GPPR Editor Bryna Antonia Cortes (MPM ’23) spoke with Khalil Cumberbatch, national leader and advocate on criminal justice policy, and Vikki Wachino, health care policy champion and former deputy administrator at the Center for Medicare and Medicaid Services (CMS), on the convening of their multi-sector coalition, the Health and Reentry Project (HARP); forthcoming CMS approval for states seeking to offer pre-release services; and the intersection of health and criminal justice systems.
“[T]he sheer amount of people that go in and out of the criminal justice system, but particularly local jails… continues to hover around the same rate, and that’s the same for red states, blue states, purple states, and that’s because there continues to be a lack of inadequate policies that exist on a local level to stop the churn – the sheer introduction of people into the criminal justice system, who don’t necessarily need to be there, because there are underlying conditions either it’s medical or mental health.” – Khalil Cumberbatch
“We know that the re-entry period poses very high risks to people in terms of their health. We see high rates of death, after release. We see high rates of overdose, after release, and we see high rates of emergency room use for a range of conditions. And suddenly there was this opportunity to flip the script.” – Vikki Wachino
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An update as of March 28, 2023:
On January 26, the Centers for Medicare and Medicaid Services (CMS) approved California’s Section 1115 request to cover a package of reentry services for certain groups of incarcerated individuals 90 days prior to release. Learn more.
Bryna Antonia Cortes: Both youth and adults transitioning in and out of prison or jail are at risk to some of the highest health adversities due to a number of issues such as social, economic, and environmental causes. For that reason, you see that most people involved in the justice system also qualify for Medicaid. Since 1965, the Medicaid Inmate Exclusion Policy has barred adults and youth from receiving Medicaid services, and for years, states have recognized the obstruction that this policy causes for youth and adults to receive crucial care. This harms their potential for success in these transitional stages. Thirteen states are currently seeking to minimize these effects through a Section 1115 (eleven-fifteen) waiver – which is the waiver request process for states to the Centers for Medicare and Medicaid Services, or CMS, to adapt Medicaid, Medicare, or CHIP fund use within their state. These waiver requests aim to provide support during the busy transition of pre-release, to improve health outcomes. These state requests are looking to provide services in varying time periods, from 30 to even 90 days before a person is released from jail or prison.
Cortes: To push efforts and provide state and federal guidance on these high-potential, Medicaid policies, the Health and Reentry Project, also known as HARP, was formed, a coalition across sectors, perspectives, and experiences, all driven to support the health of youth and adults as they are leaving prison and jails.
Cortes: I am Bryna Antonia Cortes, a National Urban Fellow in the 2023 MPM class, serving as an interview editor for the Georgetown Public Policy Review. For this episode, I am joined by an advisory member of HARP, Khalil Cumberbatch, who is a national leader and advocate on criminal justice and deportation policy, and is the Director of Strategic Partnerships at the Council for Criminal Justice. We also have HARP’s Executive Director, Vikki Wachino, a dedicated practitioner in advancing health equity through health care policy. She is also a Principal at Viaduct Consulting, and a former deputy administrator for CMS.
Cortes: It is truly a privilege to have you both here with me today. HARP has an advisory committee with an array of backgrounds and experiences, and has had a wide reach with individual interviews and a multi-sector convening, but let’s bring it back and I’d love for you two to share what is HARP and what has been your roles in this effort?
Vikki Wachino: Sure, Bryna. Thank you so much for having me. We created HARP, because for a long time there’s been unrealized potential to help connect people to health care services at re-entry and by doing so improving people’s health, public health, public safety, and helping people as they’re leaving prison and jail return to their communities and families successfully.
Wachino: But historically we’ve done very little to support people in accessing health care as they reenter. Too often, the model is you’re out on the street, and good luck to you. And that’s not a strategy for success. We know that the re-entry period poses very high risks to people in terms of their health. We see high rates of death, after release. We see high rates of overdose, after release, and we see high rates of emergency room use for a range of conditions. And suddenly there was this opportunity to flip the script.
