Authors: Silicia Lomax, John Sawyer, Vikki Wachino, and Margot Cronin-Furman
States can use Medicaid demonstration waivers to cover pre-release services to strengthen health and public safety. These changes hold the potential to improve care for people who have been incarcerated, improve public safety, reduce future justice involvement, save costs to communities, and bolster overall community wellbeing. But they must be implemented well in order to ensure success.
To facilitate a discussion about how best to carry out implementation and achieve results, in 2023 HARP convened 26 stakeholders from the health and criminal justice systems including representatives of state and local governments, probation and parole officials, public defenders, Medicaid managed care organizations, community-based service providers, state policy experts, reentry service leaders, and people with lived experience of incarceration.
The HARP-led discussion focused on Medicaid reentry waivers for pre-release services and new policies creating continuity of care for youth and young adults. HARP synthesized the cross-sector group’s observations into 10 Medicaid and reentry implementation priorities.
- States can act now to strengthen access to health care for people involved with the criminal justice system, building on past progress.
- Expand awareness of policy changes and their goals among policymakers, implementation partners, and directly impacted people.
- Directly engage and share information with the many people and constituencies who will be involved in implementation.
- Prioritize health care and criminal justice system collaboration, identifying and working toward shared goals.
- Expand guidance and highlight successful strategies on specific policy elements.
- Invest in community-based systems of care.
- Advance a holistic definition of health in implementing new policies.
- Expand the workforce to meet the needs of the reentry population.
- Advance multi-sector accountability.
- Conduct more research on health care for justice-involved populations.
Bipartisan support has grown among federal and state leaders who recognize the human, social, and financial cost of the health care gap that exists when people leave incarceration. They have coalesced around policy changes that allow Medicaid to cover targeted services as people are being released to achieve continuity of care. But achieving the full potential of these changes requires the active engagement of a range of stakeholders, including health care professionals, criminal justice practitioners, and incarcerated people including youth and young adults.
As one participant in HARP’s convening noted, “The challenge is that corrections language and Medicaid language are so different…[We] need to get more people together to learn each other’s language.” HARP seeks to foster collaboration among these core constituencies to strengthen public safety and health outcomes.