The Essential Role of Medicaid and Criminal Justice

This past month America’s first mental health court celebrated its 20th anniversary. The behind the scenes story, which led to the creation of Broward’s Mental Health Court, is a case-study of the need to preserve and expand Medicaid from a criminal justice perspective; and what happens when people in need of mental health and primary care are left behind. Aaron Wynn, a young man living in South Florida, was preparing to leave for college. According to his family, Aaron loved the ocean, his friends and playing sports. In the spring of 1989, he was struck by a car while riding his motorcycle. He sustained serious injuries. The most profound was the traumatic brain injury he endured which changed the course of his life and that of his family. For years, his parents pled for mental health care for their son. Aaron’s condition continued to deteriorate. He lost his memory and was unable to regulate his behavior. His family lived-in terror, waiting for crisis. Crisis occurred when Aaron was arrested after an argument with a police officer, and an Order by a judge to commit Aaron to a forensic hospital for competency restoration. According to expert legal testimony, Aaron spent over two and a half years in seclusion and restraint in a Florida Forensic Hospital. When he was released in 1991, his mental illness had worsened. Aaron was discharged from the forensic hospital with no linkage to community-based residential treatment and services.

In 1993, while experiencing a psychotic episode in a South Florida grocery store. Aaron darted out of the store, and tragically collided with an 85-year old woman, who hit her head on the pavement and died from her injuries sustained in the fall. Aaron was charged with murder. As noted by PBS/Frontline, Aaron Wynn became the catalyst for a new system of therapeutic justice for people with mental illness. Broward County’s Mental Health Court, was an outgrowth of a 1994 Grand Jury Investigation and relies on Medicaid to coordinate and oversee the mental health treatment, services and care for the majority of court participants.

Problem-solving courts, such as drug courts, mental health courts, veterans courts, and hybrid behavioral health courts are collaborative, inter-disciplinary and voluntary. Treatment courts exist on the juvenile and adult levels of the court system. These solution-focused courts are designed to address vexing social problems. The court, takes aim at social determinants which can be “root cause drivers” and the intersections between poverty, trauma, adverse childhood experiences and disparities in race, health and education. From a criminal and juvenile justice perspective, the role of Medicaid is inextricably connected to community restoration, public safety and the promotion of public health.

According to The Henry J. Kaiser Foundation’s report on health coverage for justice-involved adults, “there are an estimated 2.3 million adults incarcerated in jail or prison, but millions more are being supervised in the community under some form of community supervision.” Data reveals, that people entering and being released from county jails do not have health insurance and have significant unmet physical and mental health needs. According to the research, over half of prison and jail inmates have a mental health disorder, with 64% of local jail inmates having the highest prevalence of mental health disorders. In addition, the justice-involved population has a high prevalence of chronic diseases (such as HIV/AIDS, tuberculosis, and hepatitis B and C.) The role of Medicaid as the financial means for these individuals to access health care cannot be over-stated. For example, according to RAND, “the need for the State of California and other states to leverage Medicaid Expansion, “is critical to address the public health challenges of returning ex-prisoners to the community… and the needs of their children.”

As to justice-involved youth, according to The Kaiser Foundation’s Issue Brief on health coverage for youth in the juvenile justice system, the majority of youth entering the juvenile justice system are placed on some form of community probation depending on the seriousness of the offense and other factors. As of September 2010, an estimated 70.800 youth were held in juvenile justice residential placement facilities in the U.S. Per national health surveys, a majority of juveniles entering the justice system, including “crossing-over youth” from child welfare, has significant unmet health needs. The health care needs of girls and boys are complex. Many require comprehensive and on-going physical, reproductive, mental and behavioral health services upon their release into the community.

From a criminal justice perspective, Medicaid is inextricably tied to the capacity of the criminal justice system to problem-solve and effectively respond to complex social and public health problems which impact the health and safety of our communities.

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