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Patient Protection and Affordable Care Act and the Pretrial System: A "Front Door" to Health and Safety

NCJ Number
Date Published
February 2014
15 pages
This report summarizes the provisions of the Federal Affordable Care Act (ACA) and its relevance to the healthcare needs of pretrial populations of arrestees.
The ACA provides two mechanisms for accessing healthcare insurance coverage: the health insurance marketplace (exchanges) and the expansion of Medicaid eligibility. By January 2014, every State will offer insurance coverage through a health insurance marketplace (either State or federally operated) that provides a regulated venue for uninsured individuals with incomes between 133 percent and 400 percent of the Federal poverty limit (FPI) to purchase coverage. The ACA also expands Medicaid eligibility to childless adults with a minimum eligibility floor of 133 percent of the FPL. A U.S. Supreme Court decision in 2012 allows States to opt out of the ACA's Medicaid expansion component. Some States have chosen not to implement this component at this time. The ACA has significant potential to increase access to physical and behavioral health services for individuals under the supervision of the criminal justice system. Agencies that serve pretrial populations may choose to develop internal capacity or collaborate with community partners; however, it is crucial that these pretrial agencies develop methods of enrolling and supporting access to healthcare for these individuals in addressing chronic physical and behavioral health issues. Voluntarily accessing treatment services allows defendants to receive services that address critical needs, and this may influence decisions regarding diversion from prosecution. Access to insurance coverage and community-based services under ACA coverage may prevent detention while creating a stable tie to local physical and behavioral healthcare. Pretrial agencies are in a position to lead in making system changes by enrolling defendants in insurance coverage under the ACA and working with partners to implement related system changes. This guide outlines a few key steps to guide pretrial leaders in this effort. 2 tables