Illinois: State Strategies to Enroll Justice-Involved Individuals in Health Coverage

illinoisPolicy and Process Changes

State Legislation
HB 1046, introduced in the 2013-2014 legislative session, specifically allows incarcerated individuals to apply for Medicaid prior to the date of their release. If these individuals are found to be eligible for Medicaid, they will be able to receive coverage after their release. In addition, the bill allows for suspension of existing Medicaid benefits for persons who enter a correctional institution. Illinois is currently in the process of implementing this functionality. The bill was signed into law (see Sec. 1-8.5) in August of 2013 and became effective January 1, 2014.

Application Process Changes
Local assister entities have conducted the majority of the enrollment for justice-involved individuals. Some of these assister community organizations have reached out directly to county jails to provide enrollment assistance and help individuals understand how to appropriately access care once they reenter the community. At the state level, Get Covered Illinois, the state/federal marketplace partnership organization in Illinois, supports these efforts by providing the assister organizations with information about how the ACA affects justice-involved individuals. Get Covered Illinois has also offered suggestions and technical assistance to these organizations about how to connect with criminal justice entities and ways to potentially integrate enrollment processes into these facilities. View enrollment guide

Post-Release Outreach

Parole office
During Get Covered Illinois’s first open enrollment period in Fall 2013-Winter 2014, the state used the Department of Corrections (DOC) Parole Division’s automated messaging system to inform individuals they were likely eligible to enroll into health coverage, when in-person assistance was available at their nearest parole office, or how to enroll by phone. In Illinois, parolees must call the system using a toll free number to check-in, and often receive messages this way, rather than having parole agents call them. This allowed the state to pre-record a message describing parolees’ potential eligibility for health insurance and providing information about where to apply in person or online.  Additionally, assisters were available once a week at parole offices around the state to enroll individuals. Flyers were created for parole agents to distribute to individuals on their caseloads, which provided information about when in-person assistance would be available at the parole office.

Mailings and calls
Prior to the Get Covered Illinois’ second open enrollment, trying to capitalize on earlier outreach efforts, the state worked with the parole department to carry out an outbound calling campaign in targeted regions across the state.  An automated message was delivered that encouraged these individuals to enroll in health coverage and directed them to local enrollment sites. The state believes this aggressive outbound calling campaign was not as effective as the first effort; however, identifying how many of these justice-involved individuals eventually sought assistance at local enrollment sites and enrolled in coverage through this effort was a challenge because they were directed to enrollment sites in the community rather than at the parole office.

Beyond Eligibility and Enrollment Strategies

Health Literacy Materials
Recognizing that justice-involved individuals reentering the community may be unfamiliar with how to appropriately utilize health care services, officials from Get Covered Illinois have developed health literacy materials designed to help them more easily access care upon release. These materials include a palm-sized card with information on how to choose and access primary care providers, obtain prescriptions, and appropriately use emergency care. The card also includes important contact numbers, as well as space where individuals can write in information about their physicians and prescriptions. The materials were developed with input from probation offices and advocacy groups and are based on some of the most common questions they receive from the justice-involved population regarding their health care benefits. The cards are being distributed in probation offices as well as during the intake process at the Cook County jail.  See palm-cards for: Medicaid and Using Insurance (in English and Spanish).

Cross-Agency Coordination and Partnerships
In Illinois, efforts to enroll justice-involved individuals in health coverage were led through the governor’s office, which established a Workgroup on Justice Populations (WJP) and multiple interagency and regional meetings were convened. Based on these meetings, the WJP developed a resource guide designed for criminal justice personnel and community partners. The guide provides background information about relevant ACA policies along with detailed process maps outlining steps to implement enrollment procedures in correctional facilities and other settings.

Looking Forward: Future Issues to Address
State officials indicated that it was helpful to have the governor’s office lead the state’s initial efforts to enroll the justice-involved population in health coverage. This is because of the executive office’s ability to bring together a wide range of stakeholders, such as state and local officials as well as community based organizations. However, they noted the importance of developing a strong relationship specifically between staff at the state Medicaid and corrections agencies to maintain and sustain enrollment processes. Institutionalizing this relationship can help collaborations continue beyond changes in gubernatorial leadership.