Criminal justice populations have substantially higher rates of medical, mental health and addiction problems compared to the general population. For example, prevalence of Hepatitis C is nine to 10 times higher in the inmate population compared to the general population; prevalence of active tuberculosis is four times higher; HIV infection is eight to nine times higher and serious mental illness is three times higher. An estimated 39 percent to 43 percent of all inmates have one or more chronic conditions such as hypertension, diabetes and asthma.Well over 100,000 adults in Colorado are involved in the criminal justice system in some form: 75,000 people are on probation, 11,000 are on parole, and over 30,000 are housed in state prisons and county jails. Most of these people are low-income. An estimated 70 percent to 90 percent have no health care coverage.
With few options for health coverage, the primary means of accessing health care services among this population has been through jails, prisons and emergency rooms. Prisoners have a constitutional right to medical care while they are incarcerated so, for many inmates, health may improve while they are confined. But any health gains realized during incarceration are often quickly lost upon return to the community because access to medical care, behavioral health services and treatment is limited. Research tells us that the risk of relapse, reoffending and even death is most acute during the days and weeks immediately following release from a correctional facility.
The Affordable Care Act is a game changer for the health and wellbeing of criminal justice populations. Let’s start with the expansion of Medicaid. Historically, Medicaid only covered low-income families with children and the disabled. Colorado and 26 other states expanded Medicaid to all U.S. citizens under 138 percent of poverty (about $15,000 for single adult). It is estimated that three-quarters of all people involved in the criminal justice system could be eligible for Medicaid. Subsidized health coverage is also now an option. People making up to 400 percent of the federal poverty level ($46,000 for a single adult) are eligible for reduced monthly premiums. So for the first time ever, tens of thousands of people involved in the criminal justice system in Colorado—mostly low-income men—will have an opportunity for health coverage.
This is a game changing moment. The potential is enormous. Increased access to health coverage for this chronically uninsured population can improve public safety, public health, and reduce correctional spending.
By Michelle Webster