Releasing our Elders; Health Care Reform and Prisoners.

From the list-serve/newsletter of www.curenational.org (Citizens United for the Rehabilitation of Errants)

-------New Vera Report Shows Difference between Geriatric Release Policy and Practice-------

Harsh sentencing policies have made correctional facilities throughout the United States home to a growing number of older adults. Yet most states with provisions for releasing older prisoners rarely use them, despite the relatively low risk eligible inmates would pose to public safety and the opportunity for potential cost savings.

“It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release” examines statutes related to geriatric release in 15 states and the District of Columbia, identifies factors that help explain the discrepancy, and offers recommendations for those who would address it.

“The upshot is that there’s a difference between what states would like to do—save money by releasing older prisoners—and what actually happens,” says the report’s author, Tina Chiu. “If states want the result of geriatric release policies to be consistent with that objective, they should review the release process to address potential and existing obstacles.”

The Vera Institute of Justice is an independent nonprofit organization that combines expertise in research, demonstration projects, and technical assistance to help leaders in government and civil society improve the systems people rely on for justice and safety.

------------------------------ Health Care Reform and Prisoners------------------------

Thirteen million people are incarcerated in jails annually.

Three and a half million of this 13 million are incarcerated more than once during the year.

 The Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act (together referred to as "the health reform law" expands health insurance coverage by expanding Medicaid, the federal-state health insurance program for low income people, to cover everyone under 133 percent of the federal poverty level (FPL). For uninsured individuals above 133 FPL the bill sets up state-based "health insurance exchanges" or regulated insurance marketplaces where individuals and small businesses can compare and purchase private health insurance policies. (They will function something like websites like Travelocity or Orbitz, but for health insurance.) Lower income individuals will be eligible for tax subsidies to buy insurance on the exchanges.

The health reform law does not change the current inmate exclusion for Medicaid and other federal health programs. Convicted inmates are also ineligible for insurance from the exchanges. However, pre-conviction inmates remain eligible and they also remain subject to the individual mandate to carry health insurance.

Regardless of the insurance arrangements covering prisoners, jails will still have a legal obligation based on the /Gamble /decision by the Supreme Court to provide medical care for all prisoners regardless of conviction status. How this obligation will be satisfied or impacted by the health reform legislation has not been addressed.

 There are two additional references to the criminal justice system in the health care bill. First, "conviction for a relevant crime of patient or resident abuse" disqualifies a person from being hired
as a health care worker, and second, the Federal Bureau of Prisons is specifically included in the Interagency Working Group on Health Care quality.

The Legal Action Center reports that the final health care bill incorporates many key elements on addiction and mental health services, as follows:

Includes substance use disorder and mental health (SUD/MH) services as required benefits in the basic benefit package for individual and small business health plans;

Requires that all plans in the health insurance exchange comply with the Wellstone/Domenici Parity Act in providing SUD/MH benefits in the same way as all other covered medical and surgical benefits;

Expands Medicaid eligibility for all Americans up to 133 percent of the federal poverty level and require newly eligible parents and childless adults receive coverage that includes SUD/MH services provided at parity;

Includes SUD and MH prevention strategies and efforts in the bill's chronic disease initiatives;

Includes the capacity of the mental and behavioral health workforce as high-priority topics in the bill's National Workforce Strategy section; and

Includes insurance reforms and consumer protections critical for individuals seeking or in recovery, including prohibiting insurers from denying coverage to people with pre-existing conditions, charging higher premiums based on health status, and placing annual or lifetime caps on insurance coverage.