Improve Lives | Establish Continuity of Care Plans for Incarcerated Individuals Diagnosed with a Substance Use Disorder, Mental Health, or Chronic Care Condition

• Overview
• How We Measure
• Continuity of Care Rates
• Support Factors
• Delivering Results

Overview

Currently, 96% of incarcerated individuals will release back into the community. Unfortunately, the traditionalrecidivism ratehas indicated that approximately 30% of those releasing have returned to prison within three years of their release. A concerted effort to ensure continuity of care plans are in place when an individual releases from prison is crucial to the person’s success in the community. When people have control of their health, they have a means to manage their chronic conditions, the issues that brought them to prison, their chances of holding a job and succeeding at school, and an increased chance of reconnecting with their family.

Health Services Division has been assisting incarcerated persons with the Medicaid application process to ensure they have health care benefits available to them upon release. Most eligible individuals preparing for reentry participate in the application process. Through the state’s Medicaid data, individuals that receive Medicaid benefits upon release can be identified whenever they access health services in the community. We are interested in comparing those that apply for benefits prior to release with those that access services in the first six months of reentry.

How We Measure

The Department of Corrections aims to establish care plans for 40% of incarcerated individuals diagnosed with a substance use disorder, mental health, or chronic care condition by 2023. As part of this effort, the Department aims to submit a Medicaid application for at least 85% of individuals prior to their release from a prison facility.

This statistic describes the number of individuals who are released from prison facility with a completed Medicaid application as a percentage of the total number of individuals released in that quarter. Individuals releasing from non-prison facilities, such as reentry centers, are not including in this measure although they receive the same application assistance.

Continuity of Care Rates

Factors that Support Continuity of Care

Timely Medicaid application sessions at the facilities prior to release

During the period of incarceration, time is set aside to apply for medicaid.

Medicaid eligibility of the applicant

Depending on how much the applicant makes, how much outside support they have, and other factors the incarcerated individual may or may not qualify for medicaid.

Community clinics and other health services in the county of release

Some parts of the state have more healthcare support infrastructure than others. Individuals releasing to areas with fewer resources may have a more challenging time receiving services.

Continuity of care from department health services to community providers

When the Department of Corrections communicates with community clinics and doctors and ensures a smooth transition, we maximize the chances of the individual's success.

Data sharing to identify how often patients use community health resources

The Washington State Health Information Exchange contains information regarding patients who received care in the community. Determining who received care after release can assist the department in identifying whether our strategies are working.

Actions Being Taken to Deliver Results

• Expanded Affordable Care Act application training to staff in health services, custody, reentry and the graduated reentry program to reach more releasing individuals and assist them in applying for Medicaid benefits prior to release date.
• Educating the incarcerated population on the advantages of applying for Medicaid benefits prior to release. Created posters and other marketing materials to emphasize the value of health care benefits to ensure their care continues after reentering the community.
• Collaborated with Washington State Health Care Authority to flag records in databases to suspend Medicaid benefits, not terminate them, if an individual reoffends and returns to prison. This allows the individual to stay enrolled and benefits resume upon release without having to go through the application process again.
• Hiring a Continuity of Care Administrator and clinical staff to coordinate health care reentry process for individuals releasing from prison.
• Hire discharge planning staff to work with patients and community providers to ensure a soft hand-off from prison health care to community provider (in Governor’s and House proposed budgets).
• Expanding discharge planning staff to work with patients and community providers to ensure a soft hand-off from prison health care to community provider. Ensure access to all health services are considered and release plans are in place for issues like:
  • Chronic conditions such as diabetics, hypertension, Hepatitis, HIV, etc.
  • Mental Health/Psychiatric care
  • Substance Abuse Disorder
  • Requirements for hospital or long term care
• Improved patient health through staff engagement, enhanced coordination of care and communication with the patient, staff and external stakeholders aligned with National Commission on Correctional Health Care standards and clinical best practices.