The Utah Department of Health and Human Services (DHHS) launched the first phase of transitioning health services for incarcerated individuals from the Utah Department of Corrections (UDC) to DHHS by announcing a new sub-agency this month, the Division of Correctional Health Services (DCHS).
DHHS reports the transition is expected to conclude by July 1st of next year, operating under a memorandum of understanding (MOU) with UDC signed last month.
Under the MOU, 200 former UDC employees are now under DHHS as part of the new division.
“We have the same vision for our incarcerated population that we do for all Utahns, that they should have fair and equitable opportunities to live safe and healthy lives. Maintaining health and well-being for an incarcerated person is as important while they are in prison as it is when they are released. We are grateful for support from the legislature to enhance healthcare inside of our prisons and for the ongoing collaboration from our friends in the Department of Corrections as we work together in new and creative ways.”
— Tracy Gruber, executive director of DHHS
UDC officials said the collaborative effort is reshaping the future of healthcare and holistic rehabilitation for incarcerated individuals in Utah by combining the correctional expertise of UDC with the healthcare services of DHHS.
The transition is aligned with the guidance CMS issued in April around using Medicaid 1115 demonstration waivers to increase healthcare access for those departing prisons and jails. California’s plan received federal approval back in January and Illinois has a similar demonstration waiver under review.
DHHS submitted its 1115 Primary Care Network Demonstration Waiver amendment, aimed at providing Medicaid coverage to incarcerated individuals 30 days prior to their release, in 2020, which remains under federal review.
During the Utah Behavioral Health Delivery Workgroup meeting last month, Utah Medicaid Director Jennifer Strohecker shared more about the guidance.
“Some elements that CMS has defined that are a little bit different than our original application, require states with their justice work to develop models that support high-intensity case management for individuals that are justice-involved. This high-intensity case management occurs inside the carceral setting and includes either a continuous high-intensity case management upon release with either the same case manager or a warm handoff to the case manager at the external provider.
The high touch case management is a mandated element but also supports health-related social needs, which is a benefit underneath the [Medicaid Reentry Section 1115 Demonstration Opportunity] that supports up to six months of housing, high-intensity case management, and a food benefit as well.”
— Strohecker
Tonya Moore, health policy consultant with Health Management Associates (HMA), told State of Reform the guidance was aimed at health equity and policy transparency, acknowledging California’s approved plan as a benchmark for states.
States have a two-year ramp-up period for their waiver proposals to build out what the coverage and service delivery for this population will look like.
“How can [states] make the provision of care more seamless, focusing on the whole person regardless of where they are and being able to provide them a consistent, comprehensive, and quality level of care?”
— Moore
Moore says under the guidance, the scope of benefits should be focused on a case management approach that meets the health and social needs of each individual, particularly around support for behavioral health and substance use.
Utah currently has some 5,900 incarcerated individuals, 5,400 individuals in jails, and 250 youths in detention with an incarceration rate of 435 per 100,000 people that is disproportionately people of color.
Experts say mass incarceration in America has emerged as a public health crisis, creating challenges related to housing, education, and employment for those reentering society.
Research shows individuals released from incarceration have a high risk for adverse health outcomes and death because of preexisting behavioral health and chronic medical conditions along with the negative impacts of serving time in correctional facilities.
Rates of mental health issues, substance use disorders, suicide, and depression are dramatically higher for justice-involved populations compared to the general population, especially when reentering society.
The justice-involved population has been historically excluded from Medicaid and Medicare—only 28 percent of jails in the US screen for Medicaid eligibility at release.
“Even with insurance, access to care is challenging for the reentry population. Internalized racism, posttraumatic stress disorder, and the stigma associated with incarceration, mental illness, and substance use disorders negatively affect requests for needed services. Research suggests that discrimination against those with a criminal record keeps people out of the primary care system, and such perceived discrimination in health care settings is associated with increased odds of self-reported poor or fair health status.”
— 2021 policy briefing by Health Affairs
The Utah Prisoner’s Advocacy Network (UPAN) is a nonprofit organization of volunteers that advocates for the justice-involved population and their families.
Virginia Robertson, medical team director at UPAN, said DHHS has been engaged with the organization and the families of incarcerated individuals in understanding where the gaps in the current system are in order to improve timely access to medical care for people serving their sentences.
“In general, access to care is a big [need]. It’s public knowledge that there were issues with inmate care requests. And we’re still having issues with that. These inmates put in six, sometimes 11, care requests just to be seen for a simple [medical] problem. And if it’s an urgent problem, it’s not always triaged as urgent until they are so sick that they need hospitalization. So it’s that basic access in a timely manner.”
— Robertson
Robertson said the solutions will not happen overnight but she is encouraged by DHHS’s public engagement that access to care and services will improve.