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The Square One Project - Understanding Health Reform as Justice Reform 2020

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THE
SOUARE ONE

PROJECT
REIMAGINE JUSTICE

EXECUTIVE SESSION
ON THE FUTURE OF
JUSTICE POLICY
OCTOBER 2020
Lynda Zeller,
Michigan Health
Endowment Fund
Jackie Prokop,
Michigan Department
of Health and
Human Services,
PhD, University
of Texas at Tyler

UNDERSTANDING
HEALTH REFORM
AS JUSTICE REFORM:
MEDICAID, CARE
COORDINATION,
AND COMMUNITY
SUPERVISION

The Square One Project aims to incubate
new thinking on our response to crime,
promote more effective strategies, and
contribute to a new narrative of justice
in America.
Learn more about the Square One
Project at squareonejustice.org

The Executive Session was created with support from
the John D. and Catherine T. MacArthur Foundation as
part of the Safety and Justice Challenge, which seeks
to reduce over-incarceration by changing the way
America thinks about and uses jails.

E

SAFETY+JUSTICE

15!. CHALLENGE

Supported by the John D. and Catherine T. MacArthur Foundation

02

04

08

INTRODUCTION

COMMUNITY SUPERVISION
AND THE NEED FOR
A NEW MODEL OF CARE

THE POWER OF MEDICAID
TO EXPAND RESOURCES
FOR JUSTICE REFORM

11

18

20

INTEGRATED
COMMUNITY-BASED
PROGRAMS AS
JUSTICE REFORM

CONCLUSION

ENDNOTES

21

24

24

REFERENCES

ACKNOWLEDGEMENTS

AUTHOR NOTE

25
MEMBERS OF THE
EXECUTIVE SESSION
ON THE FUTURE OF
JUSTICE POLICY

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02

UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

Policymakers are becoming increasingly aware of the
failure of mass incarceration and the need for substantive
reevaluation of how justice system dollars are spent.
Learning from successes and failures of state and local
justice reform and reinvestment strategies, policymakers
have a solid framework upon which to make coordinated
changes in health and justice spending that will reduce
mass incarceration and provide healthier and safer
residents and communities.
Given the current focus on state and federal
funding, timing is exceptionally good for
states to make targeted reforms in health
spending, combined with substantive reforms
in probation and parole, in order to reduce
mass incarceration and achieve better
outcomes. These combined strategies will
be especially impactful for people who are
overrepresented in jails and prisons, including
people with mental illness and people of
color. We argue that mass incarceration
can be significantly reduced through the
abolishment of probation and parole paired

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

with state and federal investment in social
service programs (i.e. housing and education)
and with community-based healthcare and
programs powered by Medicaid expansion.
Probation and parole agencies today are not
designed to meet the needs of people with
complex health and behavioral health needs,
a population overrepresented in jails and
prisons. A Medicaid-funded community effort
to provide care coordination would bridge
a gap in healthcare provision for reentering
people and increase individuals’ ability to

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03

UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

manage life challenges and health conditions
including mental illness and substance use
disorder. “Care coordination” is a complex term
that encompasses the full array of healthcare
service activities across all systems of care,
and encompasses a wide range of actions:
organizing the care and management of
patients, improving healthcare quality, and
achieving cost savings (Prokop 2016). Then,
drawing from our local knowledge of the
Michigan health care and justice system, we
will focus on the state parole system to show
how Medicaid-funded care coordination can
provide better justice and health outcomes for
people exiting prison and jail.
People with chronic behavioral health
conditions, such as serious mental
illnesses or substance use disorders,
are disproportionately incarcerated and
re-incarcerated (Matejkowski and Ostermann
2015). Probation and parole agencies are
often unequipped to support their needs.
Community corrections thus contributes to
the criminal justice entanglement of people
with health problems. Efforts at diversion
into community-based treatment are often
hindered by the lack of funding to cover

