Reducing recidivism and supporting continuity of care

Behavioral health in the justice-involved community


The term, “justice-involved,” refers to individuals who have interacted with the criminal justice system, typically through police, the courts, or corrections.1

Justice-involved populations experience significantly increased rates of behavioral health challenges when compared with those of the general population.2 Additionally, when justice-involved individuals experience behavioral health challenges, they often have difficulty connecting to the resources they need. As a result of this disconnect, they tend to return to substance use, criminal behavior, lack of employment, and housing insecurity when they attempt to reintegrate into their communities.2

However, when justice-involved individuals receive quality behavioral health care, they are more likely to secure employment and housing, and successfully reintegrate into society. They are also less likely to experience recidivism into the carceral system. Maintaining good behavioral health is essential to individuals maintaining stable, productive lives.3
 

The new Medicaid Reentry Section 1115 Demonstration Waiver


The new Medicaid Reentry Section 1115 Demonstration Waiver allows state Medicaid programs to cover selected services for justice-involved individuals meeting specific, qualifying criteria. The services address behavioral health (BH) issues and substance use disorders (SUD).4

The waiver allows states to collect federal Medicaid matching funds to provide a targeted set of services to youth and adults in state prisons, county jails, and youth correctional facilities up to 90 days prior to release.

As the 1115 Centers for Medicare & Medicaid Services (CMS) demonstration waiver becomes available state by state, correctional facilities will be able to provide BH and SUD services covered by Medicaid to individuals as they prepare for release and re-entry into their communities.

“The 1115 demonstration will enhance behavioral health, case management, and substance use disorder services for individuals in the carceral system, when states approve the waiver,” says Steven Descoteaux, MD, Addiction Medical Director, Carelon Behavioral Health.
 

The Carelon solution


Carelon’s Justice Connect solution supports the U.S. Department of Health and Human Services’s (HHS) state guidance on applying for 1115 Medicaid reentry waivers. HHS’s goals align directly with Carelon’s capabilities and goal for the Justice Connect program, which is to improve outcomes for individuals with behavioral health needs who interact with the justice system.

Carelon’s Justice Connect program emphasizes the following goals:

  • Continuity of care to address behavioral health and substance use concerns.
  • Improved discharge planning to increase adherence to follow-up care.
  • Successful reintegration into the community.
  • Reducing state hospital and correctional facility recidivism rates.

“Carelon’s Justice Connect program creates a team dedicated to supporting the 1115 CMS demonstration waiver initiative. By offering community-based treatment to individuals in the carceral system, especially in their final weeks or months of incarceration, our program helps to serve patients during a high-risk and vulnerable time as they transition from incarceration back into their communities,” says Dr. Descoteaux.
 

The Carelon program’s unique differentiators


By partnering with the correctional system, Carelon helps to create a smooth transition for members through a multi-step process. The process includes utilizing re-entry pods, medication assisted treatment (MAT) services, a project coordinator, a care coordinator, and data collection and reporting.

Re-entry pods:

  • Carelon works with a care manager onsite at the facility to create a primary contact and connection, interacting with individuals up to 90 days prior to their release.
  • Carelon holds monthly sessions with the group to discuss Medicaid benefits and post-correctional environments, helping to streamline and simplify the Medicaid enrollment process.
  • By utilizing standardized assessment forms and evidence-based screening tools, Carelon creates roadmaps for transitioning inmates from incarceration to community-based providers.

Medication-assisted treatment (MAT) services:

  • Carelon creates a roadmap to transition inmates from facility to community-based providers who offer MAT services.
  • By providing individuals 30 days of medication, Carelon helps to facilitate a smooth transition from facility to community-based care, if needed.

Project coordinator:

  • Carelon’s project coordinator identifies individuals transitioning from facility back to community within 90 days, helping to connect them to their local community mental health center (CMHC).
  • The project coordinator works with individuals to complete transitions and release forms prior to meeting, to discuss specific needs.

Care coordinator:

  • Carelon’s care coordinator works with the project coordinator and the individual’s existing provider to schedule treatment.
  • If an existing provider is not available, the coordinators work with the individual to find another provider that will meet their needs.

Data and reporting:

  • Carelon’s team documents all contacts they make with the member prior to the individual’s release.
  • The team follows up with the member post-release to ensure that the member has made their first appointment.
  • The team continues to report as needed based on the agreement between the health plan and Carelon.

How Carelon can replicate the program state by state


Carelon can undertake several key initiatives in order to drive the solution forward.

  • Begin discussions on needs and barriers with local county and state detention system administrators, as well as the court’s key decision makers.
  • Develop an understanding of each system’s leadership, vision, and organizational culture, to partner on achieving the CMS’s justice involved goals.
  • Create collaborative structures and joint ownership of the entry and exit process for Medicaid members from correctional facilities.
  • Understand the specific data needs and challenges unique to re-entry processes for specific states and high-need counties.
  • Align all stakeholders for successful implementation of the services granted by the 1115 waivers.




Sources: 

1 North Carolina State University Institute for Emerging Issues: The Employment of Justice-Involved Persons (August 2022): iei.ncsu.edu.

2 Missouri Medicine: Care of Justice-Involved Populations (May-June 2022): ncbi.nlm.nih.gov.

3 Science Direct, SSM — Population Health: Does In-Prison Physical and Mental Health Impact Recidivism? (August 2020): ncbi.nlm.nih.gov.

4 Centers for Medicare & Medicaid Services: HHS Releases New Guidance to Encourage States to Apply for New Medicaid Reentry Section 1115 Demonstration Opportunity to Increase Health Care for People Leaving Carceral Facilities (April 2023): cms.gov.