State Strategies for Establishing Connections to Health Care for Justice-Involved Populations: The Central Role of Medicaid.

Issue: With many states expanding Medicaid eligibility, individuals leaving jail or prison are now often able to enroll in health coverage upon release. It is increasingly clear, however, that coverage alone is insufficient to address the often complex health and social needs of people who cycle between costly hospital and jail stays. Goals: To identify emerging trends in the care delivery models that state Medicaid programs use for former inmates. Methods: Literature review and interviews with state officials, plans, and providers. Key Findings: The care delivery models for individuals leaving jail or prison provide comprehensive primary care, typically including: data exchange to ensure providers are notified when someone is leaving jail or prison; "in-reach" to help inmates establish a relationship with a primary care provider prior to release, identify health conditions, and set up community-based care; strategies for addressing housing issues and other social determinants of health; use of a peer-support specialist who has experienced incarceration; and specialized training for primary care providers and specialists who work with the formerly incarcerated. Conclusion: With a foundation of insurance coverage, states have developed a range of promising, replicable approaches to providing care to people leaving jail or prison.

Improving coverage for children under health reform will require maintaining current eligibility standards for Medicaid and CHIP.

When the Affordable Care Act of 2010 is fully implemented, it will extend health insurance coverage to many adult Americans who currently lack it. It is not known, however, how the health reform legislation will affect children and parents who would otherwise be uninsured. Based on our analysis, the Affordable Care Act has the potential to cut the number of uninsured children by about 40 percent, from 7.4 million to 4.2 million, and the number of uninsured parents by almost 50 percent, from 12.7 million to 6.6 million. However, the actual impact will depend on increasing the share of children and parents who are enrolled in public coverage and on other implementation outcomes. Most strikingly, if the requirement that states continue their Medicaid and Children's Health Insurance Program (CHIP) coverage is rescinded and if Congress does not continue funding CHIP, the uninsurance rate of children could more than double, increasing from 4.2 million to 7.9-9.1 million children. In that case, the uninsurance rate among children would be higher than if the Affordable Care Act had not been adopted.

How federal implementation choices can maximize the impact of CHIPRA on health care of children with developmental and behavioral needs.

Regardless of the ultimate outcome of health reform, the Children's Health Insurance Program Reauthorization Act of 2009 set the stage for the potential to transform children's health care in the United States. The legislation included landmark provisions to find and enroll eligible low income children, as well as an unprecedented investment in quality measurement and demonstrations focused on improving health care delivery for children. However, many choices remain for the Federal government and states in implementing these provisions that could significantly affect their ultimate success. This commentary summarizes a larger report developed from legislative analysis and expert input and provides a set of recommendations for the federal government officials charged with implementing Children's Health Insurance Program Reauthorization Act. It focuses on two key provisions of the legislation which will be important regardless of the outcome of current health reform debates, enrollment and outreach and the broad set of quality related provisions, and explores the importance and specific potential impact of this legislation on children with developmental and behavioral needs.

Medicaid at the ten-year anniversary of SCHIP: looking back and moving forward.

The adoption of the State Children's Health Insurance Program (SCHIP) in 1997 spurred widespread efforts to simplify and revitalize Medicaid coverage for children. To an extent often not recognized, these Medicaid improvements were a key factor behind much of the progress that has been made in covering low-income children: These children's uninsurance rate dropped from 22.3 percent in 1997 to 14.9 percent in 2005, and more than 70 percent of those gains can be attributed to Medicaid. The program, however, faces a number of issues that will need to be addressed if the country is to continue to make progress.

Millions of mothers lack health insurance coverage in the United States. Most uninsured mothers lack access both to employer-based coverage and to publicly subsidized health insurance.

Some 5.9 million American mothers caring for young or school-aged children lack health insurance. Although nearly nine in ten uninsured mothers are members of working families, most lack access to affordable coverage through their job or a spouse's job. Most are ineligible for publicly subsidized coverage unless their incomes are far below the poverty line. The millions of uninsured mothers are at high risk of going without needed preventive and primary care. If they become seriously ill, their families can face the prospect of a financial crisis. The nation has made significant progress in extending health care coverage to children in low-income families through Medicaid and the State Children's Health Insurance Program (SCHIP), but no comparable effort has been made to insure the mothers of these children. A few states have started to address the problem by transforming their SCHIPs into family-based programs that also cover low-income parents. Bipartisan legislation under consideration, known as FamilyCare, would encourage this trend by providing more federal funding to states that could be used to extend health insurance to the parents of children already covered by publicly funded programs.