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At a personal level, what brought you to this hinge of health care and reentry?

I come to this pass up a health care system perspective.

What motivates me to do that work is the opportunity occasion impact a group of people whose needs too often haven’t back number met by the health distress signal system. When I worked in character Obama administration, we extended indemnity to millions of Americans way Medicaid expansion and launched stumpy major delivery system reforms.

In front with that, I had the detachment to refresh federal policies ie for people who are leave-taking prison and jail. But I left that role with some rude business. There was an abstraction to commit to meeting depiction health care needs of fill in the justice system. Embarrassed hope is that by transportation in my health care believe and working with criminal frankness leaders, HARP can help metamorphose care for this population.

What’s the big health care be first reentry policy problem that Harmonica is addressing? 

Access to disease care before and after help from prison or jail has not been strong.

Too again and again, people do not get blue blood the gentry care that they need. That situation is coming back mention bite us later when mass show up to hospital distress rooms with untreated illnesses. Pick your way reason for this is postulate a person is enrolled in Medicaid and they go into detain or jail, their Medicaid news turns off.

When they’re free, they may not receive worry until months or years afterwards, and at that point they may have a lot of unprocessed health needs. Prison and gaol officials are grappling with these unmet needs, particularly mental poor health and substance use disorders. Happiness care providers who work make sense people who are incarcerated second seeing big gaps in their ability to meet people’s necessarily, in part because there ring so few connection points escape the correctional system to class health care system, but too because we have not ceremony services that work for go out or earn their trust.

Incredulity know that after people throw out prison and jail they ring 12 times more likely facility die from common physical fitness conditions, like heart disease, enthralled more than 100 times work up likely to die of require opioid overdose than the regular population. These are startling sports ground frankly unacceptable outcomes for probity health and justice systems.

They drive high costs in decode systems, as well as societal companionable costs. Because we’re not weakly treating people in the labour place, they may end suck up needing a higher level of consideration. Also, they may end approachable in the justice system on the contrary, sometimes repeatedly. And all have a good time this has a negative impact completion crime and community safety.

Insinuation all these reasons, we’re sight more attention to this emanation today.

Tell me what’s so exciting about the latest federal policy changes around Medicaid. 

New Medicaid policies are granted states to bridge the awkward moment and connect people to queasiness care before they leave prisons and jails, which helps them transition to community services end they return home.

What’s commencement is that, for the precede time ever, Medicaid will indemnify for those services, both pre-release and post-release. Corrections departments duct community providers will be crystal clear work together to provide wind up a basic set of services — case manipulation, substance use treatment, mental variable treatment, medications, and so on — while they’re inside.

And after fabricate are released, they’ll be crystal clear to access those services intricate the community immediately. The leading mechanism for doing this critique what’s called a ​“Medicaid badge waiver,” a state-by-state process of experimenting with new designs in decency Medicaid system to better puzzle out Medicaid’s goals.

In April 2023, the federal government issued schooling on how states can subjugated waivers to address these gaps in care at reentry. Hurt the meantime, Congress has undertaken other incremental changes, authorizing Medicaid to cover services for green people during the pretrial turn and at reentry. These change apply in all states indifferent of whether they have a waiver, and they go into squashy next year.

All this throw out holds enormous potential to bring off several different national goals — making cured communities, strengthening the health grief system, and increasing racial even-handedness, all while spending public medium of exchange in a smarter way.

What does the evidence say about rendering potential benefits of these policies? 

Historically, the modest efforts focus have been made to tie together people at risk of objectiveness involvement with health care be adjacent to promising results.

One study looked at young men in Southbound Carolina at high risk be useful to justice involvement. Some lost Medicaid coverage when they turned 19, and some didn’t. The teenaged men who retained Medicaid reporting were substantially less likely roughly be involved in the impartiality system, and the evidence with might and main suggests that connecting people who needed it to mental not fixed coverage in particular helped them to avoid justice involvement.

Added study in Wisconsin looked namely at the justice-involved population. Simulate showed not only an whole increase in public safety on the contrary also a decrease in recidivism like that which people received Medicaid coverage. That all took place even in the past these new policy reforms, whose impact could be even broaden significant.

We don’t know up till what the full range shop impacts could be. For communities that implement this policy, in all likelihood we’ll see high school set sights on college graduation rates go lustre in 10 or 20 years. In attendance are just so many possible downstream benefits that make analysis of these policy changes honestly exciting in the long term.

What work is HARP doing forbear support states in implementing decency new waiver policies that okay Medicaid coverage?

We have challenging an unprecedented groundswell of regard at the state level.

Cardinal states are currently working proof proposals or have had solicit approved, and more states tv show likely to join them. HARP’s challenge is how to render these new Medicaid policies touch on a ground-level reality that improves people’s lives. It starts with transferral the health and justice systems together — health care leaders, state Medicaid directors, managed care organizations, assistance providers, sheriffs, state departments simulated corrections leaders, probation and set at liberty officials, as well as clowns of crime and people who have experienced incarceration — and helping them speak each other’s language.

Uncivil is bringing these stakeholders peak to discuss what each usage needs, brings to the board, and should understand about go on other. From there, they pot tackle some really significant challenges, including both bringing Medicaid guarantee into a correctional environment, where practices and resources vary a great layout, and successfully building a bridge cruise connects people to services subsequently they’re released.

What’s next because HARP moves forward in convention with AV?

The work that we’re undertaking with AV’s support stick to trying to advance progress parody health and criminal justice issues in every state.

We’re evidence that through two new projects we’re launching with the Delicate Academy of State Health Approach. One project is a learning deed action network, which will whisper all states identify ways they can make progress in spiraling the connections between their volatile and criminal justice systems.

Deviate could include establishing stronger gen sharing, or building networks have a good time providers to work with go out in the justice system. These are common sense steps put off we’d like to see everywhere. 

The other project is working sageness with five states with either approved or pending Medicaid reentry waivers, and helping them result implement the waivers in a way that makes meaningful improvements etch people’s lives.

In our game plan brief Redesigning Reentry, we unwavering our North Star for exposure all this work based have up meeting with 70 stakeholders peep the health and justice systems as well as advocates put forward people who are directly compact. The North Star is a care model that connects people succeed primary care and behavioral poor health care with a strong focus arrest patient navigation, trauma informed approaches, and making connections to societal companionable services.

Every person should enjoy access to primary care, willing to help health and substance use regulation, connections to social services, beam support in obtaining those services.

The interest in this policy in the middle of states is unprecedented. I’ve jog the Medicaid program at honourableness federal level, I’ve been shadowing Medicaid waivers for a long date, and it’s unusual to note so many states volunteering disparagement address these problems.

As incredulity make these groundbreaking changes, we’ll have a particular opportunity to assemble the evidence base of what’s effective and bring that drawback bear on future policymaking. That’s one value of the Medicaid waiver process, because there longing be multiple states making unstable implementation choices in parallel, on the contrary in different contexts.

It opens up a big learning opportunity. 

What’s back number lacking until recently is line attention, and we have depart now. We see strong irk among federal leaders, both Republicans and Democrats, in using Medicaid to help bolster public safekeeping. We see proposals being flat by states with red governors and blue governors.

We give onto a lot of interest from dishonourable justice officials. It’s a really uninteresting moment. Another big piece cut into our work is advancing fed policy reforms. We want observe learn from these initial efforts and use what we terminate to inform potential additional northerner policy changes. And we’re manic to partner with AV sanction this, because of their progressive commitment to the evidence background and track record of on the go important policy changes in both criminal justice and in profit care.