Association for Public Policy Analysis & Management

Rising incarceration rates have made jails a major health care provider for a vulnerable, high-needs population, including people who are caught in a cycle of homelessness and incarceration. Because so little is known about how health care is provided in jail, the purpose of this report is to build the evidence base by examining health care services in Denver jails and how they are coordinated with Medicaid-covered services as people cycle between jail and the community. Unlike prior national research that has highlighted the deficiency of health care in many jails, the story seems different in Denver. Although the population we focused on has very high needs, our analysis revealed these individuals are diagnosed at higher rates, and receive more care, in jail than in the community. Because the county pays for all health services provided in jail, incarcerating chronically ill people comes at a high cost. In addition, communities often do not have the capacity or resources to offer intensive follow-up services when these individuals are released from jail. Many in this high-needs population face several challenges to continuing the care they may have begun in jail or accessing care they need most, such as substance use disorder treatment. This interrupted or inadequate health care may contribute to their cycle of homelessness and incarceration. Finding a way to safely release people to quality care in the community would go a long way toward preventing their return to jail and reducing their health care costs in jail. In 2016, Denver launched the Supportive Housing Social Impact Bond (SIB), a supportive housing program designed to serve a chronically homeless population that frequently cycles in and out of jail. In addition to improving housing stability and reducing jail stays, this intervention could have a significant impact on health outcomes, which could lower the use of high-cost services such as stays in detoxification centers and emergency room visits. Funded by the Robert Wood Johnson Foundation’s Evidence for Action program, Urban Institute launched a health outcomes study as a complement to the ongoing SIB evaluation. In this report, we use two data sources—Colorado Access Medicaid claims data and jail health records—and focus on the year before people were enrolled in the SIB evaluation, giving us a picture of the status quo for health services in Denver. A future report targeted for 2020 will focus on the impact of supportive housing over the two years after people were enrolled in the SIB evaluation.