Policy Goal 2: Leverage federal resources
1. Is the state leveraging federal resources to fill persistent funding gaps and encourage systems transformation?
RATIONALE: As communities work to establish collaborative responses across the various points of justice system contact, they often cite persistent funding gaps as a barrier to advancing their justice- and health-related goals. No single funding source can support—let alone sustain and scale—complex cross-system initiatives. Though administratively onerous, braided funding is a necessary part of behavioral health and criminal justice interventions, and federal funding is a critical and often under- or inefficiently utilized part of this equation. Both pass-through and competitive federal funding can be key sources to support systemwide planning, piloting, initial operations, or expansion of interventions that serve people with behavioral health needs in the justice system at the state and local levels. Effectively leveraging federal resources to meet community needs requires coordination across state agencies.
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Ways to do it
- Encourage alignment across state agencies’ spending to ensure that restricted pass-through funds complement or support criminal justice and behavioral health priorities. The state administering agency, state Medicaid director, state mental health program director, state substance use disorder authority, and state health financing authority should communicate and coordinate with each other.
- Leverage flexible federal funding, such as Byrne Justice Assistance (JAG) grants, to fill the gaps in cross-systems efforts.
- Research competitive federal funding opportunities available to states and localities across the behavioral health, criminal justice, and housing sectors. Disseminate information about relevant funding opportunities at the state and local levels.
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Things to consider
- Federal block grants can be a source of flexible and stable funding for local initiatives. Unfortunately, silos among state agencies can result in misaligned plans for pass-through funds that duplicate efforts, perpetuate persistent gaps, and result in imbalanced funding streams that have consequences for program outcomes. It is essential that state leaders coordinate on a block grant strategy to avoid these common pitfalls.
- Competitive federal grants are often paired with training and technical assistance to help grantees through the challenges of advancing and sustaining new collaborations.
- States should take advantage of one-time federal opportunities to advance system transformation at the intersection of public health and public safety. Many states and localities leveraged the American Rescue Plan Act (ARPA) of 2021 for one-time investments, such as capital projects or data collection infrastructure, to get system transformation efforts off the ground and used stable funding streams (e.g., Medicaid, general funds, levies) for ongoing operations.
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State Examples
2. Is the state leveraging Medicaid for populations with justice involvement?
RATIONALE: Some federal resources, including Medicaid federal matching funds, can only be accessed through state action. Medicaid plays a large role in financing behavioral health services because its eligibility rules include many individuals with significant need; it covers a broad range of benefits; and its financing structure allows states to expand services sustainably with federal financial assistance.
Medicaid is an important tool to connect people with behavioral health needs who are involved in or at risk of becoming involved in the criminal justice system to care, treatment, and even housing. States across the country have implemented innovative strategies to connect people who are justice system-involved to Medicaid coverage and services so they can better manage their physical and behavioral health care needs. Several states have implemented strategies to connect people in the justice system to Medicaid coverage and care upon reentry and maintain coverage continuity for people who cycle through local jails.
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Ways to do it
- Leverage Medicaid to recoup federal matching funds for behavioral health and crisis services. Consider amending the state’s Medicaid plan or seeking an 1115 waiver to pilot new services or forge state-level partnerships with networks of Certified Community Behavioral Health Clinics to coordinate crisis services and respond to potential barriers at the local level.
- Review and, where necessary, increase the Medicaid reimbursement rates to ensure there is a geographically accessible network of diverse providers to serve the treatment needs of Medicaid recipients.
- Partner with your Medicaid agency to submit an 1115 waiver to cover prerelease services for people in the justice system and/or additional community-based supports, such as housing access, for enrollees with justice involvement.
- Broker partnerships with Medicaid agencies to support the sustainability of state-funded local initiatives serving specific populations and funding specific services.
- Leverage Medicaid to address behavioral health workforce shortages by increasing Medicaid payment rates and structures for paraprofessional and peer services.
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Things to consider
- Criminal justice, behavioral health, and housing leaders should engage in long-term planning with the state Medicaid agency to better serve people with behavioral health needs who are in the justice system. Build relationships before you need them.
- States should consider amending their Medicaid plans to increase coverage of allowable crisis-related services, such as peer services. The American Rescue Plan Act authorized an 85 percent enhanced federal match for states that cover “community-based mobile crisis intervention services” through their Medicaid programs.
- States can also seek Medicaid waivers that allow them to pilot and evaluate new approaches to serving Medicaid beneficiaries, including expanding eligibility and testing the effects of changes in how care is delivered.
- Through Medicaid, states can access federal matching funds to cover allowable administrative costs to support improvements to their information technology infrastructure (e.g., electronic health records, call center technologies), data collection, and coordination across state agencies.
- Medicaid has been used to fund a number of critical services for people with justice system involvement through a combination of state plan services and waivers. Examples of services that have been partially supported through Medicaid include planning and establishing intensive care coordination for people with complex behavioral health needs in correctional facilities; connecting Medicaid enrollees who have complex needs with prerelease care coordination services to address their social needs; suspending (rather than terminating) eligibility for enrollees who became incarcerated; and providing reentry services and jail in-reach services to enroll incarcerated individuals prior to release to ease their care transitions when they return to the community.
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