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

comprehensive treatment programs.
However, carefully targeted health reform
efforts can become justice reform: state
Medicaid programs can tailor and fund specialty
community-based care coordination and
behavioral health programming for targeted
populations. Furthermore, the reallocation of
funds through Medicaid can significantly reduce
the total costs related to incarceration.
In this paper, we will first describe how the
United States’ current community supervision
system does not effectively serve people with
chronic health conditions. Then, drawing from
our local knowledge of the Michigan health
care and justice systems, we will focus on the
example of the state parole system to show
how Medicaid-funded care coordination can
provide better justice and health outcomes
for people exiting prison and jail. Care
coordination can disrupt punitive community
supervision and prevent re-incarceration from
parole violations. This intersection of health
and justice holds the potential for smarter
spending, better health outcomes, reduced
incarceration, and fewer people with mental
illness and substance use disorders under
correctional control.

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04

UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

COMMUNITY
SUPERVISION
AND THE NEED
FOR A NEW
MODEL OF CARE

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

Community supervision, a collective term
for probation and parole, is theoretically
an alternative to incarceration, but in
reality it has driven and helped sustain
mass incarceration in the 21st century.
A staggering 4.5 million people are under

population (Goyer, Serafi, Bachrach,

community supervision in the United States,

and Gould 2019). These health problems,

which is twice the number of people that are

coupled with unrealistic expectations for

incapacitated through incarceration. A large

correctional compliance, significantly hinder

community corrections population means

opportunities for successful reintegration

large caseloads for probation and parole

into community life. Ultimately, the lack

officers. Increasing caseloads paired with

of access to healthcare affects recidivism

punitive correctional policy undermines the

while undermining efforts to maintain

capacity of probation and parole officers

or find employment, housing, family

to meet the treatment and health needs

relationships, and sobriety (Mallik-Kane,

of people with chronic conditions and other

Paddock and Jannetta 2018).

social vulnerabilities.
Community supervision was originally
Each year, an estimated 80 percent of

conceived as a progressive alternative

people released from incarceration

to incarceration that allowed people to

in the United States have a substance use

remain in their communities (probation)

disorder, mental health illness, or physical

or reintegrate after incarceration (parole).

health condition—and people suffering

During the 1980s and 90s, however,

from these conditions are significantly

community supervision shifted from

more likely to fatally overdose after

a casework model focused on rehabilitation

release from prison or jails (Mistak 2019).

toward a crime control model that relied

Moreover, the prevalence of hepatitis C

on intensified surveillance and punishment

in the same populations is 10 times the rate

(“trail ‘em, nail ‘em, and jail ‘em”) (Klingele

found in the general population, and HIV is

2013). The system incentivizes and often

eight to nine times the rate of the general

requires officers to funnel people back

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

□

EACH YEAR, AN ESTIMATED 80 PERCENT
OF PEOPLE RELEASED FROM INCARCERATION
IN THE UNITED STATES HAVE A SUBSTANCE
USE DISORDER, MENTAL HEALTH ILLNESS,
OR PHYSICAL HEALTH CONDITION.

to prison, rather than address and support

compliance. Navigating the demands of

their behavioral health needs or tackle the

community corrections, while also battling

social conditions from which noncompliance

a chronic health condition, searching for

may emerge. This shift in focus has not only

employment and housing, and meeting basic

increased the number of people supervised,

material needs, is essentially impossible

but also has standardized the punishment

(Phelps 2018). Community corrections

of noncriminal conduct (e.g. staying out

officials recognize that people with

past curfew or missing parole appointments)

behavioral health conditions need support,

(Doherty 2019). Practitioners in the field

but that the system in which they work does

lament that probation and parole officers

not easily accommodate people’s mistakes,

have been pushed away from their role

related to their illnesses or not.

as rehabilitative agents, and instead
are immersed in a bureaucratic process

In recent years, scholars and practitioners

focused on compliance. Neglecting

have written about the detrimental effects

to provide people under community

of probation and parole and the need for

corrections with valuable resources from

fundamental reform (Horn 2001; Doherty

a trusted case manager—like transitional

2016; Phelps 2018). Community supervision

housing, vocational training, health, and

practitioners have partnered with scholars

behavioral health services—is the ultimate

to call for a dramatic reduction in the

failure of the supervision system.

