Health Policy Reforms and the Criminal Justice System

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Starting on January 1, 2014, the Patient Protection and Affordable Care Act (ACA) will result in one of the largest expansions in health care coverage for Americans since the 1960s. The Congressional Budget Office (CBO) has estimated that somewhere between 20 and 30 million Americans will gain health insurance coverage over the next several years as a result of new eligibility provisions in the ACA. Final numbers will depend upon how many states participate in an expansion of Medicaid, the publicly financed insurance program for low-income individuals.

In addition to expanding health care coverage, the ACA also imposes new requirements for health plans to provide more comprehensive coverage. For example, the ACA eliminates pre-existing condition exclusions and prohibits annual and lifetime benefit limitations. It also requires most plans to offer ten categories of “essential health benefits,” including mental health and substance abuse coverage. Additional important reforms passed in 2008 and 2009, such as the Mental Health Parity and Addiction Equity Act (MHPEA) and the Health Information Technology for Clinical and Economic Health (HITECH) Act, will operate in concert with the ACA to improve health care coverage and quality of care.

These changes create opportunities to address some of the most crucial health care challenges faced by individuals involved with the criminal justice system, including the lack of health coverage and the disproportionately high rates of chronic and communicable disease. Taken as a whole, these reforms to the health care system have the potential to improve public health outcomes and public safety, while reducing existing state and local budgetary pressures.

Medicaid Expansion and Health Insurance Exchanges

Jointly run by the federal and state governments, the Medicaid program provides public health insurance coverage to certain categories of low-income individuals. Presently, most states do not offer Medicaid to childless adults, unless they meet specified disability criteria. Under the ACA as amended by the Supreme Court ruling, states now have the option to expand their Medicaid programs to all individuals whose incomes are less than 133 percent of the federal poverty level, e.g., $15,281 per year for a childless adult in 2013. 

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Status of State Action on Medicaid Expansion Decision, as of June 11, 2013 (source: The Henry J. Kaiser Family Foundation)

Regardless of whether a state expands its Medicaid program or not, all states will be required to offer subsidized insurance plans through online health insurance marketplaces known as health insurance exchanges to individuals with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for a single adult in 2013), who are also not eligible for Medicaid or employer-sponsored coverage. For individuals with incomes below 100 percent of the federal poverty level, no new assistance will be available in states that do not expand Medicaid.


KEY RESOURCES

[1] Wilper, A. et al. (2009). The health and health care of U.S. prisoners: Results of a nationwide survey. American Journal of Public Health, 99(4):666-672.

[2] Steadman, H. et al. Prevalence of serious mental illness among jail inmates. Psychiatric Services 2009 60: 761-65.

[3] Wang, E.A. et al. (2008.) Discharge planning and continuity of health care:
Findings from the San Francisco county jail. American Journal of Public Health 98 (12): 2182-2184.

[4] For people with serious mental illnesses: Finding the key to successful transition from jail or prison to the community. Bazelon Center for Mental Health Law, Washington, DC, 2009.

[5] M.R. Cheung. (2013). Lack of health insurance increases all cause and all cancer mortality in adults: An analysis of National Health and Nutrition Examination Survey (NHANES III) data. Asian Pac Journal Cancer Prevention, 14(4):2259-63.

[6] Incarcerated mentally ill: A growing issue in California. Council on Mentally Ill Offenders. Accessed on June 12, 2013, at: http://www.cdcr.ca.gov/comio/Legislation.html.

[7] Janet Currie and Jonathan Gruber. (1996). Health insurance eligibility, utilization of medical care, and child health. The Quarterly Journal of Economics 111(2):431-66.

[8] Ayanian, J. et al. (2000). Unmet health needs of uninsured adults in the United States. JAMA 286(16):2061-69.

[9] Osher, F. et al. Adults with behavioral health needs under correctional supervision: A shared framework for reducing recidivism and promoting recovery. Council of State Governments Justice Center, New York, NY, 2012.

[10] A.E. Cuellar and J. Cheema. (2012). As roughly 700,000 prisoners are released annually, about half will gain health coverage and care under federal laws. Health Affairs, Vol. 31, No. 5, 931-938.

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