Wachino: Suddenly there was a lot of attention on the part of both federal and state policy leaders in changing the re-entry process for people to help them access health care specifically by having Medicaid start to cover some services before someone is released from prison and jail.
Wachino: A bit of background, there’s very little health insurance in the correctional health care system, and Medicaid, the health insurance program that covers low-income people in the United States, is the dominant insurer of people in the justice system.
Wachino: Because so many people in prison and jail are poor, incarceration correlates highly with poverty. And also – as I expect we’ll talk about –- with race. There’s a case to be made for really expanding Medicaid’s role to better meet the needs of this population. Yet Medicaid has, since it was created, been barred from covering services, when someone is in prison and jail. So even if you’re eligible for Medicaid once you’re incarcerated, Medicaid plays no role for you and that’s part of just a larger siloing of the community health care system from the correctional health care system.
Wachino: Over time there’s been interest in changing that and meeting people’s health needs better and changing Medicaid’s role. And that’s what’s exciting and groundbreaking about this particular moment, for the first time there is very active discussion in some states, and at the federal level, of letting Medicaid cover some services like case management, like medications, before someone is released.
Wachino: This is why we created the Health and Reentry Project. We saw the active discussion about these issues, and we thought it was exciting. But we also thought that there’s a lot at stake in how these decisions get made, and then how they’re carried out. A lot at stake for the millions of people who are in prison and jail and leave it each year; a lot at stake for the communities that are affected by incarceration; and a lot at stake for the systems that will have to carry out these changes. So, we created the Health and Reentry Project to bring those entities, people, and stakeholders together around the table to have a discussion about, how should these changes take place? What is it that people really need to have their health needs met as they are reentering? And how do we make it happen?
Khalil A. Cumberbatch: Thank you again, Bryna for having me on with Vikki to talk about our work on the HARP, but also talk a little bit about the work that the Council on Criminal Justice does.
Cumberbatch: I had the pleasure of serving double duty for this particular project. I work at the Council as a full-time employee. My official title is Director of Strategic Partnerships, and I work to engage our individual membership body as well as our corporate members, and as well as other stakeholders in the field of criminal justice reform around the various different outputs that we put forth as an organization, and in this particular case the Health and Reentry Project.
Cumberbatch: I also got to serve as an advisory member to the HARP. And you know, obviously my experience as a professional in the field of criminal justice reform was one perspective that I brought, but I was really pleased to also talk about my personal experience with incarceration, as well as re-entry, and to talk a little bit about some of the experiences that I had witnessing just the complete lack of health care or structured health care system within the prisons and jails that I served time in, but also to see what it looked like on the outside, when someone exited a prison or a jail, and to really talk about some of the barriers that I saw. And through my first full time job, after I came home, I helped some of the people that I worked with, and as a case manager to help navigate some of those barriers as well. So, I was really happy to be able to lend both of those experiences to the HARP.
Wachino: I’ll just say one thing that really is unusual about HARP is that it’s a partnership. It’s a partnership between me, who spent a lot of time in health care policy; the Council on Criminal Justice, that thinks about advancing better criminal justice policy; and also, Waxman strategies, which is a strategy firm based here in Washington, DC. And then along with that, central to how we carried HARP out, was engaging stakeholders across systems, the health system, the criminal justice system, recognizing that they both have a lot at stake in this new policy. As well as people who are concerned with social justice and people with direct experience of incarceration. Bringing all of those people and stakeholders around a table together, I think, was really essential to establishing a vision of how we’re going to make these changes, and sometimes not all of those perspectives align, but we were really thrilled to have a lot of involvement from a lot of stakeholders. And clearly the input of, as I think you’ll hear more about soon, the input of people like Khalil, with direct experience of incarceration, really helps us establish a north star for implementation of these new policies.
Cortes: I was really impressed when I saw HARP’s roster of committee members: from local and state leaders, criminal justice practitioners, and public health specialists. Bringing together such a wide breadth of stakeholders who all have a unique impact and role supporting people in transition is not an easy task. We often hear so much about polarization and disagreement within the policy realm, it takes immense effort from all members to bridge these connections, facilitate, and ultimately come to mutual agreement on a set of policy recommendations. What are some guidance points you can recommend for building and collaborating with such a large coalition group?