number of people who are under community
supervision and a greater focus on providing

People with mental illness and addiction

people with the help and resources they

are particularly vulnerable to probation and

need to remain in their communities and

parole violations because symptoms from

thrive (for example, see the Executives

these diagnoses can negatively impact

Transforming Probation and Parole initiative)

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

(Muhammad 2019). Reformers have argued

Medicaid-funded care coordination models

that community supervision has driven

has the potential to contribute to significant

and helped sustain mass incarceration in

reductions in incarceration, especially

the 21st century, which is why a model that

amongst a high-need population with

can provide people with the care they need

physical and behavioral health conditions.

outside of parole and probation is necessary
and long overdue (Williams, Schiraldi, and
Bradner 2019). Reinventing and shrinking
community supervision by drawing from

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

THE POWER
OF MEDICAID
TO EXPAND
RESOURCES FOR
JUSTICE REFORM

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

Expanding Medicaid is a key mechanism
for providing health and social services
that, when carefully targeted, can ultimately
reduce the scope of the community
supervision system. As of January 2020,
thirty seven states and the District of
Columbia have expanded Medicaid under
the Affordable Care Act.1
In Medicaid expansion states like Colorado

enhanced federal Medicaid matching rate

and New York, 80 to 90 percent of people

for their local dollars invested. In 2020,

exiting incarceration are eligible for

the federal match was 90 percent, which

Medicaid and can receive these critical

is generally much higher than the state’s

behavioral health programs; in states that

regular federal match rate (Goyer, Serafi,

have not expanded Medicaid, eligibility for

Bachrach, and Gould 2019). Expanding

medical coverage and programs falls under

Medicaid coverage has provided new

10 percent. Typically, in these non-Medicaid

opportunities for states to establish care

expansion states, Medicaid only covers

coordination services to people under

low-income children, the elderly, pregnant

supervision. All people returning to the

women, and people with disabilities,

community with income at or below

thus leaving most of those who are living

133 percent of the federal poverty level

at or near poverty without healthcare

and who meet other federal citizenship

after incarceration.

requirements are eligible for these services
(Goyer, Serafi, Bachrach, and Gould 2019;

Medicaid is financed through a shared

Howell, Kotonias, and Jannetta 2017).2

state and federal funding model, making
it possible for states to access additional

The continuity of treatment from the prison

health resources. States that implement

to the community is important in sustaining

a Medicaid expansion program receive an

good health practices, particularly for

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

those with chronic conditions, while

Although Medicaid is an opportunity for

promoting a point of access to other social

expanding the availability of care, having

services. People with chronic conditions

access to healthcare is not synonymous

often receive consistent treatment in

with receipt of care. As described

prison, but then face the challenge of

below, the power of these resources is

continuing their care once they return to

better harnessed when state Medicaid

the community. Many expansion states

agencies partner with the justice system,

are enrolling people in Medicaid before they

community-based health providers, and

are released from prison, which can support

people with direct experience in designing

health immediately after incarceration.

a program to make a significant difference

Mental illness and addiction are potent

in the health of people reentering by

risk factors for re-incarceration. Care

promoting their ability to obtain health

coordination available through Medicaid

services and improve well-being (Centers

coverage will reduce the probability of

for Medicare and Medicaid Services 2018).

returning to jail or prison for high-risk
patients. A well-designed system of care
can improve health and increase the
likelihood of successful re-entry.

□

IN MEDICAID EXPANSION STATES LIKE COLORADO
AND NEW YORK, 80 TO 90 PERCENT OF PEOPLE
EXITING INCARCERATION ARE ELIGIBLE FOR
MEDICAID AND CAN RECEIVE THESE CRITICAL
BEHAVIORAL HEALTH PROGRAMS.

