What issues does this tool address?

Significant numbers of people with serious mental illnesses are admitted to U.S. jails and prisons each year,^[1] and many of them may be eligible for federal benefits or entitlement programs such as Medicaid and Supplemental Security Income and Social Security Disability Insurance (SSI/SSDI) upon release from jail or prison. For example, preliminary results from one study in Oklahoma indicated that 63 percent of inmates entering Oklahoma Department of Corrections facilities were not enrolled in Medicaid but were probably eligible, while 15 percent of these inmates were Medicaid enrolled upon entry into the DOC.^[2]

Enrollment in these programs can improve access to mental health and other services and supports which, in turn, facilitates compliance with conditions of release, thus increasing public safety and reducing spending on jails and prisons. Although studies and anecdotal reports highlight the important role benefits serve in promoting continuity of care, few individuals with serious mental illness receive such entitlements promptly upon release from jail or prison, if at all.

In many cases, case managers working with correctional facilities lack resources to assist individuals with serious mental illnesses in applying for benefits or reinstating eligibility. Further complicating matters, jail and prison administrators and other officials may be unsure how to initiate better discharge planning processes in light of complicated federal and state regulations that govern how incarceration affects Medicaid and SSI/SSDI eligibility. This tool addresses these issues by highlighting four key elements of connecting individuals to benefits: eligibility, documentation, applications, and continuity of care. Within each "key," related policies are recommended along with state examples and relevant background information.

Why focus on Medicaid/SSI/SSDI?

This tool recommends policies related to Medicaid and SSI/SSDI benefit access because both are major pathways through which individuals with mental illness returning from jail and prison can access health care, housing, and other essential supports. In addition, while limited research has evaluated the impact of benefits access on recidivism and re-arrest rates, anecdotal information and smaller scale studies indicate that such access can play a crucial role in promoting public safety (see Justice Center publication, How and Why Medicaid Matters for People with Serious Mental Illness Released from Jail for further details).

To be sure, other types of benefit programs, such as food stamps or housing vouchers, may be extremely important to an individual's successful reentry into the community. For more information on other types of benefit programs and how incarceration affects previous or current eligibility, see the Justice Center federal benefits chart.

What is the scope of this tool?

The recommendations in this tool are intended to help corrections directors, human services and social security officials, and other representatives overseeing policy decisions that affect individuals with mental illnesses returning from the criminal justice system review policy recommendations in four key focus areas: eligibility, documentation, applications, and continuity of care. With this goal in mind, the recommendations should ideally be reviewed and ultimately implemented by interagency groups with representatives from corrections departments state agencies overseeing Medicaid and mental health, and local and regional Social Security offices.

Finally, this tool outlines policies that are relevant to individuals with serious mental illness in jail or prison who may be eligible for SSI/SSDI and Medicaid upon release. However, given the time and logistics involved in coordinating applications for these benefit programs, the information in this tool is less relevant to situations involving individuals who are incarcerated for less than six weeks, individuals being transferred between jails and prisons, individuals being transferred between state and federal prison systems, and individuals being detained for immigration issues.