Image by Lisa Kennedy from Pixabay
Journal of Science Policy & Governance | Volume 17, Issue 02 | October 12, 2020

Honorable Mention
​
Policy Memo: Improving Healthcare Access Among the Newly Decarcerated

E. Rosalie Li-Rodenborn (1)*, Bernat Navarro-Serer (2)*, Stephanie Pitts (3)*, Kavya Anchuri (4)*
  1. Johns Hopkins Bloomberg School of Public Health, Department of Biochemistry & Molecular Biology, Baltimore, MD
  2. Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, MD
  3. Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
  4. Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD
*All authors contributed equally 
Download PDF
https://doi.org/10.38126/JSPG170209
Keywords: Medicaid; opioid crisis; healthcare; insurance; prison system; Maryland
Executive Summary: The American opioid crisis has disproportionately affected our incarcerated population. Approximately two-thirds of inmates nationwide struggle with substance use disorders (Maryland Department of Health 2018; Cohn 2019). Though some receive treatment during incarceration, about 60% leave prison uninsured (Maryland Department of Health 2018). Without insurance, continuing treatment becomes improbable, significantly increasing the risk of overdosing in the two weeks following decarceration (Binswanger et al. 2007). The State of Maryland has addressed this problem by expanding Medicaid coverage under the Affordable Care Act in 2014. Today, an estimated 90% of Maryland prisoners qualify for Medicaid upon release (Hancock 2016). Despite Medicaid expansion and other measures, including a 2016 presumptive eligibility policy, most inmates still leave prison unable to access the healthcare for which they qualify (Cohn 2019). This memorandum highlights policy options that ensure eligible inmates leave with unencumbered access to healthcare. We recommend using Presumptive Eligibility to enroll all qualified inmates, which prevents a coverage lapse immediately following release, with implementation of full coverage for all state correctional facilities as the long-term goal.