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

INTEGRATED
COMMUNITY-BASED
PROGRAMS AS
JUSTICE REFORM

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

MEETING THE NEEDS OF PEOPLE WITH
HISTORIES OF INCARCERATION.
Most probation and parole systems

of health and healthcare in the reentry

do not address community and personal

process remain insufficiently understood

vulnerabilities like economic instability,

(Mallik-Kane et al. 2018).

lack of access to housing and educational
opportunities, food insecurity, and

As in Michigan, all states in the nation need

other vulnerabilities captured by social

to work through potential barriers of care

determinants of health (SDOH) that are

coordination for people with chronic

associated with a higher likelihood of

conditions and justice system involvement.

incarceration and revocation. Additionally,

Careful collaboration across different health

healthcare management of behavioral health

and social service networks is needed to

needs by probation and parole officers

ensure individual success. Care coordination

are inadequate and may also contribute to

should be tailored to address an individual’s

recidivism. A five-year study of communities

healthcare needs. One particularly

implementing jail diversion programs,

challenging barrier to care coordination

pre- and post-justice involvement, reports

involves securely sharing personal health

that people in Michigan with co-occurring

information between the justice system

substance use disorders were twice as

and community-based healthcare staff,

likely to return to jail than people with

consistent with state and federal privacy

mental illness and no addiction (Kubiak et al.

laws. Quality care coordination is dependent

2019). Connecting reentry populations with

on secure information sharing across health

appropriate post-release health services

and justice community systems. Yet of ten

to manage chronic health conditions is

Michigan communities with pilot diversion

challenging because managing health

programs over five years, only four reported

may be a low, or unattainable, priority

a close working relationship between parole,

for people dealing with various survival

probation, and community behavioral health

needs and SDOH. In designing models,

programs. A five year Michigan-based pilot

researchers need to understand best

diversion program found that only four of

practices and consider the experiences

the ten programs reported a close working

of the populations they are trying to

relationship between parole, probation,

target. Returning individuals’ perceptions

and community behavioral health programs,

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

and only 30 percent of jail discharges

during, and after incarceration. Michigan

incorporated a behavioral health related

efforts include promising practices in

discharge service (Kubiak et al. 2019).

specialty reentry support and systems for
people with mental illness and substance

While many barriers and challenges remain,

use disorders, as well as bold employment

Michigan’s Departments of Corrections and

efforts such as Michigan’s “Vocational

Health and Human Services are successfully

Village” where individuals have the

working in several areas to strengthen

opportunity to leave not just with training,

the likelihood of a person’s success before,

but also with confirmed employment in hand.

CARE COORDINATION IS A HUGE CHALLENGE
FOR MANY POPULATIONS, BUT INTENSIVE
CASE MANAGEMENT PROGRAMS HAVE BEEN
DEMONSTRATED TO HELP.
Medicaid provides states with funding

reimbursement for health home and targeted

opportunities to expand care coordination

case management models.3 Both MHHs

to targeted population groups. Each state

and TCMs are predicated on a strong care

has flexibility in choosing and designing

management foundation that is instrumental

Medicaid-funded care management

in meeting the healthcare coordination

programs to address specific populations

needs for the 80 percent of individuals

with complex needs. By choosing to expand

returning home from incarceration who have

care coordination for people reentering the

chronic conditions, including mental illness

community after incarceration, states can

and addiction.

reduce incarceration and related costs.
Intensive case management programs

It is noteworthy that there is a lot of

are good investments for this target

variability amongst the states in whether

population. For example, specific options

they choose to implement special care

such as Medicaid Health Home (MHH) or

coordination models, which populations

Targeted Case Management (TCM) programs

they target, and which Medicaid policy

allow states to seek federal approval to

path (i.e. MHH, TCM, etc.) they choose to

amend their Medicaid programs to include

pursue. There are different pros and cons

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

associated with the program of choice.

admissions. For example, Bleich et al. (2015)

