Beyond The Inmate Exclusion Project

Breaking The Cycle: The Expanding Role Of Medicaid In The Criminal-Legal System
Breaking The Cycle is the key document of the Beyond The Inmate Exclusion Project. It explores how the inmate exclusion limits collaboration between health and justice systems and how Medicaid can assist in developing safety net systems that improve access and quality thus lowering cost. Read more...

COCHS’ Beyond The Inmate Exclusion Project, supported through a grant from the Robert Wood Johnson Foundation, examines how Medicaid’s Inmate Exclusion Rule has limited the collaboration between community and correctional health systems. The Social Security Act of 1965 created the inmate exclusion rule, which limited the ability of Medicaid to pay for services for otherwise eligible beneficiaries once someone is incarcerated in a jail, prison, juvenile justice facility or other “public institution.” The rule creates challenges when identifying how to improve coordination between community and correctional settings, and many beneficiaries face delays in establishing care in the community after a stay in a public institution.

In recognition of the negative impact that the inmate exclusion has played in the lives of people involved with the justice system, including health and correctional staff, Congress passed new laws that will require Medicaid-eligible juveniles to begin certain benefits before release and allows states to maintain benefits for juveniles who are pending disposition of charges. In addition, the federal government is approving waivers of the inmate exclusion through Medicaid 1115 waivers.

Scope

This project looks at the challenges created by the inmate exclusion and how it has frustrated attempts at improving care for the people involved with the justice system. This project also looks beyond the inmate exclusion to highlight the role that Medicaid could play in local criminal-legal settings.

  • Why This Matters? People are often involved with the justice system because of untreated behavioral health and substance use needs. This stresses our health and our justice systems and drives poor outcomes for people who are touched by the justice system—whether they are incarcerated there or work there. Identifying opportunities for collaboration creates a stronger health system and decreases reliance on correctional systems.

  • Who is This For? Anyone interested in improving our health and justice systems through strengthening the role of our community health systems.

  • What Comes Next? COCHS will continue to explore with you the opportunities to bridge the divide between health agencies and correctional partners in order to heal the damage done by the inmate exclusion.

Briefs

COCHS has created briefs for pre-trial service providers, prosecutors, public defenders, specialty courts, jails, community corrections, health plans, community providers, and health information technology specialists that can help you begin your journey of connecting jail and community health systems.

Medicaid And The Criminal-Legal System: Community Corrections
Every day, probation and parole professionals make critical decisions that have a significant impact on individual and community health and safety. This role is particularly challenging given the lack of coordination between safety-net systems and correctional health systems. Read more...
Opportunities For Health Providers To Partner With Justice Systems
Regardless of care setting, payment arrangement, or specialty, healthcare providers share the same goals: provide high-quality, costeffective care that improves individual and community health. Read more...
Incarceration: The Hidden Social Determinant Of Health
Social determinants of health are typically defined as economic stability, built environment, and access to education, which disproportionately impact low-income people of color. A major force in the health of low-income communities is often overlooked: Incarceration. Read more...
Medicaid And The Criminal-Legal System: Health Information Technology
Most criminal-legal information systems do not participate in data-sharing with community providers. This leads to a lack of comprehensive data that inhibits health and corrections partners from working together and prevents individuals from receiving consistent care. Read more...
Medicaid And The Criminal-Legal System: Jails
Healthcare providers in jails and prisons are often tasked with caring for people who have much greater physical and behavioral health needs than those on the outside. People who are incarcerated have much higher rates of chronic and infectious diseases. Read more...
Medicaid And The Criminal-Legal System: Pretrial Services
From assessing risk to determining appropriateness for diversion, pretrial programs have significant influence over their clients’ ability to hold a job, remain housed, or access SUD treatment. This role is particularly difficult given the failures of safety-net systems to address physical and mental health challenges. Read more...
Medicaid And The Criminal-Legal System: Prosecutors
While public health and public safety have been historically been separated, both systems increasingly recognize that cross-sector collaboration can help improve individual and community health. Partnering with healthcare providers offers prosecutors more options for prosecutorial discretion and, by extension, strengthens communities and families. Read more...
Medicaid And The Criminal-Legal System: Public Defenders
Partnering with the healthcare system provides public defenders more information with which to divert clients and to dedicate time to other individuals in their caseload. While public health and public safety have historically been separated, both systems are increasingly recognizing that cross-sector collaboration can help improve individual’s well-being. Read more...
Medicaid And The Criminal-Legal System: Specialty Courts
From assessing risk to connecting clients to essential behavioral health treatment, specialty courts play a critical role in helping people access medical care and avoid incarceration. While health and public safety systems have historically been siloed, both systems increasingly recognize that cross-sector collaboration can improve individual and community health and well-being. Read more...