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Affordable Care Act; ACA; Jail; Incarceration; Medicaid; Probation; Health Policy


Every year, millions of Americans become involved in the local criminal justice system and are held in jails, placed on probation, or some combination of the two. This paper focuses on the probation population, a group of individuals who receive correctional supervision in communities, generally as an alternative to incarceration. Individuals on probation are disproportionately low-income and uninsured; many are likely to qualify for health coverage through state Medicaid expansions and private insurance Marketplaces that are part of the Patient Protection and Affordable Care Act. Opening up access to affordable health insurance coverage for this vulnerable group of individuals is a critical step to creating coordinated and integrated health care across community settings for people who have high rates of untreated mental illness and substance use disorders. This may also create duplicative or parallel systems of drug use monitoring, calling into question how individuals with drug problems and interactions with the criminal justice system are most effectively monitored and managed within the community.

For this paper, we interviewed administrators who oversee county/city probation departments in three states and experts with knowledge of probation activities across the nation. Criminal justice-involved individuals with a history of drug use are often required to submit to periodic drug tests or to participate in drug or mental health treatment as a condition of their probation orders. Generally, drug tests are not considered a medical service, though some jurisdictions do use them as a tool to measure probationers’ compliance with drug treatment. States and localities commonly levy fees on probationers to cover the cost of probation, including supervision and drug testing. Failure to pay these fees can result in some probationers being incarcerated, although most jurisdictions include provisions for indigent probationers to reduce or waive fees. Treatment services, even when court-ordered, can be in short supply, causing people on probation to experience long waits for services or forgo them altogether. Coverage through Medicaid could link eligible probationers with mental health and substance use services consistent with their health needs and criminal justice-related requirements.

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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