For example, MHHs can be attractive to

noted that medical homes can decrease

state Medicaid programs because they

emergency department visits and inpatient

offer a 90/10 federal/state match for health

admissions by better coordinating care for

home services for the first eight quarters of

individuals with chronic diseases. Fillmore

implementation, while TCM model payments

et al. (2014) found that while emergency

receive the state’s regular federal Medicaid

department visits were higher for individuals

assistance percentage (Centers for Medicare

enrolled in a health home initially, they then

and Medicaid Services 2013). But MHHs tend

decreased and became insignificant. New

to have more administrative requirements

York found that inpatient service costs

than the TCMs. Each state must submit

decreased by approximately 30 percent

a request to add a MHH and the request

for people who were enrolled in a MHH. And

must specify the desired targeted population

Missouri’s Community Mental Health Center

to receive MHH services. The individuals

MHH has shown a 13 percent reduction in

the state chooses to cover must (1) have at

hospital admissions for the study population,

least two chronic conditions,4 (2) have one

and a decrease of 8 percent for emergency

chronic condition and be at risk for another,

department use (CMS 2013). Consistent

or (3) have one serious and persistent mental

with these MHH models, Cantor et al. (2014)

health condition; and states must ensure

found that 39 percent of the hospitalizations

that patients are not receiving more than

being studied had a co-occurring behavioral

eight quarters of MHH services at the 90/10

health diagnosis and that successful MHH

match rate. Furthermore, MHH billing is more

models reduced inpatient admissions

complex for providers—there may be a need

by 29 percent (CMS 2013).

for significant technological changes for
successful implementation—and MHHs have

In 2016, Michigan implemented a MHH

specific quality monitoring and reporting

model. Over the first 18 months of program

requirements (Social Security Act 2019).

implementation, emergency department

TCMs have more flexibility specifying the

use and inpatient hospital admissions

populations they serve.

decreased steadily. These reductions were
statistically significant when measured

Whichever model is chosen, health

at the 6-month, 7- to 12-month, and

home experiences in other states have

13- to 18-month timeframes.5 Additionally,

demonstrated that both of these programs

healthcare service utilization cost spending

result in overall reductions in emergency

decreased over the time period of review

department visits and inpatient hospital

(University of Michigan 2019).

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

INTENSIVE CASE MANAGEMENT
MODELS ARE EFFECTIVE INVESTMENTS
THAT CAN TRANSFORM OUTCOMES
FOR PEOPLE RECENTLY RELEASED
FROM INCARCERATED SETTINGS.
Managing care for people with chronic

jails or prisons. Creating systems of care

health conditions in the primary care setting

through healthcare delivery models can

is further compounded for low-income

help individuals address healthcare and

individuals and those who were recently

social needs, improving care management

released from an incarcerated setting, as

and preventing costly emergency room

they may lack access to healthcare or other

or inpatient hospital stays. Improved

critical social services (Prokop et al. 2019).

coordinated care can reduce emergency

Barriers to accessing care may lead to poor

department visits, improve access to

health outcomes and complicate the ability

appropriate outpatient visits, provide

of these individuals to reintegrate into the

behavioral health services, and promote

community. Creating a community-based

health equality (AHRQ 2007; Prokop 2016).

model that integrates physical and

Pilot initiatives have been successful

behavioral health is key to successfully

in significantly reducing recidivism

addressing their needs and advancing safety.

rates. Some have reported reducing
incarceration-return rates from 57 percent

Tailored health home and targeted case

to 16 percent in a three-year time period

management models are showing positive

(Goyer et al. 2019). It is important that these

results for people exiting jail or prison

models focus on establishing relationships

(CMS, 2018; Goyer, et al. 2019; Prokop et al,

and trust, providing patient-centered care,

2019). States such as Arizona, New York,

and addressing social determinants of health

New Mexico, and Ohio have implemented

(SDOH) (Prokop et al. 2019).

health homes or other care coordination
models predicated on the principle of

The Transitions Clinic Network (TCN),

“integrated health care management,”

a model of coordinated care for people

where healthcare provision is paired

under community supervision or exiting

with social supports for people exiting

incarceration, has seen a lot of success

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

integrating care by establishing trusted

community health workers who had personal

relationships with patients who were

histories of incarceration contributed to

formerly incarcerated. TCN was co-founded

increasing the average of new patients from

by Dr. Emily Wang and Dr. Shira Shavit in

seven to eleven per month (Wang 2019).

