Abstract
Dear Colleagues,
The new administration and new policies in Washington, DC, open a new chapter for correctional health care in the United States. The potential repeal or revision of the Affordable Care Act (ACA) and the resulting impact on the criminal justice system and the delivery of correctional health services is unknown. The impact of the policies of the new administration on the important links between community and correctional health is unknown. It is increasingly clear that the ACA will be repealed, at least partially. What is certain is that health care will not remain the same.
A recent report published by the National Association of Counties (Medicaid Coverage and County Jails: Understanding Challenges and Opportunities for Improving Health Outcomes for Justice-Involved Individuals, February 2017) found that America’s 3,069 counties annually invest $176 billion in community health systems and justice and public safety services. Counties are required by federal law to provide adequate health care for the more than 11.4 million individuals who are admitted into 2,785 county-operated jails every year. These individuals are unable to access their federal Medicaid benefits from the moment they are booked into jail, even though the majority are pretrial and presumed innocent, due to what is known as the “federal Medicaid inmate exclusion.” Other federal health benefit programs (e.g., for veterans) are also subject to similar inmate exclusions.
Medicaid is the largest source of health coverage in the United States, providing health to low-income individuals and families through a federal–state–local partnership. Traditionally, Medicaid has served three categories of low-income people: families/children/pregnant mothers, the elderly, and the disabled. The ACA allowed states the option to expand Medicaid coverage to low-income adults without children, the very population that disproportionately makes up the jail/prison population (male, minority, and poor). As a result, the number of justice-involved individuals eligible for Medicaid has increased during the past several years. To avoid violating the statutory inmate exclusion, states can suspend, rather than terminate, Medicaid enrollment when an inmate is booked into jail. The suspension of eligibility during incarceration and reinstatement prior to release ensures that essential physical and mental health services can be continued upon return to the community.
Under the new administration, access to health care for justice-involved individuals is going to change. We must continue to work together to ensure that the linkages between correctional health and community health—and how they can impact health care costs for all—are understood.
I am very proud of this issue as it offers something for everyone. I have tried to incorporate your suggestions from the last NCCHC meeting to make sure each issue has a diversity of topics as reflected in these 10 articles. I call your attention to three new topics: Addressing Social Anxiety Concurrently With Prison-Based Sex Offender Treatment, Best Practices for Nutrition Care of Pregnant Women in Prison, and Measuring Compassionate Care. Measuring Compassionate Care presents an assessment tool to evaluate the level of care that may have application in correctional settings as a follow-on to our special issue on end-of-life care (Vol. 23, No. 1).
Your continued support of the Journal is most appreciated and, as always, I welcome your ideas and comments.