Collaboration supports improving care standards for individuals involved in the criminal justice system

In the United States, nearly 2 million people are incarcerated in jail or prison on any given day.¹ High quality care is essential for individuals involved in the criminal justice system because they have higher rates of morbidity and mortality  compared to the general population.^2,3,4 Many people who are incarcerated have a history of substance use disorder or mental health challenges, making jails and prisons de facto mental health institutions.⁵ Individuals with a history of incarceration are less likely to have access to regular health care or receive preventive services after release, in part, due to a lack of insurance when they leave jail or prison.⁶ UnitedHealthcare Community & State aims to improve health care access for people who are incarcerated in jails and prisons through collaboration with leading research institutions on this issue such as the Health, Homelessness and Criminal Justice (HHCJ) Lab at the Hennepin Healthcare Research Institute (HHRI).

The HHCJ Lab's mission is to overcome barriers to optimal health and wellness for people experiencing homelessness and criminal justice involvement by studying the complex drivers of health.⁷ Its research and projects use multiple tools including clinical trials, program evaluation, data analytics and community-engaged research principles. HHCJ is housed within HHRI which oversees medical research conducted at Hennepin Healthcare, a safety-net health care system in Minneapolis, MN. UnitedHealthcare’s collaboration with HHCJ is well-positioned to make a significant impact, nationally. For example, UnitedHealthcare and HHCJ Lab presented at the International City/County Management Association conference in 2023 about the importance of public-private collaborations, community engagement and collaboration between local governments and public health stakeholders to address the intersection of homelessness, justice involvement and the opioid crisis.

The UnitedHealthcare/HHCJ collaboration has also focused their efforts on the Medicaid Inmate Exclusion Policy (MIEP). This policy prohibits Medicaid from paying for health care that is delivered in a jail or prison, which worsens the quality of care provided during incarceration and creates barriers to smooth health linkages at release. However, for the first time since the passage of Medicaid in 1965, the Biden-Harris Administration has advanced opportunities to use Medicaid for individuals reentering communities from correctional settings via the 1115 Medicaid Reentry Waiver.⁸ Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot or demonstration projects that will promote Medicaid program objectives.⁹ The reentry demonstration specifically focuses on the health care needs of individuals who are incarcerated or transitioning out of a jail or prison. While the new reentry waivers require a set of foundational services, largely focused on substance use disorder and mental health, this opportunity also opens the door to provide better care for an aging prison population, as well as to impact maternal health outcomes by increasing access to care coordination and services for people who are pregnant or postpartum.

While the reentry waiver improves access to care for those transitioning back into the community, there is also an opportunity to give greater attention to care provided to individuals during incarceration. For example, states could work across agencies to implement quality measures consistent with that of Medicaid.¹⁰ There are currently no uniform standards for health care in jails and prisons like there are for hospitals or clinics in the community. HHCJ, Transitions Clinic Network (TCN) and the SEICHE Center for Health and Justice at Yale University recently developed a comprehensive roadmap to guide program evaluation and quality measurement for 1115 Medicaid Reentry Waivers. By adopting higher quality standards, Medicaid programs can improve health outcomes for this population.

In 2024, the UnitedHealthcare/HHCJ collaboration is exploring opportunities to improve health care for individuals involved in the criminal justice system such as expanding access to medications for opioid use disorder (MOUD). This first-line treatment is recommended in all settings including jails and prisons.¹¹ Within the past five years, access to MOUD, such as buprenorphine and methadone, has improved in jails and prisons, but remains limited in many facilities across the United States.¹² Access to these medications is critically important given that the primary cause of death immediately following release from jail or prison is overdose.¹³ New care models such as those used by the (TCN) are also being developed at Hennepin Healthcare through the HHCJ Lab’s collaboration with Yale University and the National Institute on Drug Abuse.¹⁴ TCN uses a multidisciplinary care team that employs community health workers with lived experience of incarceration to help recently released individuals navigate local health care systems.

People who have been involved in the criminal justice system or have substance use disorder also experience high levels of stigma within the health care system. Stigma can stem from limited criminal justice/substance use education or a lack of experience working with these populations. As systems of care are developed through the 1115 Waiver process for people reentering from jails and prisons, training and education of the health care workforce will be critical to creating a trusting environment and delivering non-stigmatized care.

UnitedHealthcare’s collaboration with HHCJ aims to re-structure the health care system to provide equitable care for individuals involved in the criminal justice system. By advocating for increased access to high quality health care, the collaboration is committed to improving health outcomes and access to care for people reentering our communities.