The year is winding down and many of us are preparing for a busy 2013. I recently polled a group of more than 50 correctional nurse leaders on their top picks for news stories of the past year. Below are the leading four responses along with my commentary. These issues cross all areas of corrections. Security, service, and healthcare staff will be work together to make the best of these themes in the year ahead. Happy New Year!
Affordable Care Act
The number one health care news story of 2012 for many sectors of the economy is the Affordable Care Act (ACA). With the passage of the act in March of 2010 and the recent re-election of President Obama, the ACA is poised to begin implementation. When fully implemented there is promise for greater continuity of ongoing healthcare for incarcerated citizens; for inpatient hospitalizations during incarceration and at release. Although much of the legislation remains unclear, expert see the following implications for our patient population:
• More Medicaid-eligible inmates: Policy experts suggest that changes in Medicaid eligibility will allow more health care funds for incarcerated individuals.
• Health care exchanges for detainees: Inmates detained but not convicted will be eligible for enrollment in the health care exchange systems being created for the unemployed or uninsured. There are many challenges to implementing enrollment in the jail setting that will need consideration in the year ahead.
• Better coverage after re-entering the community: Released inmates have opportunity for continued Medicaid coverage or health care exchange enrollment for ongoing care. Experts suggest that a third of released inmates may be eligible for Medicaid support and a quarter eligible for credits toward health care exchanges. Re-entry programs will need to gear up to support post-release enrollment.
• Reduced correctional health care costs over time: Assuming a large percentage of the underserved and marginalized citizenry begin receiving ongoing healthcare, experts expect a reduction in healthcare needs while incarcerated. Improved healthcare services outside the correctional setting could mean reduced needs while behind bars.
Things are heating up in the area of GLBTI (Gay, Lesbian, Bisexual, Transgender, Intersex) management in correctional settings. Facilities grapple with issues of housing assignment, victimization, and medical care. A surprising (maybe not!) ruling in MA this year requires their DOC to pay for sex reassignment surgery for GID (Gender Identity Disorder)as the only appropriate response to the inmate’s 8th amendment right to adequate health care. This judgment indicates medical costs may be increasing for facilities that house GLBTI inmates diagnosed with GID. Already the ruling is being appealed while the inmate requests taxpayer funded electrolysis treatment for hair removal, which was denied.
Solitary Confinement and Mental Health
Mental health issues continue to abound in corrections. It is not news that we have more mentally ill in the US behind bars than in hospitals. Storm clouds are gathering over the mental health effects of incarceration and correctional practices, especially solitary confinement. Expect this issue to see growing concern in the new year as studies emerge on the detrimental effects of prolonged isolation. Like the issue above, solitary confinement could easily be positioned as an abrogation of an inmate’s 8th amendment right to adequate health care.
Infectious Disease Advances
The detection and treatment of infectious diseases keeps many a correctional health professional busy as our patient population is prone to infection transmission. Advances in HIV treatment and efforts in the corrections community have greatly reduced the prevalence of this infection in our populations. That’s good news! While some systems (AL and SC) are struggling to manage their HIV population, there are growing concerns over Hepatitis C management. This disease could easily increase correctional health care costs in the near future if correctional systems are pressured to increase treatment.
Do you have correctional healthcare change makers that did not make this list? Share your thoughts in the comment section of this post.