Cumberbatch: Building any coalition is not easy, especially when you’re building one where one of your main principles is to ensure that there is a wide gamut of experiences. And so, the HARP, when being convened, obviously, we wanted to continue that practice. We wanted to ensure that we had people who worked in the medical field, people who worked as policymakers, people who worked in corrections, people who were law enforcement officials. We even had the Lieutenant Governor of the State of Illinois as a member, and of course, to listen to people who were directly impacted. And so, that is always a challenge.
Cumberbatch: One of the things that I think continuously pleases me, and is always something to admire, is people come to this work from various different angles, but generally people come to this issue, particularly around criminal justice and criminal justice reform – in this case the intersection of health and re-entry – people generally agree on what the desired outcomes are, which is that we want safer communities, we want a system that is giving people exactly what they need when they need it, and we want them to do it in a just and fair and equitable way.
Cumberbatch: Now, obviously when we’re talking about HARP there were a ton of complexities, because you weren’t only talking about jails and/or prisons, which that in and of itself, is a very complex conversation. We are also talking about the structure and delivery of health care, in general in this country, and which – in and of itself – is also a very complex conversation. But then you’re also talking about Medicaid, and that is a complex apparatus as well. Having someone like Vikki, with her experience helping to guide that, made that a little bit easier. Essentially, we’re talking about three massively complex systems that at the crux of this one issue, health and re-entry, they all overlaid and sometimes stacked on top of each other.
Cumberbatch: When understanding that, and kind of engaging in that endeavor of having a conversation, I think that you know obviously one of the key underlying structures that you want to build a foundation on is just respect. The fact that you know someone’s perspective of a particular issue may be very different.
Cumberbatch: When you see someone who is a sheriff or someone who works in corrections, or someone who works in law enforcement, having a conversation with someone who is formerly incarcerated about re-entry. There are a bunch of assumptions that come with that. But in the end, as I said, people generally come to that conversation wanting the same outcome.
Cumberbatch: Same thing happened here with HARP, which is that we tried to build an advisory group of people who had respect for each other’s experience, both lived and professional. We also tried to have guiding principles of people generally listening to other perspectives, and listening and respecting other perspectives, they don’t always go hand in hand. But in this case, we obviously tried to maintain that.
Cumberbatch: I think it’s important to understand, as a professional, that my professional experience stops somewhere. I’ve never been a person in law enforcement. I’ve never been someone who has worked within the healthcare system. I’ve never been someone who has been responsible for running a jail. And so, I had to understand, although I’ve lived through some of those experiences, that didn’t mean that my experience was the end all be all within that group. That was also a key important point, to make sure that folks were listened to, respected, and that folks understood that in the end of all of it, your experience only goes so far, we needed to rely on the experience of other advisor group members to help color in the picture as much as we could.
Wachino: I think coalition and collaboration is always important to implementation of new policies. But in this case, there are two unique features of the need for collaboration that really stand out to me.
Wachino: One is that the criminal justice system and the health care system have very few touch points. They are somewhat strangers to each other, and as states, and local governments make these changes, it’s really essential that they work together and get to know each other. In many cases they don’t even speak the same language. They were created, the two systems created, for different purposes that operate by different rules.
Wachino: Both of those perspectives and sets of circumstances need to be navigated to produce successful outcomes for the person who’s re-entered. So, I think that underscored the need for collaboration, in this case. The other thing to underscore earlier to Khalil’s point, we each should recognize the limitations of our own experiences. I think it’s very difficult for policymakers to understand the circumstances in prisons and jails, because they’re literally, and intentionally, walled off from us as a society. There aren’t that many people who have insights into what the health care services are like there, and what the circumstances of reentering are like.
Wachino: I think it is critical to have the perspective of people who operate the systems, of people who staff the systems, and importantly, the people who have experienced the systems, actively engaged in the conversation. Because those of us who haven’t experienced incarceration, have literally no visibility into what’s happening in those systems.
