Ensuring access to care for justice-involved individuals — people who have interacted with the criminal legal system as defendants — is key to reducing repeat offenses, improving health outcomes, and reducing overall health-care costs.
Many of the justice-involved who live in our state are challenged by houselessness, addiction, and behavioral health issues; the Honolulu Police Department estimates that 43% of those arrested are houseless and 72% of those facing houselessness are mentally ill or under the influence of drugs. Justice involvement, then, is influenced by “social determinants of health,” issues outside of traditional healthcare that have a profound impact on a person’s health and wellness: joblessness, houselessness, transportation challenges, financial stressors, and more.
People who are or have been incarcerated experience significant physical and behavioral health care needs. Compared to the general population, incarcerated people experience higher rates of chronic diseases, and over half of prison and jail inmates report having a mental health disorder. Incarcerated populations often have limited access to health care services, which can result in them leaving jail and prison with unaddressed chronic health problems and worsened symptoms of mental illness. These concerns can rise to dangerous levels: the risk of death by drug overdose, for example, is sharply increased in the first two weeks immediately following release.
UnitedHealthcare Community Plan of Hawaii is dedicated to addressing these issues and removing barriers to care for this population through our Community Transitions Program for the Justice-Involved.
Established in 2022, the program was initiated to support our members as they re-enter society from incarceration in jail, prison, and the Hawaii State Hospital. It has since expanded to serve members with open criminal cases who are currently still in the community and those whose previous justice involvement may affect their ability to access housing, employment, and other social and economic opportunities.
Through the program, any member transitioning out of incarceration — up to six months post-release — can receive health coordination services tailored to their needs. It’s a trauma- informed, whole-person approach, working with each member to support their transition by understanding their needs and providing connections to health care and social services.
Also established are referral programs with community and government agencies that identify members who may benefit from health coordination. In turn, justice-involved members are referred to resources including housing and employment services to help with transition and integration back into the community.
Over the past year, the program has served 180 people across Oahu, Maui, Kauai and the Big Island with promising results:
>> Among those transitioning back into the community, a 59% decrease in outpatient costs and 100% decrease in ER visits (based on a rate calculated per thousand members).
>> A 25% decrease in per-member per-month costs and 65% decrease in ER visits among those with open criminal cases.
>> A 67% decrease in per-member per-month costs and 95% decrease in ER visits among those with past justice involvement.
Providing health coverage to those who have been recently released makes our communities safer. Per a 2022 Prison Policy Initiative report, offering Medicaid coverage to recently released people resulted in decreases in the rate of rearrests, including a 16% reduction in arrests for violent crime for two years following release. As PPI concludes, “access to affordable, quality healthcare results in a myriad of benefits to public health, public safety, and public coffers.”5
We believe in helping all our members live healthier lives. By helping justice-involved members navigate health care and social resources, we can reduce costs and improve health outcomes while making our communities and state a better place to live.
Michelle Fei, J.D., B.S.N., R.N., is UnitedHealthcare’s Community Transitions Program lead.
