Category Archives: Jails and prisons
A recent essay by columnist Nicholas Kristof of The New York Times looked at a critical problem faced by jails across the country, which often double as behavioral health treatment centers. For many inmates, mental health problems have been the significant factor in committing a crime, with some even purposely flouting the law in the hopes of getting into jail where they can get free treatment. As a result, the United States has a national inmate population where half of all male inmates and three quarters of all female inmates have a behavioral health condition.
Solutions are beginning to emerge, though critical problems remain. At a recent health initiatives forum convened by the National Association of Counties and held in San Diego, county health officials talked about the promise of the Affordable Care Act, which will allow jail health specialists to help enroll inmates in coverage in advance of their discharge to help continue care—behavioral and physical—outside of jail.
Read the full column here.
>>Bonus Link: Read NewPublicHealth’s coverage of the recent NACo Health Initiatives Forum.
A key session at the National Association of Counties (NACo) Health Initiatives Forum held last week in San Diego focused on the opportunities and implementation challenges of the Affordable Care Act for inmates of county jails.
Most county jail inmates are there awaiting trial because they can’t afford bail, and a large percentage have physical and/or mental health problems. While in jail, the cost for their health care falls to the county; Medicaid and other benefits inmates have in the community end once they enter the jail system, and many have no benefits. Typically, the care inmates received in jail ends on release since there is generally no entity to help them transition to community benefits and care.
And benefits under the Affordable Care Act are generally elusive for inmates—and counties—desperate for care and a break on the high cost of health care for inmates. While just about all inmates would qualify for coverage under the Affordable Care Act either through health insurance marketplaces or Medicaid expansions in those states that have changed their Medicaid rules under the health law—expanding Medicaid benefits to those without children who qualify financially because of low incomes—current laws do not permit inmates to be covered for health care costs under Medicaid while in jail, except for hospitalizations while they’re incarcerated.
Many counties in states that have expanded Medicaid to include low-income adults without children have petitioned their state Medicaid offices to amend current rules and allow coverage for health care under Medicaid during incarceration.
However, counties are taking initiative to help inmates sign up for coverage that will kick in on their release, reducing the chance for recidivism and improving the chance for healthier and more productive lives. For example, last week in San Francisco the city sheriff sent a bill to the city’s Board of Supervisors that would make the sheriff’s office responsible for helping inmates sign up for the Affordable Care Act.
At the NACo meeting, Farrah McDaid Ting, Associate Legislative Representative for Health and Human Services at the California State Association of Counties, said a key issue both for county budgets and for the health of people released from jail into the community is that without benefits and a transition to care, often care was only sought afterward and delivered when there is a crisis. Ting says among the requests being made in California is to have Medicaid suspended rather than terminated for people in jail under a year, which would allow a person to transition back to care immediately on release.
Another critical need in jail is technology infrastructure to allow inmates to be signed up. Some counties in California, according to Ting, are using outside nonprofit groups to sign up eligible inmates before release.
“What we want to reduce is that person ending up back in jail,” said Ting.
During a town hall meeting in Minnesota last month, the Target Corporation, one of the largest employers in the United States, announced that the company will remove the criminal history question from its initial employment application. While Target has already removed this question in states where it is legally prohibited, this announcement will apply to all U.S. Target locations, even in areas where asking the question is permitted by state or local law. In Minnesota, the Ban the Box law will go into effect January 1, 2014.
“Over the past year, members of the Target team have had many productive conversations with TakeAction Minnesota,” says Molly Snyder, a spokesman for the company. “Many of our discussions have focused on Minnesota’s racial jobs gap and the barriers individuals with criminal records face when seeking employment.”
The decision by Target is in part the result of efforts led by the TakeAction Minnesota Education Fund, a Robert Wood Johnson Foundation (RWJF) Roadmaps to Health community grantee, to address job discrimination based on criminal background. Often tied to significant unemployment throughout the country, studies show that having a criminal record is a barrier to employment opportunities and depresses wages. And data from Minnesota finds that half of all former offenders are unemployed, with the rate higher for ex-offenders of color who disproportionately make up the prison population.
The Roadmaps to Health Community Grants are collaborations that have received two year funding of up to $200,000 to work with diverse coalitions of policy-makers, business, education, health care, public health, and community organizations. The grantees and their partners are pursuing policies or system changes that address the social, economic, and environmental factors that influence how healthy people are and how long they live. The Roadmaps to Health Community Grants project is a major component of the County Health Rankings & Roadmaps program—a collaboration of RWJF and the University of Wisconsin Population Health Institute.
TakeAction Minnesota is using its grant to promote new statewide fair hiring standards for businesses, such as persuading prospective employers to consider criminal records only when they directly relate to the position rather than asking questions on applications that promote blanket rejections. Earlier this year, the Minnesota legislature passed the “ban the box” legislation and it was signed into law in May, making Minnesota the third state in the nation to adopt “ban the box” in both the public and private sectors. Under the new law, an employer will no longer be allowed to include a check box about criminal background on the initial employment application.
NewPublicHealth recently spoke with Justin Terrell, manager of the Justice 4 All program at TakeAction Minnesota, about the intersection of employment and health.
NewPublicHealth: What are the ways in which employment impacts health?
How many children could possibly identify with a new Sesame Street character whose dad is in prison? Close to two million, according to many experts. A White House “Champions of Change” event yesterday honored twelve men and women who have spent their careers researching and improving the lives of children who have at least one parent in prison. That explains why Sesame Street released a new video and toolkit yesterday, as part of their "Little Children, Big Challenges" series, that tells the story of Alex, whose dad is in prison. Alex’s grown up and peer friends help him talk, and sing, about his feelings about his dad and how other people speak about his dad’s prison stay. The "Challenges" series includes issues many kids face such as divorce and a parent in the military, and the resources are distributed through therapist's offices, schools, jails and other key places to reach kids.
The White House program, led off by Domestic Policy Council director Cecilia Munoz and Secretary of Health and Human Services Kathleen Sebelius, included panel discussions on the needs of kids whose parents are in jail, which is a recognized “adverse childhood experience” that can lead to poor health outcomes as children become adults. Among the problems kids of incarcerated parents can face are decreased living standards, social isolation because of the stigma they feel about having a parent in prison, and long-term or permanent separation from the incarcerated parent.
>>Watch a CBS News story on the Sesame Street program that will help support kids with incarcerated parents.