with a housing system, healthcare system, behavioral healthcare system, the workforce system, and all those things.
It’s virtually impossible for someone getting out of prison to go to 15 different places and get what they need. So we have these justice system-impacted people that navigate [services] for them and make sure that there are handoffs.”
— Victor Dickson, president and CEO of Safer Foundation
Dickson said the state has released nearly 300,000 thousand people from prison and jails since 2019 when the state ordered parole reviews for most crimes committed by those under 21 years of age.
Those released from prison are ten times more likely to be hospitalized with an acute mental or physical health issue, and eight times more likely to die from a drug overdose in the first 30 days of their release than the rest of the population.
Dickson said that improving the outcomes for this population will be costly but not as costly as doing nothing.
“Recidivism reduction, which is traditionally what we think of as reentry, means that you do something that breaks that cycle of people committing new crimes and getting incarcerated again. Recidivism reduction is improvement in public safety—it’s harm reduction. Of course, this word now also has the focus of dealing with the social determinants of health …
We as taxpayers pay for it—$40,000 a year to keep a person incarcerated. We pay for— $120,000 every time there’s a recidivism event. We pay for caring for other people’s kids when they could work and would love to do that and pay for their own kids—we pay for that. And we pay for that every day we turn on the television and hear about crime and violence, we pay for more policing and more courts. And we pay for it in our fear that we have of the people that live around us.”
— Victor Dickson
The transformation collaborative will be informed by the justice-involved population to design, implement, and operate the HRSN system.
Deanne Benos, co-Founder of Women’s Justice Institute (WJI), a policy think tank, said her team, 70% of whom are formerly incarcerated women, consult and advocate on behalf of criminal justice reform at the local, state, and national levels. WJI’s work led to the passage of House Bill 3414, reforms to criminal sentencing for minors, particularly for young girls and women.
WJI put forth a plan in 2021 to cut the women’s incarcerated population in Illinois by half, which called on the state to improve health, well-being, and outcomes among justice-involved women, their children, families, and communities. In the same year, the Pritzker administration authorized WJI to lead a task force on developing a state plan.
Benos’s team worked with over 600 incarcerated and formerly incarcerated women to develop the Women’s Justice Pathways Model, a proposal to cut the women’s carceral population by 50% and transform the criminal justice system—transitioning from gender-neutral and recidivism-focused policies to gender-responsive and humane policies. Federal approval of the transformation waiver will be integral to reducing the number of incarcerated women.
“We’ve tried to change the structure and the narrative of how we look at systems as rights—rights and needs of women … Health and well-being, safe and stable housing, economic security, empowerment, supported families, and relationship safety.
Women experience these things, men do too, but women experience them differently. And so we’ve carved out as a model, pathways to justice. This is justice. Justice is not the criminal legal system in our opinion. This is the pathway to justice, the pathways to prison are [where] women’s rights and needs are not met.”
— Deann Benos, WJI director and former associate director of the Illinois Department of Corrections
The pathways models would establish a comprehensive system of coordinated health and behavioral health care for women throughout jails and prisons statewide that ensures access to a medical home, health insurance, and other benefits when released.
Cheryl Rucker-Whitaker, MD, MPH, FACP, managing director of Health Care Services, studies how systemic racism through incarceration impacts HRSN for African Americans. The former physician head of Chicago’s Institute of Medicine has been analyzing the city’’s Black Medicaid-Medicare dual-eligible and Affordable Care Act (ACA) population who are justice-involved.
“We have [Medicaid claims] data on over 25,000 men and their experience in the healthcare system. So for the first time in my life, I can actually see, through claims data, their experience and where they went.
We also had experience trying to build a network where we have 50,000 members … we had trouble getting primary care providers to contract with us … the current brick-and-mortar primary care network does not support these [justice-involved] gentlemen. Let’s not fool ourselves, please. It does not support—it barely supports us.”
— Cheryl Rucker-Whitaker, MD, MPH, FACP, managing director of Health Care Services
Rucker-Whitaker believes the state should be focused on building out culturally responsive providers and networks. She said while the government was busy signing the justice-involved population up for ACA coverage when it debuted, the state of Illinois had not built out a system to care for them.
“So many of these gentlemen age into chronic kidney disease because dialysis is an entitlement. So once you have kidney disease, you’re eligible for care. But you can’t get the preventive nephrologist to see you and you can’t get your [preventive medication]. How do we change that so that upstream, we can prevent the amount of disability that we’re seeing?”
— Cheryl Rucker-Whitaker
As the justice-involved population ages, many are struggling with acute chronic conditions that are costly to manage. Rucker-Whitaker believes the state should be focused on removing barriers to preventive care—getting people healthier while they serve their time.
The federal public comment period for the healthcare transformation waiver started on Wednesday and will be open through July 28th.