When states began pursuing the federal opportunity to waive the Medicaid “inmate exclusion” through 1115 Reentry Demonstrations, a critical question emerged: What does the health care system have in common with the justice system, and how can those areas of overlap be turned into shared strategy?
Anyone who’s worked across justice and health care knows that these two systems often address many of the same people, issues, and goals, but they use different models to frame the discussion. Bridging that gap requires a shared language to align health and safety.
The first step is decoding some profession-specific language to reveal strategies that help people at the intersection of both systems. Social determinants of health describe the broader community conditions that influence health and well-being. The health care system uses the health-related social needs (HRSN) framework to identify non-medical factors within those conditions that affect a person’s health and stability. The HRSN domains map directly to people and areas where Medicaid can be leveraged to address those needs.
Meanwhile, the justice system uses the evidence-based Risk-Need-Responsivity (RNR) model to assess criminogenic risk, needs for support, and responsivity to an individual’s circumstances and match people to appropriate interventions to reduce future justice involvement.
When you compare these two models, the overlap is apparent, and the conclusion is profound: Addressing factors known to improve health can also reduce the risk of recidivism.
The same factors that drive poor health outcomes—unstable housing, social isolation, unemployment, food insecurity—are also among the strongest predictors of justice involvement. At the root of both is the larger issue of people and communities struggling to have their basic needs met, often because of inequitable access to health and social services. The overlap between these models creates a powerful opening for health and behavioral health leaders, including Medicaid agencies, and justice system leaders to work together around shared priorities.
To help these two systems align, CSG Justice Center staff members Sarah Wurzburg and Bridget Rivera Degnan created two charts. The first shows where the two frameworks overlap, and the second shows how Medicaid can address each shared HRSN.
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