How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic

Issue Brief
  1. See, most recently, Ryan, Pagel, at al., “Connecting the Justice-Involved Population to Medicaid Coverage and Care: Findings from Three States,” Kaiser Family Foundation, June 1, 2016 https://www.kff.org/medicaid/issue-brief/connecting-the-justice-involved-population-to-medicaid-coverage-and-care-findings-from-three-states/

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  2. Kamila Malik-Kane and Christy A. Visher, “Health and Prisoner Re-entry:  How Physical, Mental and Substance Abuse Conditions Shape the Process of Reintegration,” Urban Institute, February 2008, https://www.urban.org/sites/default/files/publication/31491/411617-Health-and-Prisoner-Reentry.PDF

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  3. Jennifer Bronson, et al., “Drug Use, Dependence and Abuse among State Prisoners and Jail Inmates, 2007-2009,” Bureau of Justice Statistics,2017, Washington, D.C. The rate of drug dependence and abuse in the general population age 18 and over is five percent.

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  4. A North Carolina study estimated that the state’s post release overdose death rate outpaced that of the general population by a factor of 40. Shabbar I. Ranapurwala et al., “Opioid Overdoes Mortality Among Former North Carolina Inmates,” Journal of the American Public Health Association, 108, no. 9 (2018).  In Washington State, researchers estimated that former prisoners were 129 times more likely to die of overdose in the immediate post-release period than the general population, Ingrid Binnswanger et al., “Release from Prison –a High Risk of Death for Former Inmates,” the New England Journal of Medicine, 356, no. 2 (2007).

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  5. World Health Organization, Preventing Opioid Overdose Deaths in the Criminal Justice System Ingrid A. Binswanger, MD, MPH, Patrick J. Blatchford, PhD, Shane R. Mueller, MSW, and Marc F. Stern, MD, Mortality After Prison Release:  Opioid Overdose and Other Causes of Death, Risk Factors and Time Trends from 1999 to 2009; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242316/; http://www.euro.who.int/__data/assets/pdf_file/0020/114914/Preventing-overdose-deaths-in-the-criminal-justice-system.pdf

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  6. Larney, Sarah, Natasa Gisev, Michael Farrell, Timothy Dobbins, Lucinda Burns, Amy Gibson, Jo Kimber, and Louisa Degenhardt. “Opioid Substitution Therapy as a Strategy to Reduce Deaths in Prison: Retrospective Cohort Study.” BMJ Open 4, no. 4 (2014): e004666. https://doi.org/10.1136/bmjopen-2013-004666; Mancuso, David, and Barbara E.M. Felver. “Providing Chemical Dependency Treatment to Low-Income Adults Results in Significant Public Safety Benefits.” Olympia, Washington: Department of Social and Health Services, Research and Data Analysis Division, February 2009. https://www.dshs.wa.gov/sites/default/files/SESA/rda/documents/research-11-140.pdf; National Sheriff’s Association and National Commission on Correctional Health Care, 2018.

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  7. The ACA required coverage of mental health and SUD services for people in Medicaid expansion, and regulatory and other administrative changes have also strengthened mental health and substance use coverage. See Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children’s Health Insurance Program, and Alternative Benefit Plans, Final Rule, Federal Register vol. 81, no. 61 (March 30, 2016) https://www.govinfo.gov/content/pkg/FR-2016-03-30/pdf/2016-06876.pdf; Medicaid Managed care, CHIP delivered in managed care, and revisions related to third party liability, Federal Register,vol. 81, no. 61 (May 1, 2016) https://www.govinfo.gov/content/pkg/FR-2016-05-06/pdf/2016-09581.pdf.  In addition, the SUPPORT Act permits states to cover 30 days of residential treatment for SUD in a calendar year.

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  8. Center for Medicaid and CHIP Services, “Strategies to Address the Opioid Epidemic,” SMD 17-003, https://www.medicaid.gov/federal-policy-guidance/downloads/smd17003.pdf

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  9. Kathleen Gifford, Eileen Ellis, Barbara Coulter Edwards, Aimee Lashbrook, Elizabeth Hinton, Larisa Antonisse, Robin Rudowitz, “States Focus on Quality and Outcomes Amid Waiver Changes;  Results from a 50-state Medicaid Budget Survey for State Fiscal Year 2018 and 2019” Kaiser Family Foundation, October 25 2018, https://www.kff.org/medicaid/report/states-focus-on-quality-and-outcomes-amid-waiver-changes-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2018-and-2019/

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  10. This count does not include the waivers in Arkansas and Kentucky, which have been set aside by the court. See “Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State,” Kaiser Family Foundation, April 18, 2019 https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/

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  11. According to Ohio, individuals automatically qualify for pre-release transition assistance if they have HIV, Hepatitis-C, are pregnant or have delivered a baby during incarceration, or are receiving MAT in the corrections department. In addition, individuals with at least two of the following also qualify: severe and persistent mental illness, recovery services (highest acuity level) or a chronic condition. Written communication from Ohio Medicaid staff, May 17, 2019.

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  12. Traci C. Green, Jennifer Clarke, Lauren Brinkley-Rubinstein, “Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System,” research letter published in JAMA Psychiatry 2018.

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