A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Continuity of care for the incarcerated: New policy may help

Continuity of care for the incarcerated: New policy may help

August 6, 2014

The guest post below is by Melissa Shannon, Director of Government Relations & Public Affairs at the Commonwealth Care Alliance (CCA). CCA is a consumer-governed health care organization (founded by HCFA and other groups) that serves the "dually eligibile" - people enrolled in both Medicare and Medicaid. CCA covers seniors enrolled in the state's Senior Care Options (SCO) program, and people with disabilities in the One Care program. CCA focuses on people with complex medical needs, and provides enhanced primary care and care coordination through multi-disciplinary clinical teams including physicians, nurses, and behavioral health and geriatric specialists. For more commentary from Commonwealth Care Alliance, visit their blog, Dually Noted.


Shortly after we launched our One Care program last fall, we found that we wouldn’t hear from some members for a time and wouldn’t know why—only later to discover that they had been spending time in the criminal justice system, either awaiting trial or serving time.

Sadly, this isn’t too surprising: MassHealth estimates that roughly 70% of the One Care population (under 65 years old, disabled and eligible for Medicaid and Medicare) has a mental health condition, while one half of the jailed population in the United States has a mental health problem, according to the Bureau of Justice statistics. It’s logical to assume that there is significant overlap between these two groups, and that a portion of the One Care population has – or will – spend time in the criminal justice system.

Problems with continuity of care
We realized early on that many of our One Care members experienced lapses in coverage because they were in and out of the criminal justice system. That’s because of a longstanding federal law that terminates Medicaid and Medicare coverage for anyone who is incarcerated. Over time, we will be able to better quantify how many of our members have experienced these lapses in coverage and for how long, but presently this poses a significant question for us: how do we ensure continuity of care for our members in the criminal justice system?

Interestingly, as we’ve started to get our arms around these continuity of care challenges, we’ve noticed a surge in interest among policymakers and healthcare leaders on the subject. Health Affairs, for example, devoted most of their March 2014 edition to the intersection of Medicaid eligibility and incarceration. This increased interest stems partly from the Affordable Care Act, which expanded Medicaid to cover many more childless adults, resulting in more people in the criminal justice system being Medicaid-eligible.

County sheriffs call for change
Many have advocated for changes to the federal policy regarding continuity of care for the incarcerated, including county sheriffs’ offices, who, historically, have found themselves stuck with the (substantial) bills for inmates’ hospitalizations. To the sheriffs’ credit, they are not just concerned with unpaid hospital bills. They know the needs of their population well and want to see their inmates reconnected with their health insurance upon release, so they can receive the care and medications they need to stay healthy and on the right side of the law. (Sheriff Peter Koutoujian of Middlesex County is a leader on this issue here in Massachusetts.)

Enter Massachusetts State Senator Pat Jehlen (D-Somerville) and State Representative David Viera (R-Falmouth), who adopted the sheriffs’ cause and advocated successfully to have language included in the 2015 state budget to require that Massachusetts Medicaid benefits (MassHealth) be merely suspended when someone is incarcerated and immediately reactivated upon their release. This should be a big step forward in ensuring that recently released inmates are reconnected with the insurance for which they are eligible.

Though this may seem like a small change, it will have a significant impact on some of the most daunting issues facing our One Care members—like getting proper treatment for substance abuse and mental health treatment.

How will it work for One Care Members and others enrolled in managed care?
We at Commonwealth Care Alliance are interested in not only seeing members reconnected with their health care providers but also with their individual care plans. We know that having an active insurance card is not the same as receiving the care you need, particularly for the most vulnerable.  We also know that continuity of care is especially critical for the mentally ill and other vulnerable populations.

While it’s great to see this legislation pass, questions remain. MassHealth has until December 31 to submit an implementation plan for the new law to the legislature. 

Ideally, we would really like to care for our members while they are incarcerated for true continuity of care, but we cannot do so under current law (For an inspiring example of a health center that was able to do just that, see Hampden County Sheriff Michael Ashe’s piece on his unique partnership with the Brightwood Health Center in Springfield in the March 2014 edition of Health Affairs). However, once the new law takes effect, we wonder who will pay for our members’ care while our coverage is suspended? Will we get hospital bills for our members whose care we were not allowed to manage while they were incarcerated? We also wonder what will happen to the monthly payments for MassHealth members, like ours, whose care is managed by a plan. Will we be notified when our members are incarcerated so we are aware that their payments may be temporarily stopped? Will we know that we may not be able to get in contact with them while they’re incarcerated to make arrangements to resume care upon their release? 

These questions and more will need to be resolved by MassHealth in the coming months. 

Improving care, reducing recidivism
The sheriffs have done a great job in advocating for their needs and those of their inmates.  It’s time for Massachusetts’ healthcare thought leaders to think carefully about how to ensure the best care for MassHealth members who are incarcerated.  There is potential to not only significantly improve care for this vulnerable population, but also to noticeably reduce recidivism.  Let’s hope all the right questions get asked, and answered.