Vermont looks to extend Affordable Care Act to released prisoners

The federal expansion of Medicaid through the Affordable Care Act has allowed more than 55,000 Vermonters to enroll in the health insurance program for the poor.

Now the state has set its sights on enrolling a greater portion of people released from prison, a population that often has high medical needs and is likely to qualify for Medicaid, according to Dr. Dee Burroughs-Biron, the Department of Corrections health services director.

Recent legislation charges the Department of Corrections and the Department of Vermont Health Access with helping people in the criminal justice system obtain health coverage and connecting them with chronic disease management, mental health and substance abuse services.

The provision is part of a package to strengthen pretrial services and did not include an appropriation, but Burroughs-Biron said providing increased access to health coverage could be accomplished with existing resources.

The Affordable Care Act expanded requirements for health plans to cover mental health and substance abuse services in parity with other medical services. It also includes guidelines requiring states like Vermont that expanded Medicaid to cover additional mental health and substance abuse services through the program.

The idea is to make sure the criminal justice population benefits from those changes.

There is not good information on the health insurance status of Vermont’s criminal justice population. Intake medical examinations ask if someone has insurance, but that information isn’t easily accessible, Burroughs-Biron said.

She said her department does plan to take a point-in-time survey of the incarcerated population this summer as part of its work to expand health coverage.

Having an information technology system that can more easily aggregate that data will be part of the request for proposals when the Department of Corrections seeks a vendor to overhaul its offender management system next year.

More than eight of 10 released prisoners have chronic physical, mental or substance abuse conditions, according to a 2008 report from the nonpartisan Urban Institute.

The report states that, “Returning prisoners face multiple, often simultaneous tasks as they embark on the process of re-establishing their lives outside prison,” such as finding housing, getting a job and reconnecting with children and family. Accessing health care can get pushed down on the priority list with serious consequences.

“Those with severe or unmanaged health problems face an increased risk of adverse outcomes, including physical illness, relapse into drug use or, particularly in the case of mental illness, inappropriate behavior that provokes a police response,” the report adds.

Figures from the Department of Corrections show that 44 percent of male inmates and 73 percent of female inmates in Vermont required mental health services, according to a point-in-time census conducted in June 2013.

In fiscal year 2013, inmates housed in Vermont made 41,342 sick call requests or requests for medical services. Thirty-two percent of those were related to a chronic physical illness and 18 percent were related to mental illness. There were about 2,100 inmates held on a given day in Vermont and out-of-state prisons in FY 2013.

Burroughs-Biron is planning to meet with DHVA officials to discuss how to help prisoners get a subsidized health plan through Vermont Health Connect or find out if they are Medicaid eligible.

“We’re working on changing the process so we can sign more people up while they’re in prison,” Burroughs-Biron said. “I wish it was as simple as just letting people sit down and log on to the portal, but we don’t have that type of access as yet.”

The two departments will explore how Vermont Health Connect navigators, trained to help the public get health coverage, might be able to work with corrections health care staff or caseworkers as part of existing re-entry programs.

With few exceptions, the Department of Corrections can’t bill Medicaid for care provided to people while they’re incarcerated, but the idea is to ensure they have coverage upon re-entry, Burroughs-Biron said.

“Sometimes individuals who find themselves in and out of jail have not taken good care of themselves and have seen a provider only sporadically,” Burroughs-Biro said. “Once they’re in jail … they may get seen more frequently.”

The project’s goal is to make sure they continue to access appropriate care upon release, she said.

That could mean helping them access mental health or substance abuse services as well as helping them find a medical home and care coordinator through Vermont’s Blueprint for Health – the state’s chronic disease management initiative.

“We often have people who have one or more chronic diseases which are quite complex,” Biron said. “It would be great for them to go into a medical home to help upon release.”

The project’s success ultimately depends on people’s willingness to address their problems, be it addiction, mental illness or a physical condition, Biron said.

“They have to want to take responsibility for their health,” she said.