This week in Realignment: October 11, 2013

150 150 Christopher Nelson

The theme of the week has been legislation, with Gov. Jerry Brown signing significant bills into law in the areas of election reform and broadband infrastructure. The realm of inmate health care was no exception.

Signed this week was AB 720, which amounts to a common sense piece of legislation allowing two things. First, those who go to jail or prison who, prior to AB 720,would have had their Medi-Cal canceled are now eligible to have it suspended instead. Second, it allows jails to enroll people in Medi-Cal prior to their release so they have no break in heath coverage after they get out.

What’s important to note is that this is not a mandate so, per Proposition 30, there are no state funds required. Simply put, this is a good bill that extends the authorities provided to state prisons and local jails.

As the Los Angeles Times’ editorial board correctly points out:

When people leave jail without medical coverage, their ailments often go untreated and they wind up in the emergency room with more expensive, acute problems. The ultimate cost usually ends up being covered by taxpayers in any case because hospitals can sign them up for Medi-Cal retroactively. What’s more, former jail inmates who suffer from mental health issues and substance-abuse problems but who don’t receive treatment are more likely to end up back in jail, according to studies of jail populations in Florida and Washington.

The importance of the Affordable Care Act (ACA) to county corrections budgets cannot be understated. Anything that increases the authority at the county (or state) level to create more gateways to enrollment simply expands the cost-saving opportunities at all levels. Starting January 1, 2014 until the same day in 2016, the federal government will be reimbursing 100 percent of the medical costs for a vastly expanded pool of eligible offenders. After that it gradually drops to 90 percent over the next few years.

Those are numbers that California Forward’s Partnership for Community Excellence has been fixating on and putting front and center at all of the regional convenings conducted with counties to get them educated and ready for ACA enrollment, which began on October 1. It’s simple math: the more offenders who are enrolled, the more money the county will save overall on inmate health care. Even those in pre-trial status are eligible and in those cases, not only will treatment reduce the number of bodies in beds, it may keep someone who doesn’t belong in jail from ever going there.

The response has been overwhelming thus far. Many of these stakeholders in the process don’t often speak with one another so simply getting them in the same room and putting names to faces is valuable unto itself. But more importantly, county corrections and health care officials leave with a concrete roadmap to catalyze enrollment. 

Our most recent convening in Santa Cruz was particularly inspiring. Santa Cruz is a county that has fully embraced the new approach to corrections that is slowly taking hold across the country. They understand that some offenders don’t belong jail and that treatment and other evidence-based practices are the real cornerstones of fighting recidivism and reducing prison/jail populations in the long run. They understand the flexibility offered in split sentences and they have judges who are on board with putting them to use.

This recent Pew study indicates that many other states are in tandem with Santa Cruz. The premise of the study is based on more than a dozen governors who, over the past seven years, “have spearheaded research-based sentencing and corrections reforms that slow the growth of prison costs while reducing reoffense rates and keeping communities safer.”

The sooner all of California, not just the counties with more manageable prison populations, gets on board, the better. The Los Angeles County board of supervisors’ mulling over new spending for new jail construction is merely a symptom of the larger issue: change moves much more slowly in a county with the largest jail system in the nation than it does in Santa Cruz or Santa Barbara.

However, with progressive minds like Terri McDonald leading the charge, it’s very premature to claim that LA County doesn’t get it or doesn’t care to make changes. And with a PCE convening happening there later this month, the opportunities to get on the right track exist. California simply must stay the course and hope that Sacramento continues to keep its focus on long term solutions and that the three judge panel provides the breathing room to do so.


Christopher Nelson

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