Supporting Health Plans to Address Justice Involvement as a Social Determinant of Health

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For justice-involved (JI) individuals, the lack of solid community-based relationships is among the most significant social determinants of chronically poor health.

It makes sense then for health plans to establish and nurture solid, collaborative relationships with community-based service organizations necessary to effectively serve JI individuals.

Justice-involved individuals typically carry an interconnected mix of high-cost medical issues with them into jail or prison. These include chronic medical conditions, drug dependence or use, a history of mental health problems, and serious psychological distress.

Data shows these same issues follow them through to their release—often in an even more serious condition with potentially dangerous results. The relative risk of death for individuals who were previously incarcerated is 3.5 times higher than other residents for all causes. (In Massachusetts, previously incarcerated adults were 120X more likely to die from an opioid overdose than individuals with no history of incarceration.)

In ACA expansion states, an overwhelming majority of JI individuals—more than 95 percent—will be income eligible for Medicaid upon release from incarceration. Many states help these individuals to enroll in (or reactivate) Medicaid prior to release and assign them to a managed care plan.

Building critically important connections

For a health plan to meet the complex, ongoing needs of JI individuals depends on helping them build connections and trust in those who will manage an integrated treatment plan—one that incorporates the full scope of medical, mental health and addiction care, social services, and social supports.

For community providers, it’s equally important to build connections and trust among five key agencies and the individuals who play key roles in helping to develop and expedite effective care plans for JI individuals. These include state departments of corrections, probation, and parole, as well as local sheriff’s offices, and specialty courts.

These agencies have contact with JI individuals at five key intercept points where there is an opportunity for effective intervention: pre-arrest; pre-trial; post-adjudication (courts); community re-entry; and rehabilitation. By working closely with staff at these agencies, health plans can identify individuals who are in need of behavioral health treatment, and can help connect them to appropriate services.

By understanding the challenging work these justice entities do—how and where they interact with JI individuals and what their respective responsibilities are—and by nurturing close working relationships, state and community-based health plans build necessary skills and knowledge that improve their capacity to meet the needs of JI individuals.

At Commonwealth Medicine, the healthcare consulting and operations division of UMass Chan Medical School, our experts in health policy, Medicaid, and health and criminal justice apply a research-driven approach to help health plans build the knowledge, skills, and organizational capacity to collaborate effectively and deliver comprehensive community supports and healthcare services for JI individuals.