Publications on Community-Based Care

Most former prisoners grapple with health problems while trying to make the already-difficult transition back into the community, says a new Urban Institute report. Returning prisoners with physical, mental, or substance-abuse conditions have more trouble than other ex-prisoners refraining from committing new crimes or staying out of prison, and many fare poorly in finding housing and employment.

More than 8 in 10 returning prisoners have chronic physical, mental, or substance abuse conditions. This research report demonstrates how each of these health conditions is associated with distinct reentry challenges and service needs. Using a representative sample of men and women from the Urban Institute’s multistate Returning Home study, we assessed health status at release and gathered data on reintegration experiences through multiple postrelease interviews. We present typologies of reentry experiences by health status, detailing individuals' success finding housing and employment, reconnecting with family, abstaining from substance use and crime, and avoiding reincarceration. Using these typologies, we conclude with targeted strategies to improve service delivery and reentry outcomes.

Health planners must invest in programs to maximize effectiveness and reach communities with the highest need. They often lack data to rationally allocate resources based on need. Using data from multiple sources, this study asks whether the resources devoted to outreach activities and the subsequent enrollment services are aligned with estimates of uninsured children among service planning areas and health districts in Los Angeles. Funds for outreach have been relatively well allocated in proportion to the distribution of uninsured children. Differences within SPAs, particularly with respect to outreach contacts and applications completed, were more noticeable. This suggests that some reallocation of outreach investment could lead to expanded coverage in some communities.

This brief examines Medicaid beneficiaries who receive long-term care services using data from the Medicaid Statistical Information Summary files. Medicaid long-term care users accounted for 7 percent of the Medicaid population in 2002 but over half of total program spending. Three-quarters of these dollars were spent on long-term care and 25 percent were spent on acute care and supportive services. About 55 percent of long-term care spenders were elderly and 34 percent were nonelderly disabled individuals. Children and adults not deemed disabled but using long-term services are a unique population whose medical needs should be assessed in light of recent DRA-related Medicaid changes. (Available from the Kaiser Commission on Medicaid and the Uninsured.)

During difficult economic times, many California counties have expanded health insurance coverage for low-income children. These Children's Health Initiatives (CHIs) enroll children in public programs and provide new health insurance, Healthy Kids, for those ineligible for existing programs. This article describes the policy issues in implementing the Santa Clara and San Mateo County CHIs, as well as the children's enrollment levels and utilization of services. These CHIs are among the first of the thirty California counties planning or implementing such initiatives. Their success depends on leadership from county agencies that have not traditionally worked closely together, as well as the development of a diverse public and private funding base. This effort to provide universal coverage for all children is important to national policymakers desiring similar goals.