Whether you are a Republican or a Democrat, a public safety
professional or a health care worker, we all woke up this morning to
a new chapter of the American journey. While it is too soon to
definitively prognosticate what President-elect Trumpís policies may
be at the intersections of health care and criminal justice, we at
COCHS have spent the morning peering into our crystal ball
concerning community and correctional connectivity, just as we did
once when the Affordable Care Act became law. |
While it is unlikely that the ACA will be fully repealed, it will
most certainly not remain the same. What comes in its place is
likely to address some of the political and marketplace weaknesses
of the ACA (e.g., the individual mandate, federally defined
benefits, inability of capital to effectively cross state lines).
Most justice-involved individuals are eligible for Medicaid in
expansion states. As leaders in conceptualizing the future of health
care for the most disadvantaged, our inboxes have been bombarded
with questions about how last nightís vote is likely to affect the
health care needs of justice-involved individuals. We have several
- Medicaid is unlikely to remain the same.
States are likely to be given far more freedom to design and fund
programs that meet their local health and behavioral needs,
including those of justice-involved individuals. Medicaid in the
future could turn into state-directed block grants or 1115 waivers
could give states more leeway in designing a local product.
- Essential Health Benefits may be a thing of the
past.Much like in designing state plans, states are also
likely to be given a great deal of freedom in defining the benefit
structures that best meet the needs of the state.
- Investment in data interconnectivity across the health
and justice sectors is likely to increase. Many of the
laws that incentivized data connectivity were created under a
Republican administration. We are becoming increasingly aware of
the importance of secure data systems for improving the health and
safety of the public.
- Policies that stand in the way of assessing criminal
risk, and thus limiting the ability to divert those who can be
safely diverted, are unlikely to survive in the new
administration. As our tools for connecting data across
health and justice sectors grow, the likelihood of identifying
threats to public safety will increase. To the extent that states
become free to design their own benefit structures and programs
that respond to the health and behavioral health needs of diverted
individuals, it is possible to expect lower recidivism. For this
to occur, risk-and-needs-based tools would have to be tied to
flexibility in health benefits and programs.
We look forward to working with you over the next several months and
years as we define the specific strategies and policies that cross
over health and justice sectors. COCHS is also looking forward to
its own transition process over the next several months. After
founding COCHS eleven years ago, it is time for me to begin the
transition to the next generation. At our October board meeting I
announced that I have begun the process of my own retirement. I, and
our board, acknowledged that we have been incredibly fortunate that
Dan Mistak, our General Counsel for the past several years, will be
able to lead this journey forward when I retire in 2017.
President, COCHS |
General Counsel, COCHS |