This report serves as a resource for local criminal justice and health stakeholders to guide strategic planning processes in which they decide on the implementation of specific information sharing initiatives. As stakeholders develop and implement any information exchange, it will be important to develop measures and mechanisms to determine whether the exchange is working as intended. Questions to be addressed include whether the amount of information exchanged increased and practitioner assessments of whether the information exchanged has been beneficial. To further the adoption of criminal justice and health information exchanges, Federal agencies, state agencies, or private foundations may consider establishing local demonstration projects to answer these and
additional questions about implementation impacts. Such a demonstration project would document the lessons learned in a number of pilot sites and evaluate implementation impacts, such as improved retention in treatment, reduced assessment time, improved health status and functioning, fewer gaps in access to prescription medications in the community, and criminal justice outcomes (e.g. reductions in drug abuse, criminal activity, and recidivism). Several recommended, potential projects are below.
6.1
Criminal Justice and Health Collaboration Phase 2 Project
A Phase II continuation of this project is highly recommended to:
Select one or more Information Exchange Synopses for creation of appropriate service specification packages and implementation of those services as pilot implementations.
This could result in a proof of concept, lessons learned, and technical and business templates for future criminal justice-health implementations.
Explore and document the application of these information exchange synopses to the juvenile justice arena.
Examine and document privacy constraints for each Information Exchange Synopsis. Add (potential) new Information Exchange Synopses46, including:
Submission of mental health records to the NICS
Corrections/detention submission of immunization records to the department of health registry
Corrections/detention requests immunization records from the department of health registry
Corrections/detention submits cancer records to the department of health registry Corrections/detention requests cancer records from the department of health registry Corrections/detention submits syndromic surveillance records to the department of health registry
46
Corrections/detention requests syndromic records from the department of health registry
One of the deliverables of this project was to provide a recommended Project Charter, Goals,
Deliverables, and Participants for the recommended Phase 2 Criminal Justice and Health Collaboration Project. These are provided in Appendix C.
6.2
Potential Future Information Exchanges under Health Care
Reform
The implementation of health care reform in 2014 under the ACA creates additional opportunities for criminal justice and health information exchange that generally do not yet exist in today’s policy
landscape. Most notably, the expansion of Medicaid health coverage to low-income adults under age 65 (the so-called “childless adult” population) is expected to increase access to health care among criminal justice-involved persons in those states that opt to participate. Information exchange between criminal justice agencies and Medicaid agencies have the potential to facilitate enrollment and to manage benefits as follows.
6.2.1
Criminal Justice Records to Facilitate Enrollment into Medicaid
The majority of the justice-involved population is expected to qualify for Medicaid on the basis of low income (133 percent of the Federal poverty level or below). Some state Medicaid agencies that already extend coverage to low-income childless adults have established “presumptive eligibility” policies, whereby justice-involved individuals are enrolled in Medicaid in anticipation that most will meet the eligibility requirements. In Connecticut, for example, soon-to-be released inmates submit a simplified Medicaid application containing only brief demographic and contact information. Applications are approved in an expedited manner and benefits are activated when the Medicaid agency receives notification of the actual release. This is presently done as a paper-based application process but could potentially be accomplished through a combination of client consent and electronic data transfer to the Medicaid agency.
6.2.2
Admission and Release Dates from Incarceration to Manage Medicaid Benefits
Current Federal regulations prohibit Medicaid from reimbursing care that is provided during
incarceration. Rather than terminate benefits on admission to prison or jail, some states have developed policies to suspend benefits on admission and reinstate benefits on release. Electronic transfer of admission and release dates to the Medicaid agency can enhance the efficiency of this process,
especially after 2014, when larger numbers of persons entering jail can be expected to have Medicaid. A secondary benefit is to avoid the lapse in treatment after release allowing continuous care of seriously ill persons being released from custody.
6.2.3
Potential Medicaid Coverage of Services to Incarcerated Individuals Who Are
“Pending Disposition”
Under the ACA, persons who are awaiting trial in jail may enroll and receive services from health plans participating in a state’s health insurance exchange. Present Medicaid policy does not allow
reimbursement for the care of detainees who are “pending disposition,” (i.e. incarcerated while awaiting trial because they could not meet bail requirements), but there are efforts underway to bring Medicaid provisions for this population in line the ACA. Should this occur, jail systems and Medicaid
agencies may develop electronic mechanisms for transmitting health claims and reimbursements for pretrial detainees.