A New York initiative intended to enroll millions of residents who qualify for Medicaid under the Affordable Care Act (ACA) could lead to significant changes to the state's pre-trial detention system, advocates said today at a conference on health care and corrections at the John Jay College of Criminal Justice in New York City.
The program, called Medicaid Health Homes, is designed to facilitate communication between all of an individual's caregivers, including those assigned by the criminal justice system, said Tracie Gardner, director of state policy at the non-profit Legal Action Center.
“Health Homes are designed to be a case management top to bottom approach that looks at someone in terms of their specific pathologies and really approaches what they need,” Gardner said.
Under the ACA — often referred to as Obamacare — millions of New Yorkers who previously had not qualified for Medicare are now eligible. While the majority of enrollees are relatively healthy, the Health Homes program is designed to assist healthcare providers with complicated medical and behavioral issues that are often associated with the criminal justice system.
For law enforcement and courts, that could mean a greater ability to quickly identify alternatives to incarceration for those with mental illness and substance abuse issues.
Tim Murray, executive director of the Pretrial Justice Institute, said that healthcare and substance abuse counseling is more effective at mitigating risk than jail.
“When you're drunk and stoned you don't come to court as much as when you're straight and sober,” Murray said.
Murray argued that health interventions at the pretrial stage can prevent much of the crime associated with recidivist criminals.
“More than anything, there's the necessity, there's the obligation to confront the way the front door to our justice system operates,” he said, noting that in many defendants from poor communities cannot afford to post the bail required for release from jail.
But two dozen states have yet to adopt the Medicaid expansion, which Gardner warned could lead to a “two-tiered system” in the courts: those that regularly refer detainees to alternative health services and those that don't.
Studies of post-release health care have shown both short- and long-term reductions in recidivism rates.
For many states, Murray said, the electorate won't be convinced to participate until they've gotten to see side-by-side comparisons with their neighbors.
“If you can show that this approach is cost-effective, improves society and improves the living condition among those who represent the majority in society, this has a chance,” Murray said.
Graham Kates is Deputy Managing Editor of The Crime Report. He welcomes comments from readers. He can be found on Twitter @GrahamKates.