Cortes: I want to highlight the point you both made around expertise and experiences. It’s an important reminder that we cannot know it all – and it’s alarming if we think we do. Even as stakeholders, we must know our limits. Finding mutual ground and having respect is crucial to get the work done, while creating effective policies.
Cortes: You both also bring up crucial points about the importance of identifying and linking these two entities, the criminal justice system and health care. HARP’s information page does a good job summarizing how broadening our lens on health care supports the advancement of “multiple national goals, from improving health equity to reducing recidivism, strengthening public safety, and addressing public health crises related to mental health, addiction, and COVID-19.”
Cortes: As the health field continues to assess and prepare for COVID-19 long term impacts on public health, there has also been amplified response and attention to health equity across the sector. The pandemic further exposed health inequities based on race and ethnicity, and some of our lowest paid workers who are essential to our economy and community needs. Additionally, the murder of George Floyd amplified attention to the inequities of our justice system that continues to have an overwhelming misrepresentation of Black, Indigenous, and communities of color. In the policy realm, I’m curious about the impact these pieces have had on these initiatives. Where did ideas for this project lie pre-COVID-19? And how would you describe the efforts that supported the growth of this policy priority?
Wachino: I think clearly, COVID-19 exposed some of the inequities in terms of health care that exist in the criminal justice system all the time. COVID-19 really magnified them. There are estimates that people who were in prison had COVID rates five times that of the general population. The conditions in prisons and jails are ripe for transmission of infectious disease.
Wachino: People live in very close quarters, sometimes overcrowded. There’s no social distancing possibilities. Sometimes the facilities themselves are not fully sanitized. People go in and out, and I think this is one key aspect of incarceration that COVID really helped illustrate which is, we think, of people as being walled off. But first of all, you cannot build a wall against infectious disease. Second, people do exit and enter the system all the time, particularly in jails.
Wachino: So many people have short stays, some just a few hours. And of course, the correctional staff themselves leave every day and go home to their families, then come back the next day. That is really an environment that’s ripe for transmission, not just within the facility, but without it. I think it really demonstrated from a public health perspective that if we’re going to tackle public health challenges, we need to think differently about prisons and jails.
Wachino: Now, in all candor, too often there was inaction taken. We didn’t really live up to our potential to apprehend the virus and prisons in jails. But to your question, Bryna, I think it did help illustrate some of the challenges there, and it coincided with the time that we were as a society taking a new look at incarceration. The role mass incarceration is playing in society.
Wachino: The fact that the United States has the highest incarceration rates of any nation. The fact that people who are Black are five times more likely to be incarcerated than people who are white, that reflects improvement over the past ten or twenty years. But it’s still a really stark racial disparity.
Wachino: As we started thinking about how to achieve equity, how to improve health, it kind of turned policy makers’ attention to thinking differently, about, how can we support people at re-entry?
Wachino: Predating COVID, I will say there was a growing interest particularly at the Federal level in re-entry generally, and how do we help people successfully reenter? There’s a good bipartisan base of interest in return and redemption that I think COVID, and the recognition of equity and mass incarceration are really built on to bring us to this moment where we’re sitting here starting to talk about the first changes to Medicaid’s role since it was created.
Cumberbatch: Vikki’s response is spot on about just the sheer way that COVID exposed major flaws within health care delivery, within the incarceration settings, but also just the living conditions.
Cumberbatch: I will say that, as a country, while we were all grappling with how to deal with COVID-19 on the outside, there were some really good efforts by some states and localities to try to manage the issue, to protect folks who are being detained and/or incarcerated, as well as correctional staff.
Cumberbatch: But the reality is that many of those conditions still exist, and I think that’s also an important point to keep in mind as we talk about not only HARP, but also the intersection of medical, particularly medical treatment, and people who are detained and/or incarcerated.
Cumberbatch: For example, the delivery of health care within correctional settings still continues to be subpar – at best subpar – in some places completely non-existent. As Vikki has mentioned, there are people, who are incarcerated who have histories of incarceration or criminal justice involvement, who are much more likely to have long term chronic illnesses, and need much more intensive medical care; and it’s statistically proven that those people all too often are the same ones who suffer the most, and in many cases have the most severe symptoms because of COVID-19.
