National Alliance on Mental Illness
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Getting Health Coverage in the Justice System

Every year, almost 12 million Americans are caught up in the criminal justice system – in jail or prison, out on bond and awaiting trial, or on probation or parole.  The vast majority of these individuals have no health insurance and many have mental health and substance abuse conditions. Starting this fall, the new health care law will make it possible for many people involved in the justice system to get health coverage. Health care for people involved in the justice system can help people stay healthy, get jobs and stay out of trouble with the law.

New Health Law Makes It Easier to Get Insurance

Enrollment in new health insurance starts in Oct. 1, 2013 and the new health law requires most people to have health insurance starting in 2014. The law also makes it easier for people to get coverage they can afford. Low income people will be able to get health coverage through expanded Medicaid programs in many states. Medicaid is a government insurance program that provides coverage for people with low-incomes and disabilities.

If you are not eligible for government insurance, you can buy insurance through marketplaces that will make it easier for consumers to choose an affordable health plan for their needs. The federal government will help pay for coverage for people who can’t afford it.

New Insurance Plans will Cover Mental Illness

New rules are also improving the quality of insurance, so that all insurers will have to provide care for mental health, substance abuse, preventative services and many other vital services. Insurers will also no longer be able to discriminate against people with mental health and substance abuse conditions by denying coverage, charging higher premiums and co-pays or dropping coverage for people with these conditions. Insurers will have to cover everyone fairly.

People in Jail or on Probation or Parole Can Apply for Insurance

Not everyone involved in the justice system is eligible for new health coverage. People in prison generally are provided health care by the prison and are not eligible for insurance. People in jail who have been convicted of crimes are also not eligible.

However, that leaves millions of Americans who are in jail awaiting trial or out on bond who are eligible to apply for health insurance. These individuals have not been convicted of any crime and may be re-entering the community very soon. A small group of people with serious mental illness cycle repeatedly through jails, facing minor charges. The new law makes it possible for these individuals to apply for insurance while they are in jail or while out awaiting trial, so that when they are released they will have the care needed to be successful in their communities. Health care is vital for these individuals to get well and stay out jail.

Millions of Americans on probation and parole also have new opportunities for health coverage. These individuals have served their sentences and can do well in the community with the proper support, including health insurance that helps with mental health and substance abuse care. 

Health Care Now Will Save Money Down the Line

Helping people involved in the justice system get health insurance make sense for everyone:  it will save money down the road by keeping people out of jails and emergency rooms. Health care, especially for mental health and substance abuse, helps people stay well enough to work and build strong family ties.

It Won’t Happen Without Advocacy

The new health law is very complicated, and most states and communities are not entirely sure what role they should play in enrolling people in coverage. The law covers almost all Americans and it is a daunting task to enroll tens of millions of people in coverage. Without advocacy by NAMI State Organizations and Affiliates, your community may miss opportunities to help people living with mental illness who are involved in the justice to get covered. Here are some things your NAMI organization can do:

  • Meet with sheriffs and jail and prison administrators in your community. Educate them about the opportunity for people in jail and prison to apply for coverage while they are incarcerated so that coverage will start sooner after their release. Waiting for people to apply once they are out of jail or prison can mean longer delays in getting the care needed to prevent future crime. Ask what you can do to help jails and prisons people enroll while they are incarcerated.
  • Meet with probation and parole agencies, as well as pretrial services agencies and ask how NAMI can help educate people in these programs about new opportunities for health coverage. Help connect these agencies to the “navigators,” agencies in your state that are responsible for helping people enroll.
  • Meet with county and state health care reform coalitions and volunteer to contribute to efforts to enroll people involved in the justice system.
  • Educate NAMI members and their families about the new opportunities for all uninsured Americans to get health coverage.

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