2006, and is a national network of medical
homes for people reentering society post

People reentering society after

incarceration who are experiencing chronic

incarceration who are experiencing mental

disease. Grounded in community and a public

illness and substance use problems need

health approach to serving people reentering

the kind of care that TCN provides, rather

society with intensive health needs, TCN

than traditional community supervision.

caters to the most vulnerable to support

States can seek federal approval to

them in the successful reintegration into

amend their Medicaid programs to include

their lives and neighborhoods.

reimbursement for health home or targeted
case management models predicated on

The San Francisco Department of Public

the principles of TCN. Through either of

Health opened the first Transitions Clinic

these Medicaid mechanisms (TCM or MHH),

(TC) to provide transitional and primary

states can provide an enhanced system

care as well as case management to people

of care coordination to assist individuals

with chronic illness that are reentering

in managing their chronic conditions and

society post-incarceration in San Francisco.

integrating into the community. Medicaid

Dr. Wang published a formal analysis of

can be the foundation upon which justice

the effectiveness of the San Francisco

reformers can build and finance a new

TC in 2010, which measured the rates

model that provides critical healthcare

of program participants’ attendance for

and social support.

the initial appointment and the six-month
follow-up appointment post-incarceration.

Similarly, in Michigan, a specialized model

Results of the study show that of the

that was piloted in October 2017 has seen

185 TC participants observed between

a great deal of success. Several Federally

January 2006 to October 2007, attendance

Qualified Health Centers (FQHC) partnered

at initial appointments was reported at

with the Department of Corrections to

55 percent, with a six-month follow-up rate

implement a health program to coordinate

of 77 percent, compared with 40 percent

care for people on parole. The program,

and 46 percent, respectively, for non-TC

called Connection to Care (C2C), was

patients seen at Southeast Health Center

designed to address and ensure that the

(Wang 2019). Furthermore, clinics with

behavioral and physical health needs of

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

justice-involved people are addressed after

The FQHCs completed a patient satisfaction

prison release. The model is centered on

survey for the 73 individuals served by the

a peer support specialist or “health coach,”

program that focused on access to care

and allows the person soon-to-be-released

measures. People under supervision were

on parole to establish a relationship with

very receptive to ongoing engagement

FQHC staff before leaving the incarcerated

in this model and with their health coach.

setting. In the first year of operation,

All of the respondents indicated that it

100 percent of C2C patients had an

was not hard to get to the appointment,

appointment scheduled and were seen

91 percent indicated that they received help

by their primary care provider within seven

to access healthcare, 98 percent indicated

days from discharge. The FQHC staff were

that it was easy to share health problems

successful in connecting with paroled

with the doctors and the C2C staff, and they

patients as the peer support specialist

provided a high rating for their first visit

or health coach contacted each patient an

(4.7 on a 5.0 scale) (Boinapally 2019).

average of twice per month (Boinapally 2019).

□

FOR PEOPLE RECENTLY RELEASED FROM
INCARCERATED SETTINGS, CREATING
A COMMUNITY-BASED MODEL THAT
INTEGRATES PHYSICAL AND BEHAVIORAL
HEALTH IS KEY TO SUCCESSFULLY ADDRESSING
THEIR NEEDS AND ADVANCING SAFETY.

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

CONCLUSION
Justice reform strategies to reduce mass

Eliminating punitive supervision while

incarceration will not be successful without

providing healthcare recaptures the

healthcare and social supports for people

spirit of rehabilitation at the core of

with chronic health conditions.

community corrections when it was first
envisioned. State Medicaid leadership can

This is particularly true for those with

build specialized community-based care

mental illness or substance use problems.

management models into Medicaid programs

Community supervision today is overly

for those returning home from incarceration.

punitive and offers little support for

When state Medicaid leadership receives

successful return to the community.