Cumberbatch: Just the healthcare delivery in and of itself continues to be subpar, the overcrowding and dilapidated conditions that exist within correctional settings, both prisons and jails continue to exist. We’ve seen viral videos of correctional settings being exposed by people themselves who are incarcerated. Just the living conditions are completely subpar for a country like the United States.
Cumberbatch: The churn of people that continue to go through jails is almost the same as it was during the height of the COVID pandemic. Now I will say that churn, the sheer amount of people that go in and out of the criminal justice system, but particularly local jails, as Vikki had mentioned, continues to hover around the same rate, and that’s the same for red states, blue states, purple states, and that’s because there continues to be a lack of inadequate policies that exist on a local level to stop the churn – the sheer introduction of people into the criminal justice system, who don’t necessarily need to be there, because there are underlying conditions either it’s medical or mental health that bring up a need that when you deploy law enforcement to address that need, they view that as a threat – could view it as a threat and all too often do, view it as a threat – and therefore detain that person, run them through the criminal justice system, which again, in terms of COVID-19 conditions, is a primer for people to continue to be exposed to the virus, and all too often get infected.
Cumberbatch: One clear example of this is what we’ve recently heard the New York City Mayor, for example, talk about implementing, which is that he’s going to use law enforcement the New York City Police Department to essentially detain people who are homeless or are transient. Who also display some level of a mental health need, and they’re going to detain those people, send them to local hospitals and or jails against their will, even if they refuse to, and that has not been the policy. In terms of COVID-19, and the current position that we are in around the pandemic. It’s just another prime example of inadequate local policies that are driving this churn, that in terms of health and the correctional system are only prime examples and prime conditions for the continuous spread of not only COVID-19 but also other communicable diseases.
Cortes: I really appreciate the way you describe that this is really a continuous churn of our high incarceration rates. You both paint an important picture on the root issue that we see around the intersection of chronic illnesses and incarceration and how this very much existed pre-COVID-19. We have known for a long time that change is needed. This opportunity for Medicaid to provide more innovation and creativity to support the needs of our most vulnerable community members, in tandem with criminal justice policies, is crucial to not only change how we provide proper support services for people to have higher health outcomes, but also how we view our criminal system as a whole. As we move towards this initial step to increase health access and attention to have healthier people and decrease recidivism rates, what do you think are the next steps for Medicaid and criminal justice policy if the Section 1115 Waivers for re-entry are accepted?
Wachino: It’s a great question, because I think we really stand at the cusp of a pretty exciting moment in terms of the evolution of health care policy. Where we stand right now is that there are thirteen states that have gone to the federal government to ask for authority for them to cover some services in the period immediately before someone is released from prison and jail. The way that these proposals work are that the federal government has authority to waive some of the provisions of Medicaid law, and so in this case, they would be waiving the provision of Medicaid law that says you can’t cover services, except for hospital services, when someone is incarcerated. Once the state makes that proposal, there is a period of discussion and negotiation between the state government and the federal government, and I think with some states that process is going on actively right now. They explore questions like, how is this actually going to work? What policy authority do we need to provide? Those would be state specific changes that are made if they’re approved in each state.
Wachino: There’s also, at the same time, federal legislative changes under discussion. The Medicaid Re-entry Act would allow Medicaid to cover services in the thirty days prior to release all across the country in all states. There’s still potential for that to be enacted, this year.
Wachino: So, lots of activity at the State and Federal level. Now the question you asked Bryna, and the question that the Health and Reentry Project really tried to interrogate was, how should this work? How could we translate these changes so that they have maximum impact on people’s lives, taking into account the need for the criminal justice system and the health system to do their jobs and hopefully do them better.
Wachino: We engaged seventy stakeholders earlier this year from across sectors. We had an advisory committee made up of cross-sector leaders. As Khalil mentioned earlier, they came together easily, around a vision for how these changes should take place. They prioritized having active supports for someone when they’re re-entering rather than allowing someone to navigate systems alone at a time of great vulnerability in their lives. They advocated for direct patient navigation supports, having people access primary care that’s linked to behavioral health care prior to and after release, and prioritizing trauma informed approaches to health care approaches that can help people overcome a history of trauma which many people who are leaving the justice system do.
