How to make the Affordable Care Act

How to
make the
Care Act
work for you
• Who makes up the pre-adjudicated population?
• How will the ACA affect this population?
• Clients/inmates responsibility to engage in health
care decisions
• Providers responsibility to engage clients/inmates in
health care decisions
• How to use technology to make these links
• Overview of benefits of the ACA for both clients and
• Closing thoughts
Who makes up the pre-adjudicated
• Largely male, people of color
and poor
• People are often at their sickest
when detained
• 80% of detained individuals
with chronic illnesses have not
received the treatment they
need in the community prior to
their arrest
• High chronic care needs which
include medical, mental health
and addiction
Population Statistics
• 11.7 million annually cycle though local jails
• 4.7 million on community supervision through
probation and parole
• Historically, vast majority of clients/inmates
who leave correctional facilities (jail, state,
federal prison) leave without health insurance
• Justice system has become the new “mental
health” facility due to lack of resources for
treatment in the community
Treatment Advocacy Center Statistics
People with Serious
Mental Illness
• Jails and Prisons
• Mental Hospitals
Substance Abuse
Substance Abuse and
Mental Health Services
Administration (SAMHSA)
22 million Americans need
substance abuse
1.6 million will receive
How will ACA affect this population?
• ACA is the biggest
change to our health
care system in 50 years
• Opens a door between
health care and criminal
justice systems
• Requires all criminal
justice systems to learn
about health care,
including probation and
parole departments
• ACA provides opportunities
for payment for treatment in
mental health and substance
abuse treatment programs
• Pays for prenatal care
• Pays for preventive care
• Pays for prescriptions
• Provides protection for
people with pre-existing
health conditions—no denials
• **Savings when sending
someone to the hospital past
24 hours/Medicaid eligible**
Clients/Inmates responsibility in health
care decisions
• Clients/Inmates oftentimes do
not have a history of talking
with providers about their
health care needs
• Some have no history in their
families of going to a health
care provider except during
times of crisis or births
• Taking care of their health care
needs isn’t part of their
• Often see the provider in the
jail/prison as their PC provider
• Clients often have added
incentives to not be
honest with a provider
(want prescriptions)
• Difficult time
communicating with
providers because of their
mental illness
• Clients are used to not
being believed when
sharing their health care
• They are used to
demanding that they
receive care
How to help clients/inmates talk to
health care providers
• Talk with clients about the ACA
• What’s in it for them
• Walk through the process; making an
appointment, showing up on time for the
appointment, having all paperwork needed for
the intake process
• Advocate for yourself, don’t let them brush you
• Follow up with the treatment care plan
• Fill and take your prescriptions as prescribed
Providers’ responsibility in providing
health care to this population
• Understand the population isn’t
used to receiving care except
on an emergency basis
• Complex health care needs;
often co; and tri-morbid
• Learn about mental health and
• If you’re going to treat this
population on an ongoing basis
provide an environment for
them that is welcoming (get
better outcomes)
Providers in the Criminal Justice system
need to make referrals to outside agencies
• Don’t wait for Primary
Care Providers to call
• Give outside Providers
tours of the institution
• Let them know what you
do in the jail/prison
• Co-locate staff
• Grand Rounds
• Conferences
Electronic Linkages
• Google map
• Discharge paperwork to client
• Referral paperwork to
providers; use their forms
• Enroll clients in the ACA,
complete necessary tests,
labs before the client is
• Use the Electronic Medical
Record to your advantage
• Use mid-level health care
staff to help client’s navigate
the system
Benefits of the ACA for clients
• Treatment of chronic care
conditions (substance abuse,
mental health, medical issues)
• A chance to address the issues
that contribute to arrest and
• Opportunities to make long
term changes in their behavior
which benefits themselves and
future generations
Benefits to Health Care Providers
• Providers want to be able to
address client’s health care
needs. Clients with insurance
have the ability to follow
through with treatment care
• Cuts the cost of health care,
use that money to build back
the staff that have been lost
due to reductions that have
been necessary to pay for
health care costs
Benefits to the criminal justice system
• Clients/inmates in the jail will
have fewer high cost health
care needs, keeps health care
costs lower
• Addresses some of the core
issues around criminal
communities safer
• Jail/prison—meet their
missions again, no longer de
facto mental health agencies
Closing Thoughts
• The ACA saves money!
• It will take time to change the way clients
in the criminal justice system relate to
their health care providers
• It will take time for health care agencies
to adjust to working with the criminal
justice population
Thank you
Nancy Griffith
Director of Corrections Health
Multnomah County Health Department
Portland, OR 97204
[email protected]
Office number: 503.988.5821
Cell number: 503.260.4080