SALT LAKE CITY — On the heels of proposed prison reforms by the Utah Commission on Criminal and Juvenile Justice, stakeholders met on Wednesday to discuss avenues to get incarcerated Utahns the mental and medical care they need upon release.
The idea is that if offenders get the treatment they need, when they need it most, it can have lasting impacts, resulting in potentially lower recidivism rates.
"We are starting to figure out who we can get enrolled," said Dan Chesnut, an administrator with the Utah Department of Corrections. He said better collaboration between the judicial system, insurance providers and mental health practitioners will help to influence more change in the long run.
"The impact is going to be huge," he said, adding that people will likely become better associated with their communities if Gov. Gary Herbert's Healthy Utah plan — an alternative to Medicaid expansion that aims to ensure more of Utah's uninsured population — is approved.
"They will become pro-social and feel like they are part of a community that has an interest in their well-being," Chesnut told a group of federal, state, county and city corrections workers, as well as behavioral health providers, health plans and Department of Workforce Services employees.
The Healthy Utah plan, which will be discussed in more detail during Thursday's meeting of the Health Reform Task Force, intends to give health care access to people who fall into a "coverage gap," meaning they are too poor to afford health insurance on their own and are not poor enough to qualify for subsidies through the federal health care marketplace.
Utah's jailed population is not eligible for Medicaid, as current policy terminates a person's benefits upon incarceration. Stakeholders, as discussed Wednesday, may seek a change in policy in the upcoming legislative session. At least 12 other states exercise a suspension of benefits, rather than termination, so that benefits can pick up again and be effective for offenders upon their release. The provision would allow quicker access to necessary mental and behavioral health services.
Rick Schwermer, state drug court coordinator, said that 80 percent of people who come through the Utah court system "have some sort of behavioral health need."
"It used to be that judges acted as referees, calling the shots and more and more, they are becoming coaches with an invested interest in the outcome of the case in front of them," he said, adding that drug court justices are limited in how they handle cases because of the limited availability of treatment slots.
Approximately 93 percent of people in drug courts, Schwermer said, quoting an ongoing survey of services, would be eligible for medical and mental health benefits under the governor's proposed plan.
"The impact would be enormous within the criminal justice system," he said.
Health benefits available under the Healthy Utah plan would be required to contain the 10 essential benefits, which include access to mental health care, as dictated by the Affordable Care Act. Proponents believe utilizing Medicaid/taxpayer dollars in a different way would ultimately be beneficial to Utah, resulting in fewer unnecessary incarcerations.
"People could be treated when they want to be treated, when they need to be treated, soon after release from prison and before they turn to another behavior," said Adam Cohen, CEO at Odyssey House, a residential treatment facility that hosts various drug and alcohol recovery programs. He said there are still some facets of coverage that need to be ironed out to make for a more seamless transition from jail to treatment homes, and from there to community living.
Other issues could also help with better delivery of services, such as changes to what judges dictate about care, according to Dr. Scott Whittle, a psychiatrist who also works at SelectHealth.
"People who have been living without health care don't really know how to use it," he said, adding it takes about two years for people to become comfortable using their own health benefits. Whittle said certain barriers need to be reduced to enable easier access.
Provisions of the Healthy Utah plan have yet to be worked out and while the ultimate decision on implementation lies with the governor, Herbert has said he would let state lawmakers hash it out first.
Utah is one of only a handful of states that has not taken action set forth by the Affordable Care Act to either expand or not expand Medicaid, which leaves tens of thousands uninsured and millions of federal dollars on the table.
The governor and state health officials have been working with federal offices to procure what has been called a "Utah solution," unique to Utah's needs.
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