federal approval for specialty care

Until probation and parole are replaced

coordination models, the financing of these

with a system that can address these

services is shared between the state and

serious health needs, people with behavioral

federal governments, thus increasing the

health conditions will continue to be

resources available for these impactful

over-represented in the penal system, suffer

and cost-effective strategies. Financing

high rates of re-incarceration, and remain

of community supervision models is not

incarcerated for longer periods of time.

similarly shared, however, when Medicaid
is not available. Because of this, states that

Health system reform built upon the

do not expand Medicaid will be greatly limited

foundation of Medicaid programs can

in their ability to substantially reform and

provide many of the health and social

reduce punitive community supervision.

supports needed to help people with health
problems successfully return and remain

While this paper focuses on tools that can

in their communities. For states that expand

be used to reduce mass incarceration of

Medicaid, these supports and services can

people with chronic physical and behavioral

be offered to most people released from

health needs, these health reform tools

jails and prisons. Care coordination and

have potential application to address

management models provided through

unique needs of other people who are

Medicaid are effective and can be powerful

overrepresented in jails and prisons. With

tools to finance the provision of health

the disproportionate incarceration of people

and behavioral health services in a socially

in poverty and of racial and ethnic minority

supportive environment.

populations, more attention needs to be
given to how these tools and models can

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

be designed and utilized to address racial

models can improve access to healthcare

health and justice disparities. Further study

and quality of care and help to prevent future

is warranted to determine whether specialty

incarceration. When used together by state

care coordination models need refinement

Medicaid and state correctional system

to address unique needs of specific races,

leadership, these tools at the intersection of

cultures, and localities.

health and justice reform provide a powerful
opportunity to improve health and help end

In conclusion, specialty care management

mass incarceration.

models built upon state Medicaid programs
provide an opportunity to reduce and
ultimately end the use of current parole and
probation models for targeted populations
with better results. This opportunity is
exponentially increased for states that
expand Medicaid. Medicaid care coordination

□

STATE MEDICAID LEADERSHIP CAN
BUILD SPECIALIZED COMMUNITY-BASED
CARE MANAGEMENT MODELS INTO
MEDICAID PROGRAMS FOR THOSE
RETURNING HOME FROM INCARCERATION.

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

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20

UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

ENDNOTES
1 In August of 2020 the Kaiser Family

3 A “Medicaid health home” is

4 Qualifying chronic conditions listed

Foundation released an interactive map

a comprehensive system of

in section 1945(h)(2) of the Social

of the current status of state decisions

care coordination for Medicaid-eligible

Security Act.

on the Affordable Care Act.

individuals with chronic conditions.

2 Immigrants with income
below 133 percent of the federal
poverty level would not be eligible
for Medicaid services.

“Targeted case management” refers
to case management for specific
Medicaid beneficiary groups or for
individuals who reside in statedesignated geographic areas, thus
“targeted” by the state for services.

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

5 6- to 12-month: emergency
department p< 0.001, inpatient hospital
p = 0.011; 7- to 12-month: emergency
department p< 0.001, inpatient
hospital p = 0.003, and 13- to 18-month:
emergency department p< 0.001,
inpatient hospital p = 0.24.

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21

UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

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24

UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

ACKNOWLEDGEMENTS

AUTHOR NOTES

The authors would like to thank
their Square One Executive Session
colleagues—particularly Vikrant
Reddy, Vincent Schiraldi, Bruce
Western, Madison Dawkins, Katharine
Huffman, and Anamika Dwivedi—for
their thoughtful feedback, research,
and support. They also wish to
acknowledge Michigan Department
of Corrections, the University of Texas
at Tyler School of Social Work, the
University of Texas School of Nursing*,
and Wayne State University-Center
for Behavioral Health and Justice
for their relentless work to bridge
research and practice.

Lynda Zeller is the Senior Fellow
for Behavioral Health for the
Michigan Health Endowment Fund.

*Author Jackie Prokop received her PhD
from the University of Texas where she
began conducting the research that
provided the foundation for this paper.

designbysoapbox.com

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

Jackie Prokop is the Program
Policy Division Director of the
Michigan Department of Health
and Human Services.

