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As a North Carolina business leader, I endorse the following statement:

We, as North Carolina business leaders, understand that a strong economy and a thriving workforce require healthy families. Right now, too many hard-working families are uninsured. In fact, about two-thirds of all uninsured adults in North Carolina work. They are construction workers, farmers, child care providers, and even veterans. We urge the North Carolina General Assembly to achieve a bi-partisan solution to close the health insurance coverage gap. Now is the time to act. There are proposals on the table that would require no investment of state tax dollars and closing the gap would create an estimated 37,000 jobs and billions in economic activity. Much of this economic activity would benefit our rural communities and other areas most in need of an economic boost. Closing the health insurance coverage gap is a good deal for the health of North Carolina families and for our economy. We urge you to work together and achieve a policy solution that closes the health insurance coverage gap.

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Closing Coverage Gaps to Promote Successful Prison Re-entry for Persons with Mental Illness

November 17, 2020 by Hailey Gutzmer Leave a Comment

By Marvin Swartz, MD

The United States has the largest prison population in the world, with over 2.3 million people incarcerated. It is estimated that 8% to 20% of the prison population has a severe mental illness   and persons with mental illness are three times more likely to be incarcerated, compared with the general population. One key element of successful re-entry of incarcerated persons with severe mental illness is ongoing mental health treatment after release. But how to pay for needed treatment, including sometimes expensive medications?

Almost all incarcerated persons with severe mental illness depend on Medicaid coverage or by unreimbursed charity care if uninsured. Medicaid coverage is usually be suspended after only a   month in jail or prison. After 12 months of suspension, coverage can be completely terminated. According to a recent survey two-thirds of the states terminate Medicaid benefits and about one-fifth suspend benefits after 12 months. Given that the average duration of a prison sentence is over 2 years, most prison inmates have either lost or been suspended from Medicaid before they are released.

Enrollment in some form of health insurance upon release is crucial for access to effective care. Several states have initiated successful programs to expedite enrollment or re-enrollment of persons eligible for Medicaid on their release and follow up studies have shown a marked uptick in access to treatment as a result. 

North Carolina has two distinct opportunities to close coverage gaps on re-entry. One is to launch a state-wide program to expedite Medicaid re-enrollment and assist previously eligible unenrolled persons to enroll in Medicaid upon leaving prison. Some North Carolina counties have made a start on this, but a state-wide program is needed. In a growing number of states case managers are deployed to reach into prisons to assist in this process. 

The second major opportunity would come with Medicaid expansion. States that have expanded Medicaid to adults with incomes below 138 percent of the federal poverty level, have created a significant opportunity to provide coverage to people after their release from jail or prison.  A recent study estimated that with the implementation of health reform, up to 33.6 percent of inmates released annually could enroll in Medicaid. 

The revolving door for justice-involved persons with severe mental illness is pernicious. North Carolina could make great strides in closing the revolving door by closing these coverage gaps.

[Marvin S. Swartz, M.D., is Professor in the Department of Psychiatry and Behavioral Sciences at Duke and a Faculty Member at the Wilson Center for Science and Justice at the Duke School of Law. Dr. Swartz has been extensively involved in research and policy issues related to the organization and care of mentally ill individuals at the state and national level.]  

Category iconUpdates Tag iconCoverage Gap,  Criminal Justice,  Mental Health / Substance Abuse

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Phone: (919) 710-0220
Email: care4carolina@gmail.com

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