Opportunities Presented by the Affordable Care Act for Criminal Justice Reform: Spotlight San Diego County

Over 60,000 individuals pass through San Diego County jails annually, and 90 percent have no health insurance when they are released. With the expansion of Medicaid under the Affordable Care Act, the majority of this population is eligible for insurance that includes coverage for mental health and substance use disorder treatment. Recognizing the opportunity, the County of San Diego has brought together stakeholders from various disciplines to ensure an effective system to enroll people who come into contact with the criminal justice system into healthcare coverage. At the time of this abstract, applications from justice-involved populations in San Diego total over 1,800 and rising.

With expanded coverage for mental health and substance use disorder treatment, the ACA shifts the treatment of these conditions from a criminal justice approach to one of public health. Opportunities exist to infuse health in criminal justice policy and assure people are connected to needed health interventions, including appropriate alternatives to custody.

This presentation will detail efforts in San Diego County to enroll justice-involved people into health coverage, both pre- and post-release. The presenter will describe the different stakeholders involved in San Diego to inspire advocates to form similar partnerships in other jurisdictions. For non-Medicaid expansion states, the presenter will explain the public safety argument for expansion and strategies to engage non-traditional allies for support of Medicaid expansion. The presenter will discuss how to maximize the ACA to shift treatment of mental health and drug use away from the criminal justice system and towards public health.