Decarcerating Correctional Facilities during COVID-19 Advancing Health, Equity, and Safety (2020) / Chapter Skim
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4 Community Systems for Decarceration
4 Community Systems for Decarceration
Pages 63-78
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From page 63... ...
Recognizing that communities are grappling with varying levels of viral transmission as well as potential resource limitations, this chapter highlights a number of community support services that can be leveraged to support individuals who return home. Reentry during the pandemic will require a unique set of discharge plans, including testing and quarantining individuals prior to release, as well as supports and resources from community health care and housing systems.
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From page 64... ...
. Absent intentional coordination and linkages to the community health system, providing prescriptions alone did not ensure that formerly incarcerated individuals could engage with and access the needed care upon release.
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From page 65... ...
Health Insurance Coverage Without health insurance, obtaining primary care and substance use and mental health treatment immediately following release can be difficult. There are a number of opportunities within federal health insurance programs, including Medicaid, Medicare, and the Veterans Health Administration, for easing the transition from correctional to community health care, which is especially important during the pandemic.
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From page 66... ...
This means that individuals who can afford to "bail out" will remain covered by federal health care benefits, but poor defendants who are jailed for failing to pay bail may face a gap in health care coverage when released until they are able to reenroll for state health benefits. A joint report of the National Association of Counties and the National Sherriff's Association, "Addressing the Federal Medicaid Inmate Exclusion Policy," indicates that these interruptions result in poor care transitions, disruptions in treatment for chronic mental health and medical conditions (e.g., hepatitis C treatment or cancer care)
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From page 67... ...
State Waivers to the Medicaid Inmate Exclusion Policy Two types of federal waivers could be used to expand Medicaid coverage or support access to covered services for incarcerated individuals during the COVID-19 crisis: Section 1115 and 1135 waivers. However, the Centers for Medi care & Medicaid Services (CMS)
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From page 68... ...
. Evidence on these programs suggests some best practices for facilitating the enrollment process, including training correctional staff to serve as navigators to help incarcerated people complete applications, creating plans for direct handoffs from correctional health care providers to community health care providers following release, and providing individuals with information about Medicaid and community-based systems of care prior to their release (Ryan et al., 2016)
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From page 69... ...
HEALTH CARE While health insurance is critical during the pandemic for people to access COVID-19 screening and testing, chronic disease management, and substance and mental health treatment, it is important to note that Medicaid coverage is not a panacea for improving health care access. Howell and colleagues (2020)
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From page 70... ...
. During the COVID-19 pandemic, TCN programs in California, Connecticut, and North Carolina created statewide hotlines to facilitate collaborations with state prison systems and local jails and community health care systems so that people released from incarceration could receive a "bundle" of services that include expedited primary care appointments, as well as in some locations phones prior to their release, and connections to rapid rehousing.4 4 See https://transitionsclinic.org/ and https://cceh.org/wp-content/uploads/2020/04/DOC Re-entry-Housing-Assistance-Program.pdf.
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From page 71... ...
The Centers for Medicare & Medicaid Services temporarily waived restrictions, allowing Medicare and Medicaid to cover additional telehealth services.5 And the Substance Abuse and Mental Health Services Administration and the U.S. Drug Enforcement Agency issued new guidance for opioid treatment programs, indicating these programs could prescribe buprenorphine via telehealth and liberalized the number of days of take-home medications for methadone, reducing in-person visits.6 Video communication is associated with higher patient understanding and satisfaction compared with telephone communication (Nouri et al., 2020)
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From page 72... ...
. Permanent supportive housing or subsidized housing with associated voluntary supportive services has been shown effective in housing individuals with disabling diagnoses (Caton, Wilkins, and Anderson, 2007; Raven, Niedzwiecki, and Kushel, 2020)
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From page 73... ...
. To access either permanent supportive housing or rapid rehousing, individuals must be engaged with the coordinated entry process for people experiencing homelessness.
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From page 74... ...
. An example is the Family Reentry Pilot Project, implemented through a partnership among the New York City Housing Authority, the Vera Institute on Justice, the Corporation for Supportive Housing, and the New York
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From page 75... ...
EMPLOYMENT AND INCOME SUPPORTS Regular income generated through employment or government programs can help formerly incarcerated individuals meet basic health and housing needs. Employment income, in particular, can also help those with incarceration histories build pride, social status, and daily routine (Sullivan, 1989; Western, 2018)
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From page 76... ...
Income Support For released individuals who cannot find work, ensuring access to income support will be important for maintaining housing stability, food security, and safety as well as preventing reincarceration. This may be particularly relevant in the face of the widespread unemployment seen during the pandemic.
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From page 77... ...
Research by Western and colleagues (2015) has revealed that formerly incarcerated individuals in Boston experienced a number of stressors and hardships during reintegration and often lacked the ability to meet basic needs, including food and housing (Western et al., 2015)
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From page 78... ...
Reentry planning will need to balance these considerations, as well as testing prior to release, the ability to quarantine in the community, and a complement of health care, housing, and income supports, as they are available; they are all important complements to decarceration efforts to maximize individual, family, and community health and safety. Decarceration will be most successful if correctional system leaders collaborate with community health care and social safety net systems to provide support to this population and eliminate barriers to existing resources and programs, including Medicaid, housing programs, and SNAP, which collectively can help mitigate both public health and public safety risks.
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