HomeMy WebLinkAboutAgenda 10-03-23; 8-j - Resolution Supporting Medicaid Availability Prior to Re-Entry for Incarcerated Individuals 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: October 3, 2023
Action Agenda
Item No. 8-j
SUBJECT: Resolution Supporting Medicaid Availability Prior to Re-Entry for Incarcerated
Individuals
DEPARTMENT: Criminal Justice Resource
ATTACHMENT(S): INFORMATION CONTACT:
Resolution Commissioner Phyllis Portie-Ascott, 919-
245-2130
Caitlin Fenhagen, 919-245-2303
PURPOSE: To approve a resolution supporting federal legislation and policy reform currently
under consideration that would allow individuals who are incarcerated to access Medicaid prior to
release from prison or jail.
BACKGROUND: Commissioner Phyllis Portie-Ascott recently attended the National Association
of Counties (NACo) and North Carolina Association of County Commissioners (NCACC) meetings
and learned about pending federal legislation and a policy change that would positively impact
residents of Orange County. Commissioner Portie-Ascott shared information at the Board's
September 5, 2023 Business meeting and petitioned for the Board to consider a resolution
supporting the proposed federal legislation and policy change.
The Medicaid Inmate Exclusion Act currently prohibits individuals from receiving Medicaid funding
for services while they are incarcerated. This gap in coverage leaves individuals re-entering the
community from incarceration at high risk for dangerous health outcomes and death. In addition
to dangerous health outcomes, this policy has led to more overdoses, less safety, increased
healthcare costs and higher recidivism.
There are two current pieces of legislation in the US Congress that would address this gap in
services to very vulnerable individuals in need of health care and support services. The Reentry
Act (HR 2400/S 1165) proposes allowing Medicaid payments for medical services provided to
individuals incarcerated in prisons and jails at 30 days prior to their release. The Due Process of
Continuity Act (HR 3074/S 971) amends the Medicaid Inmate Exclusion Policy to allow for
Medicaid coverage of health services for pre-trial detainees.
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Additionally, the NC Department of Health and Human Services is currently seeking federal
authority through the Medicaid Reform Section 1115 Demonstration Renewal Request to provide
targeted pre-release Medicaid services to incarcerated individuals within 90 days of their release.
The proposed federal legislation and the policy change request would dramatically improve
healthier outcomes for the formerly-incarcerated by reducing disparities and improving care
coordination and harm reduction strategies prior to and immediately upon re-entry.
Orange County has a long, demonstrated commitment to reducing barriers to re-entry and
supporting individuals returning to the community. Support for the legislation and policy change
is aligned with the County's health and racial equity goals, as well as its social justice goals.
FINANCIAL IMPACT: There is no financial impact associated with consideration of the
resolution.
SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable
to this item:
• GOAL: FOSTER A COMMUNITY CULTURE THAT REJECTS OPPRESSION AND
INEQUITY
The fair treatment and meaningful involvement of all people regardless of race or color;
religious or philosophical beliefs; sex, gender or sexual orientation; national origin or ethnic
background; age; military service; disability; and familial, residential or economic status.
• GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY
The creation and preservation of infrastructure, policies, programs and funding necessary
for residents to provide shelter, food, clothing and medical care for themselves and their
dependents.
• GOAL: CREATE A SAFE COMMUNITY
The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang
activity, substance use and domestic violence.
ENVIRONMENTAL IMPACT: There are no Orange County Environmental Responsibility Goal
impacts associated with this item at this time.
RECOMMENDATION(S): The Manager recommends that the Board approve and authorize the
Chair to sign the attached resolution. If adopted, the Manager further recommends that the Board
direct the Clerk to the Board to send a copy of the resolution to:
• US Representative Valerie P. Foushee;
• US Senator Thom Tillis;
• US Senator Ted Budd;
• the members of Orange County's legislative delegation — Senator Graig Meyer,
Representative Allen Buansi and Representative Renee Price;
• North Carolina Department of Health and Human Services Secretary Kody H. Kinsley; and
• The Towns of Hillsborough, Carrboro and Chapel Hill.
RES-2023-065 3
ORANGE COUNTY BOARD OF COMMISSIONERS
RESOLUTION SUPPORTING MEDICAID AVAILABILITY PRIOR TO RE-ENTRY FOR
INCARCERATED INDIVIDUALS
Whereas, Orange County seeks to improve the health and well-being for all North
Carolinians, and for Orange County residents in particular, and this commitment includes
advancing health access by reducing disparities for historically marginalized populations;
and
Whereas, Orange County has a demonstrated commitment to incarcerated individuals
and their successful re-entry back into the community. The Orange County Local Reentry
Council (LRC) has been in operation since 2018 through the Criminal Justice Resource
Department with two County positions managing the LRC and supporting Orange County
residents returning to the community from incarceration. In addition, two community
health workers are employed in the Orange County Health Department with the Formerly
Incarcerated Transitions (FIT) program supporting people re-entering with chronic health
issues; and
Whereas, Orange County has a long history of seeking to reduce barriers to re-entry from
prior incarceration in areas such as employment, housing, transportation, harm reduction
and health care; and
Whereas, formerly-incarcerated individuals, who are disproportionately people of color,
are at a higher risk for poor health outcomes, injury, overdose and death than other
community members. These individuals are particularly vulnerable during the period
immediately following release from a correctional institution. Over half of all people in
state prisons and two thirds of individuals in jails have a substance use disorder, 30%
have identified physical health needs and 50% have other mental health needs.
Significantly, individuals leaving incarceration are 40 times more likely to die of a drug
overdose in the first two weeks of release than the general population; and
Whereas, due to restrictions in federal Medicaid law, states have historically been unable
to draw down Medicaid funding to provide health care services to individuals when they
are incarcerated (known as the "Medicaid inmate exclusion"). This creates a serious
coverage gap when individuals are released and severely impacts health, stability and
recidivism; and
Whereas, vital legislation and policy reform is being considered in the United States
Congress and efforts underway at the NC Department of Health and Human Services
(NCDHHS) to address this Medicaid exclusion. The Reentry Act (HR 2400/S 1165)
proposes allowing Medicaid payments for medical services provided to individuals
incarcerated in prisons and jails at 30 days prior to their release. The Due Process
Continuity of Care Act (HR 3074/ S 971) amends the Medicaid Inmate Exclusion Policy
to allow for Medicaid coverage of health services for pre-trial detainees and provides $50
million in planning grants to states. Finally, NCDHHS is seeking federal authority through
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the Medicaid Reform Section 1115 Demonstration Renewal Request to provide targeted
pre-release Medicaid services within the 90-day period prior to release from correctional
settings. The services include case management, medication assisted treatment and a
30-day minimum supply of medication at release;
NOW THEREFORE BE IT RESOLVED, that the Orange County Board of Commissioners
hereby strongly supports these state and federal efforts to improve access to critical
medical and behavioral health care through Medicaid funding to individuals near release
from incarceration; and
BE IT FURTHER RESOLVED, that the Orange County Board of Commissioners believes
Medicaid eligibility prior to re-entry will advance health access by reducing disparities and
improve care coordination for historically marginalized populations. This will make our
County safer, healthier and more equitable.
This the 3rd Day of October 2023.
Jamezetta Bedford, Chair
Orange County Board of Commissioners