CHCF supports projects that expand proven models of care and research into policy approaches to improve the coordination and delivery of care for people before and after they leave correctional settings and return to the community. Following is a summary of our current work in this area.
In California, about 35,000 people are released annually from the state’s prisons, and of the more than 350,000 people booked into jails each year, most are released within a few months. This “reentry” population — people returning to their communities from jail or prison — have acute health needs but often have difficulty accessing timely, appropriate care after release.
People involved with the justice system experience high rates of physical and mental health problems within complicated social contexts, including trauma, unemployment, and poverty. Many have complex health conditions: An estimated 60% of California prison inmates have substance use disorders, one-quarter have serious mental illness, and many also have multiple physical health conditions including hypertension, infectious diseases, and asthma.
California’s continuing expansion of Medi-Cal eligibility means that most people in the reentry population who previously lacked health insurance are now eligible for Medi-Cal coverage.
CalAIM’s Enhanced Care Management and Community Supports
CalAIM (California Advancing and Innovating Medi-Cal), a multiyear reform of the state’s Medicaid program, includes specific initiatives to improve the health access and outcomes of people leaving jail and prison. CalAIM’s Enhanced Care Management and Community Supports programs provide additional services to certain Medi-Cal enrollees, including people who have been incarcerated.
Enhanced Care Management provides a high-touch care coordinator for Medi-Cal managed care enrollees with multiple complex needs. This benefit is intended to ensure that enrollees with complex needs are actively connected with the clinical and nonclinical services and resources that help them meet those goals.
Community Supports gives managed care plans the option of providing certain housing or independent living supports not traditionally covered.
Beginning January 2023, people released from prison or jail who experience homelessness, serious mental illness, substance use disorders, or complex medical conditions will be eligible for these services.
CHCF has published a collection of tools and resources aimed at helping organizations understand and implement CalAIM, including its Enhanced Care Management and Community Supports programs.
A key CalAIM provision is its request to the federal government to allow a “pre-release” Medi-Cal application process.
Since Medicaid was created in 1965, federal law has barred the use of federal Medicaid funds for services for people who are incarcerated. In part for this reason, when people leave prison and jail, they often experience gaps in care in accessing health care in their community.
As part of CalAIM, California has asked the federal government for approval to engage with people in jail or prison who meet specific clinical criteria in the 90 days prior to release. This may include people who are seriously ill with physical or behavioral health conditions. Their health and social needs would be assessed, and they would be connected — via “warm handoff” — to care in their community after reentry.
In addition, by 2023 CalAIM seeks to ensure all eligible people are enrolled in Medi-Cal before they are released from county jails and youth correctional facilities, a process already in place in the state’s prisons.
CHCF is supporting the Health and Reentry Project, a national effort that seeks to promote continuity of care between correctional and community settings and to maximize the benefits of potential Medicaid policy changes. The project is managed by the Council on Criminal Justice, Waxman Strategies, and Viaduct Consulting.
The project has published two issue briefs exploring proposed changes to Medicaid policy regarding the reentry population.
Transitions Clinic Network
In addition to work on CalAIM reentry policies, CHCF has since 2017 supported California expansion of the Transitions Clinic Network, an evidence-based model of integrated care designed to serve people returning to the community from incarceration. Transitions Clinic Network California has trained 21 clinics in the state to participate, and more are scheduled to begin operations by 2023. The CHCF Blog profiled one of the clinics in the network.
Other CHCF Resources
Two CHCF Almanac reports, one on mental health in California and a second on substance use disorder, include interactions between the criminal justice and behavioral health systems.
The Council on State Governments Justice Center is hosting a webinar series designed to equip justice system leaders with tools for effective collaboration with housing and behavioral health partners to provide housing for people leaving incarceration. CHCF supports this series, and recordings of prior webinars are freely available.
California Health Policy Strategies offers two publications CalAIM for Reentry and Justice-Involved Adults and Youth: A Policy Implementation Guide (PDF) (2022) and Reentry Health Policy Project: Meeting the Serious Health and Behavioral Needs of Prison and Jail Inmates Returning to the Community (PDF) (2018).
For more information, please contact CHCF’s Catherine Teare.