Please note that the policy
recommendations put forth in
this paper do not reflect those
of the Michigan Department
of Health and Human Services.

■
25

UNDERSTANDING HEALTH REFORM AS JUSTICE REFORM

MEMBERS OF THE EXECUTIVE SESSION
ON THE FUTURE OF JUSTICE POLICY
Abbey Stamp | Executive Director,

Greisa Martinez Rosas | Deputy

Nneka Jones Tapia | Inaugural Leader

Multnomah County Local Public Safety

Executive Director, United We Dream

in Residence, Chicago Beyond

Coordinating Council

Jeremy Travis | Co-Founder, Square

Pat Sharkey | Professor of Sociology

Amanda Alexander | Founding

One Project; Executive Vice President

and Public Affairs, Princeton University

Executive Director, Detroit Justice

of Criminal Justice, Arnold Ventures;

Center & Senior Research Scholar,

President Emeritus, John Jay College

University of Michigan School of Law

of Criminal Justice

Arthur Rizer | Director of Criminal

Katharine Huffman | Executive

Justice and Civil Liberties,

Director, Square One Project, Justice

R Street Institute

Lab, Columbia University; Founding

Bruce Western | Co-Founder, Square

Principal, The Raben Group

One Project; Co-Director, Justice

Kevin Thom | Sheriff, Pennington

Lab and Professor of Sociology,

County, South Dakota

Columbia University
Danielle Sered | Executive Director,
Common Justice
Daryl Atkinson | Founder and
Co-Director, Forward Justice

Kris Steele | Executive Director, TEEM
Laurie Garduque | Director,
Criminal Justice, John D. and
Catherine T. MacArthur Foundation
Lynda Zeller | Senior Fellow

Elizabeth Glazer | Director, New York

Behavioral Health, Michigan

City’s Mayor’s Office of Criminal Justice

Health Endowment Fund

Elizabeth Trejos-Castillo |

Matthew Desmond | Professor

C. R. Hutcheson Endowed

of Sociology, Princeton University

Associate Professor, Human

& Founder, The Eviction Lab

Development & Family Studies,
Texas Tech University
Elizabeth Trosch | District Court Judge,
26th Judicial District of North Carolina

Melissa Nelson | State Attorney,
Florida’s 4th Judicial Circuit
Nancy Gertner | Professor, Harvard
Law School & Retired Senior Judge,

Emily Wang | Associate Professor

United States District Court for the

of Medicine, Yale School of Medicine;

District of Massachusetts

Director, Health Justice Lab &
Co-Founder, Transitions Clinic Network

EXECUTIVE SESSION ON THE FUTURE OF JUSTICE POLICY

Robert Rooks | Vice President, Alliance
for Safety and Justice & Associate
Director, Californians for Safety
and Justice
Sylvia Moir | Chief of Police,
Tempe, Arizona
Thomas Harvey | Director, Justice
Project, Advancement Project
Tracey Meares | Walton Hale Hamilton
Professor, Yale Law School & Founding
Director, The Justice Collaboratory
Vikrant Reddy | Senior Fellow, Charles
Koch Institute
Vincent Schiraldi | Senior Research
Scientist, Columbia University School
of Social Work & Co-Director, Justice
Lab, Columbia University
Vivian Nixon | Executive Director,
College and Community Fellowship

THt
SQUARt ONt

PRDJrCT
REIMAGINE JUSTICE

The Executive Session on the
Future of Justice Policy, part
of the Square One Project, brings
together researchers, practitioners,
policy makers, advocates, and
community representatives to
generate and cultivate new ideas.
The group meets in an off-the-record setting
twice a year to examine research, discuss new
concepts, and refine proposals from group
members. The Session publishes a paper series
intended to catalyze thinking and propose
policies to reduce incarceration and develop
new responses to violence and the other social
problems that can emerge under conditions of
poverty and racial inequality. By bringing together
diverse perspectives, the Executive Session tests
and pushes its participants to challenge their
own thinking and consider new options.

~ COLUMBIA UNIVERSITY

I JUSTICE LAB

 

 

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