Building Pathways to Care for Patients with Chronic Medical and Behavioral Health Conditions leaving Cook County Jail

Before the expansion of Medicaid, only one in 10 detainees leaving Cook County Jail had any type of health insurance. Not surprisingly, the remaining 90 percent did not receive significant medical and behavioral health care, with the paradoxical effect of actually increasing costs to local public health systems. Untreated, former detainees are more likely to come into contact with the justice system again, perpetuating a cycle of untreated care and criminal behavior. This environment is changing with new Medicaid and insurance coverage options under the Affordable Care Act, and specifically Cook County’s Medicaid expansion initiated through a federal 1115 waiver to encourage early enrollment for low-income County residents beginning in the spring of 2013. Through a subcontractual arrangement between this Medicaid managed care plan (“CountyCare”) and TASC, a social service agency for the justice–involved, application assistance is now a standard protocol at the Cook County Jail, in County probation, and among certain Cook County specialty courts.

In addition to enrollment in coverage, Cook County advocates have also develop intentional linkage to covered services with the goal of both improving population health and reducing health-related recidivism. Working from the premise that opportunities for broad-scale health and pubic safety improvement can be best realized through systematic medical and social service delivery system investments, this presentation will illustrate the early successes achievable through collaborative planning in a post-ACA environment, discuss the core principles that lay the foundation for this work, and propose specific recommendations that counties can implement to achieve these aims.