Wachino: The potential of adopting that approach is that we could advance equity, meet people’s needs and help people basically return to their families and communities healthy and whole. Now there’s also a lot of nuts and bolts that goes along with that, and we can talk about that. But that was really the overall vision of what it is that someone really needs a release to be successful.
Cumberbatch: I would just add that what are the next steps, as in what need to be the next steps, and what I hope some of the next steps, all too often could be two different answers. What I hope is that the implementation of this notion of access to Medicaid, as a way to address what would have been gaping holes that we all know exist around re-entry, particularly as it relates to the kind of seamless care of not only medical, but also mental health treatment. I hope that this is a test that really goes well, because it is, you know, to Vikki’s point earlier. It is remaining a fact that the United States of America continues to be the leading incarcerator in the world. Policies, law enforcement policies, criminal justice policies still exist that will maintain those numbers.
Cumberbatch: Unfortunately, we still have over a million people incarcerated in some state prisons across this country. We still have roughly about half a million people churning in and out of local jails across this country. We still have about more than one hundred thousand people in federal prisons and federal custody in this country. Still, there are almost two million people who are in some jail correctional setting, prison cell at any point in time on any given day in this country.
Cumberbatch: What I’m hoping is that this is a test that will open the eyes and the minds of policymakers and decision holders to understand that the process of re-entry is not just a incarcerated person in their family and communities issue, it’s really issue that if deeply invested in and if done correctly, could allow for the complete elimination of, or at least the dramatic reduction of, recidivism – which we know, unfortunately, even if we remove crimeless revocations, still is an issue for people who are re-entering.
Cumberbatch: As someone who has re-entered, now at this point, almost thirteen years ago. The reality is that, whether it was thirteen years ago or thirteen days ago, for the most part, people that leave jails and prisons don’t want to go back. But they lack the systemic supports needed to actually balance themselves off and to actually get on good footing to then begin to live a different life.
Cumberbatch: I’m hoping that this is a test that goes well. There’s a lot at stake. But there’s still a lot of uncharted water in front of us, including the Medicaid Reentry Act, but a slew of other local policies that could hinder and/or support something like access to Medicaid dollars, which I’m hoping will be the first test of many that goes successfully.
Wachino: I just want to call out three of the things, three of a larger set of things that will be needed to make the implementation successful.
Wachino: The first, is making sure we have a strong base of access to community health care and behavioral health care services that are there at release. They are there to serve someone at release as well as to serve people, before the idea of incarceration ever becomes a reality for them. It is not like people’s lives were generally going great, and then they get incarcerated. Then suddenly it’s derailed. There are significant numbers of people who come into the justice system with acute health care, behavioral health care needs that have not been met.
Wachino: The imperative, I think, is to expand community health services through things like health centers, through reentry service providers, through social service providers, to try to make sure we’re meeting people’s needs both before and after release. I think that’s really the key to cracking some of the public safety and public health nut.
Wachino: In addition, cross sector collaboration, bringing people around a table, making sure that law enforcement and courts, community health centers, and hospitals all understand each other, and the rules of the road, and how to work together, along with an accountability system. Accountability to communities, and accountability to people who are actually re-entering and helping them help oversee the implementation of these services and fine tune it. It’s a policy that in implementation I think we’re going to learn as we go. There’ll be some successes and some places where we’re going to need to fine tune. Having some type of accountability structure in place, I think, will be essential.
Cortes: I think most people without proximities to prison or jail, have – maybe unspoken, and unrealized or very much spoken and realized – thoughts that people who have prison and jail experiences are deserving of whatever conditions they receive, and that that notion should help disincentivize people from going to jail or prison in the first place. And what those thoughts lack is the ugly fact of overcriminalization and that trauma that you mentioned Vikki. People are not entering prisons or jails healthy, and even if so, the trauma created within such institutions should not be acceptable. The quoted “punishment” people are serving is not death or infections, or mistreatment. It is the space away from society to prevent more immediate , quotes again on “crime”– and I think that often is forgotten when we think about the safety and care of justice involved people.