-Read the full article through download.-
Download PDF

References

  1. Baltimore City Health Department. 2018. "Baltimore City’s Response to the Opioid Epidemic." https://health.baltimorecity.gov/opioid-overdose/baltimore-city-overdose-prevention-and-response-information
  2. Binswanger, Ingrid A., Marc F. Stern, Richard A. Deyo, Patrick J. Heagerty, Allen Cheadle, Joann G. Elmore, and Thomas D. Koepsell. 2007. "Release from prison—a high risk of death for former inmates." New England Journal of Medicine 356(2): 157-165. https://doi.org/10.1056/nejmsa064115
  3. Centers for Disease Control and Prevention 2017. Understanding the epidemic. Centers for disease control and prevention. https://www.cdc.gov/drugoverdose/epidemic/?utm_source=EWSE+July+2017+Newsletter&utm_campaign=EWSE+Jul+2017&utm_medium=email
  4. Cohn, Meredith. 2019. “Maryland Made a Plan to Help People Leaving Prison Get Drug Treatment - but It Never Used It.” The Washington Post. March 11, 2019. https://www.washingtonpost.com/local/maryland-made-a-plan-to-help-people-leaving-prison-get-drug-treatment--but-it-never-used-it/2019/03/11/93ae2f30-3f61-11e9-922c-64d6b7840b82_story.html
  5. Donovan, Doug. 2019. “Maryland Legislature Approves Bill to Expand Use of Medicines for Addiction Treatment in Jails.” baltimoresun.com. Baltimore Sun. June 29, 2019. https://www.baltimoresun.com/politics/bs-md-addiction-treatment-prison-20190405-story.html
  6. Estee, Sharon L., and Daniel J. Nordlund. Washington State Supplemental Security Income (SSI) cost offset pilot project: 2002 progress report. Washington State Department of Social and Health Services, Management Services Administration, Research and Data Analysis Division, 2003. https://www.dshs.wa.gov/ffa/rda/research-reports/washington-state-supplemental-security-income-ssi-cost-offset-pilot-project-0
  7. Ettner, Susan L., David Huang, Elizabeth Evans, Danielle Rose Ash, Mary Hardy, Mickel Jourabchi, and Yih‐Ing Hser. "Benefit–cost in the California treatment outcome project: does substance abuse treatment “pay for itself”?." Health Services Research 41, no. 1 (2006): 192-213. https://doi.org/10.1111/j.1475-6773.2005.00466.x
  8. Fiscella, Kevin, Leo Beletsky, and Sarah E. Wakeman. 2017. "The inmate exception and reform of correctional health care." American journal of public health 107(3): 384. https://doi.org/10.2105/AJPH.2016.303626
  9. Guyer, Jocelyn, Kinda Serafi, Deborah Bachrach, and Alixandra Gould. 2019. "State strategies for establishing connections to health care for justice-involved populations: the central role of Medicaid." New York Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2019/jan/state-strategies-health-care-justice-involved-role-medicaid
  10. Hancock, Jay. 2016. “Thousands Leave Maryland Prisons With Health Problems And No Coverage.” NPR. April 24, 2016. https://www.npr.org/sections/health-shots/2016/04/24/475271336/thousands-leave-maryland-prisons-with-health-problems-and-no-coverage?t=1595253458688
  11. Hogan, Larry, and Governor–Boyd Rutherford. 2019. "Drug-and alcohol-related intoxication deaths in Maryland, 2019 Q3." https://health.baltimorecity.gov/opioid-overdose/
  12. Jannetta, Jesse, Jane B. Wishner, Rebecca Peters, Justice Policy Center, and Health Policy Center (Urban Institute). Ohio's Medicaid Pre-Release Enrollment Program. Urban Institute. https://www.urban.org/sites/default/files/publication/88051/ohio_medicaid_1.pdf
  13. Johns Hopkins Bloomberg School of Public Health. State and Local Initiatives to Enroll Individuals in Medicaid in Criminal Justice Settings, 2015. Johns Hopkins Bloomberg School of Public Health. https://www.jhsph.edu/research/centers-and-institutes/center-for-mental-health-and-addiction-policy-research/research/economics-and-services-research/arnold-foundation-project-map/
  14. Jordan, Neil, Grant Grissom, Gregory Alonzo, Laura Dietzen, and Scott Sangsland. 2008. "Economic benefit of chemical dependency treatment to employers." Journal of Substance Abuse Treatment 34(3):311-319.
  15. Maryland Department of Health. (2018). “Report on Connecting Individuals Who Are Transitioning from the Criminal Justice System to Health Care.” Maryland Department of Health. https://mmcp.health.maryland.gov/Documents/JCRs/2017/inmatepresumptiveeligibilityJCRfinal11-17.pdf
  16. Merrall, Elizabeth LC, Azar Kariminia, Ingrid A. Binswanger, Michael S. Hobbs, Michael Farrell, John Marsden, Sharon J. Hutchinson, and Sheila M. Bird. 2010. "Meta‐analysis of drug‐related deaths soon after release from prison." Addiction 105(9):1545-1554. https://doi.org/10.1111/j.1360-0443.2010.02990.x
  17. Moyer, Stephen T. and Robert R. Neall. “Hogan Administration Officials: Maryland Prisoners Are Getting on Medicaid.” Baltimore Sun. June 2, 2019. https://www.baltimoresun.com/opinion/readers-respond/bs-ed-rr-maryland-prisoners-medicaid-letter-20190319-story.html
  18. National Drug Intelligence Center. 2011. “The Economic Impact of Illicit Drug Use on American Society.”  United States Department of Justice. https://www.justice.gov/archive/ndic/pubs44/44731/44731p.pdf
  19. National Institute on Drug Abuse. 2019. “Criminal Justice DrugFacts.” National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/criminal-justice
  20. Office of National Drug Control Policy. 2012. Cost Benefits of Investing Early in Substance Abuse Treatment. Office of National Drug Control Policy. https://obamawhitehouse.archives.gov/sites/default/files/ondcp/Fact_Sheets/investing_in_treatment_5-23-12.pdf
  21. The Ohio Department of Medicaid. 2018. “2018 Ohio Medicaid Released Enrollees Study.” The Ohio Department of Medicaid. https://medicaid.ohio.gov/reports  
  22. Wakeman, Sarah E., and Josiah D. Rich. 2015. "Addiction treatment within US correctional facilities: bridging the gap between current practice and evidence-based care."  Journal of addictive diseases. 34(2-3):220-225. https://doi.org/10.1080/10550887.2015.1059217
E. Rosalie Li-Rodenborn is a second-year graduate student studying public health biology at The Johns Hopkins Bloomberg School of Public Health. Her interest exists in the space where science meets policy, and she hopes to change the way scientists approach public engagement. Her publication NOVEL SCIENCE helps scientists learn to communicate with lay audiences while producing content that prioritizes excellence in writing, scientific rigor, and aesthetic. She hopes to pursue a Ph.D.
 
Bernat Navarro-Serer is a third-year Ph.D. Candidate studying pancreatic cancer at The Johns Hopkins University School of Medicine. He studies mechanisms of invasion in pancreatic ductal adenocarcinoma using 3D organoid models from human derived tumors. He is the Social Media Chair at the Johns Hopkins Science Policy Group and the Eastern Hub Co-Chair at the National Science Policy Network.
 
Stephanie Pitts is a third-year Ph.D. candidate in Cellular and Molecular Medicine at the Johns Hopkins University School of Medicine. Her research focuses on targeting RNA polymerase I as an anti-cancer therapeutic strategy. She holds a B.A. in Biology from Brown University.
 
Kavya Anchuri is a second-year MD candidate at the University of Calgary’s Cumming School of Medicine in Alberta, Canada. She completed a Master of Health Science at the Johns Hopkins Bloomberg School of Public Health in 2018, where she published her thesis research on the epidemiology of suicide among emerging adults in the U.S. After this, she worked for the Nova Scotia Health Authority in Atlantic Canada to evaluate transitions-of-care between pediatric to adult mental health services in the region.

Acknowledgements
The authors wish to thank the Johns Hopkins Science Policy Group in the preparation of this manuscript.
DISCLAIMER: The findings and conclusions published herein are solely attributed to the author and not necessarily endorsed or adopted by the Journal of Science Policy and Governance. Articles are distributed in compliance with copyright and trademark agreements.

ISSN 2372-2193
ISSN 2372-2193