Background
Currently, there are thousands of people in prisons and jails who suffer from chronic diseases, mental health issues, and substance use disorders. Generally, when these individuals reenter the community, they do not receive the necessary care for their health conditions because they lack health care coverage. In most states, they are not eligible for health care under current state health benefit polices. These individuals then turn to emergency services as their primary outlet to receive medical treatment. Effective October 1, 2013, however, as a result of the Affordable Care Act (ACA), many justice-involved individuals will be eligible for either Medicaid or low-cost health insurance through state health insurance programs. While this is a great step in the right direction to provide a much needed service to a high-risk population, there is no standardized process in place for connecting justice-involved individuals with health care coverage that will be available to them under the ACA. Consequently, corrections and court personnel will play a critical role in helping offenders who are being released back into their community access health care coverage by determining eligibility at intake onto probation, jails, prisons, and parole and facilitating the application and enrollment process. To prepare for the imminent changes under the ACA, the Illinois Governor’s Office convened the Workgroup on Justice Populations (WJP), which comprised high-level individuals from state behavioral health, corrections, and Medicaid agencies to share information on the best way to rollout a statewide plan for putting protocols in place to meet new federal health care requirements. The WJP began meeting in 2011 to focus on the identification of opportunities and mutual education, the development of capacity within justice agencies to fully participate in health reform implementation, and the development of pilot projects to test opportunities such as projects with enrollment in jails, prisons, and probation agencies. Additionally, the Governor wanted to get a head start on how to best train criminal justice practitioners on implementing health care changes and what their role would be in ensuring justice-involved populations are identified and enrolled in an appropriate health care plan. To accomplish these goals, the Governor’s office reached out to the Bureau of Justice Assistance (BJA) National Training and Technical Assistance Center (NTTAC) to work with stakeholders on a strategy for implementing statewide health care changes, understanding what systems are in place to share information, and developing strategies for greater information sharing. Summary of the DMA Health Strategies Technical Assistance (TA) Engagement BJA NTTAC submitted a request for proposal, evaluated various responses, and identified DMA Health Strategies (DMA) as the appropriate provider to assist the Illinois Governor’s office with implementing an innovative approach to connecting justice-involved populations with health care. DMA, in partnership with Treatment Alternatives for Safer Communities (TASC) of Illinois and Advocates for Human Potential, Inc. (AHP), engaged in the initial step of the TA engagement with developing information-sharing opportunities for stakeholders to educate each other on their current processes and policies regarding health care services to justice-involved populations and to provide basic education on the ACA. DMA and its partners also organized and facilitated various in-person meetings and conference calls for the WJP. Among WJP’s members were representatives from the county jail system, probation and parole offices, the Illinois Department of Corrections, and the Illinois Department of Human Services. WJP’s primary goal was to advise the Governor on key strategies to maximize the benefits of health care reform to reduce crime and associated incarceration costs, and to improve the health among this population. To that end, WJP is developing a first-of-its-kind health reform implementation guide for justice-involved populations that other states across the country could easily replicate. To ensure a holistic approach to developing the guide, DMA and its partners held meetings with state and county stakeholders to discuss the type of care currently offered to people under the justice system and identify ways to broadly engage people in health insurance coverage in various justice settings. Additionally, the partners met with probation administrators across Illinois to build the capacity to assist probationers with Medicaid and insurance applications, and make referrals to human services providers and community health centers. Illinois successfully implemented an early expansion of Medicaid coverage under the ACA in Cook County (Chicago), with significant commitment to covering and treating people under justice supervision. Representatives from Cook County can share valuable lessons learned on implementing the ACA with other jurisdictions seeking to enroll justice-involved populations in Medicaid. Secondly, DMA and its partners helped the WJP to develop enrollment maps, which identify key points throughout the intake processes where criminal justice professionals can collect and share health information and medical history on justice-involved individuals to complete health care enrollment forms. For example, the WJP discussed utilizing the Illinois Jail Data Link – an online system that identifies persons previously served by community mental health agencies – during intake procedures to determine the mental health status and history of persons taken into justice supervision. Knowing offenders’ health histories and completing their enrollment forms at intake is critical to making sure that justice-involved persons have access to care upon reentry to the community. According to Dr. Lisa Braude, DMA Senior Associate, “the ideal situation is to have individuals enrolled in a health benefit program when they are released from custody.” Lastly, TASC is in the process of holding team-based seminars to educate and train more than 100 justice professionals across the state of Illinois on the implementation of health care reform and the enhanced intake and discharge processes to link justice-involved populations to health care. As an additional resource, the WJP has developed job aids to assist corrections and court personnel as well as probation and parole staff in implementing the ACA enrollment of justice-involved populations. The effective implementation of health care reform will improve the overall health and well-being of justice-involved populations, provide long-term public health benefits, and increase public safety by reducing crime and recidivism. In the state of Illinois, state and local agencies are collaborating with criminal justice professionals and health care administrators to develop a statewide process for linking justice populations with health care services offered to them under the ACA. BJA NTTAC looks forward to sharing best practices and lessons learned from the DMA TA engagement to help guide other states in implementing ACA changes in their state. To submit the work of your organization or jurisdiction for consideration to be featured in a future TTA Spotlight, please email BJANTTAC@ojp.usdoj.gov.