This Could Help Us Reduce Crime. Is Shasta County Ready to Do It?

The goal of our criminal justice system and jail, in particular, should be to protect us from those who are likely to be dangerous and reduce the likelihood that convicted criminals will commit crimes again. One of the key ways to reduce inmates’ likelihood of reoffending is to help them make a successful transition back into the community.

We know inmates experience health challenges at higher rates than the rest of the community. A study from 2011 found the following health conditions present in California’s prison population:

  • Physical: 18% hypertension, 14% asthma, 13% hepatitis, and 9% a sexually transmitted disease
  • Mental: 19% depression, 8% anxiety, 10% mania, 6% PTSD, 6% schizophrenia
  • Behavioral: 58% drug abuse or dependence

As of 2019, over half of Shasta County’s jail inmates had an active mental health case – which was significantly above the state median of 33%. Almost 20% were receiving psychotropic medications.

While someone is in county jail, the county provides health care to the individual – but what happens when they leave? An estimated 80% of those exiting jail are eligible for Medi-Cal, but many experience a lapse in coverage when they leave jail because it can take them weeks to re-enroll, if they do at all.

What happens as a result of this lapse in coverage and care? Many experience severe health problems or mental health episodes, making them much more likely to commit crimes again. A study in Washington found that 1 in 12 inmates were hospitalized for an acute condition within 90 days of release.

California is taking steps to address this by allowing inmates to enroll in and receive care via Medi-Cal 90 days before release (known as the CalAIM 1115 Demonstration). Up to 4 counties will begin this initiative as early as this October. All counties will have to implement this by September 2026.

The state has given counties ~$69M since 2022 to prepare to implement this initiative and others like it.

Shasta County has received $0.

The purple counties below have received these funds:

Who is eligible for Medi-Cal in the 1115 Demonstration?

Incarcerated individuals must meet the following criteria to receive in-reach services:

Be part of a Medicaid or CHIP Eligibility Group, and meet one of the following healthcare need criteria:

  • Mental Illness
  • Substance Use Disorder (SUD)
  • Chronic Condition/Significant Clinical Condition
  • Intellectual or Developmental Disability (I/DD)
  • Traumatic Brain Injury
  • Pregnant or Postpartum 

Note: All Medi-Cal/CHIP-eligible youth incarcerated at a youth correctional facility are eligible to receive pre-release services and do not need to demonstrate a health care need.

What services can they receive via Medi-Cal through the 1115 Demonstration Initiative?

  • Reentry case management services;
  • Physical and behavioral health clinical consultation services provided through telehealth or in-person, as needed, to diagnose health conditions, provide treatment, as appropriate, and support pre-release case managers’ development of a post-release treatment plan and discharge planning; 
  • Laboratory and radiology services; 
  • Medications and medication administration;
  • Medication-assisted treatment/medications for addiction treatment (MAT), for all Food and Drug Administration-approved medications, including coverage for counseling; and
  • Services provided by community health workers with lived experience.

In addition to the pre-release services specified above, qualifying individuals will also receive covered outpatient prescribed medications and over-the-counter drugs (a minimum 30-day supply as clinically appropriate, consistent with the approved Medicaid State Plan) and durable medical equipment (DME) upon release, consistent with approved state plan coverage authority and policy.

How could this save Shasta County money?

Medical costs for inmates are one of the leading costs of incarcerating individuals. The chart below shows that California prisons spend 32% of the total cost on health care.

While county jails may spend a bit less, it is likely to be a leading cost as well. I'll need to do further exploration to understand how inmate healthcare costs are funded, but if it comes from the County General Fund, as most public safety funds do, then shifting healthcare costs to Medi-Cal could save the county money during the last 90 days of incarceration in addition to providing better outcomes.

If Shasta County wants to begin this initiative, the soonest it could is January 2025 - and we’d have to apply by July. But since we haven’t received any of this funding, could we even be ready that soon?

I hope so and I plan to find out. If we want to reduce crime, slash our need for more jail space, stop overwhelming our emergency rooms, reduce homelessness, and improve the health of our people, we need to be among the first counties to implement programs like these, not the last.

Maybe there are facts about this initiative I’m missing that make it a poor fit for Shasta County or maybe we’re further along than it seems? If so, please let me know.

Update as of May 1, 2024:

The County doesn’t discontinue an inmate’s Medi-Cal services; it suspends the services temporarily, allowing them to reinstate those services upon release. Inmates can also request reinstatement pre-release, but currently, Medi-Cal won’t cover any services pre-release. (Thanks to the HHSA staff member who clarified this for me!)

Both Probation and the Sheriff’s Office received this funding in the 3rd round and are developing plans to implement this program. Probation expects to submit its plan this summer so that it could begin this program for youth as early as January 2025, pending state approval. This is good news! I think the Sheriff’s Office is planning for implementation in 2026, but I need to confirm this.