Cortes: HARP’s recommendations are clear in addressing the importance of centering community into services, such as alignment and connection of justice systems and community health centers, creating opportunity for those impacted by the justice system to work as community health care workers and peer support providers, and also to ensure that impacted stakeholders, particularly people formerly in jail or prison are collaborated with in decision making, strategic planning, and execution.
Cortes: For my last question, I know you touched on this earlier in our discussion, but I wanted to leave room to ask about what your identity, or your lived experiences, have added to what you offer at the policy making level and how it particularly impacts the way you navigate the Medicaid and healthcare field?
Wachino: I’ll speak from the policy level. I come to this work as someone who’s worked on health policy and health systems change for decades. What brought me to this issue is having worked to try to advance public health. Having worked to try to advance mental health, having worked to try to advance substance use, and to address common chronic diseases like asthma and diabetes, infectious diseases – not just COVID – but syphilis, HIV, Hepatitis C.
Wachino: We’re not going to get to those goals for a health system if we’re turning our back on the millions of people who are incarcerated in the United States. They experience nearly all of those conditions at higher rates than the general population. Yet when they’re released, we’re not addressing those needs. If you look at this from a macro-health policy or health systems perspective, if you just look at the question of how do we, as the United States, perform better on public health chronic conditions, infectious disease? There’s an imperative to really work with people who are leaving the justice system and help them get on track. Get to a point where they’re also not just being healthy, because that’s not the end goal for them, the end goal for them is to succeed in society, have healthy relationships with their families, and successfully be part of their communities. These Medicaid changes can be part of unlocking that potential.
Cumberbatch: I’ll say in terms of my professional experience. When I – well mixed with my personal experience – when I left the New York State prison system, I returned to New York City, and when we talk about re-entry and just a sheer amount of resources that are invested, not only by private philanthropy, but also, by a local municipality – in this case New York City.
Cumberbatch: New York City is essentially the epicenter for re-entry. It is well resourced, there are a ton of community based organizations, and not-for-profits that exist exclusively to help serve people who have left the criminal justice system. When I returned, my re-entry was into this entire system. But yet, there was still gaping holes that existed around the services that were needed, and the resources that were still needed to adequately address the problem of re-entry, which, to one of Vikki’s earlier points, has the overlapping of many other social and personal issues that exist. That was the existence in which I re-entered.
Cumberbatch: One of my first jobs after I came home was working as a case manager for people who were HIV and AIDS positive, who many of them had criminal justice involvement.
Cumberbatch: Later I went to work at one of the largest re-entry not-for-profits in New York City, that provides the plethora of services needed for people who are exiting prison and/or jails, many of them exiting New York City’s largest jail, which is Rikers Island.
Cumberbatch: My experience has been both as a service provider, as someone working to change policy as an advocate, but also someone who has been directly impacted. To come to this project, to come to HARP, was really bringing all of that experience. I will say it was really refreshing to see people who were law enforcement officials, government officials, people who were advocates who worked in healthcare people who, people like Vikki, had tremendous amount of experience on a federal level to manage Medicaid in, and of itself, let alone to talk about all of the complexities of it. It was really refreshing to see that as a group we all had the same end goal, we all wanted to see people be given all of the resources and help that they needed to live their best potential life.
Cumberbatch: That’s the experience that I brought. I hope that I shared it adequately to the group, and it was really refreshing to see people working collaboratively to lay out steps that are going to be needed to properly ensure that implementation is as successful as it can be.
Cortes: This podcast was recorded in December of 2022, and the Section 1115 waiver approval announcements from CMS were expected by the end of the year. There are rumors that California’s will be announced first, which would be an exciting first, since it is one of the states that requested coverage starting 90 days pre-release. The CMS will include guidance on funding use following their approval, so we are waiting patiently.
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Established in 1995, the Georgetown Public Policy Review is the McCourt School of Public Policy’s nonpartisan, graduate student-run publication. Our mission is to provide an outlet for innovative new thinkers and established policymakers to offer perspectives on the politics and policies that shape our nation and our world.
