Addressing the Justice-Involved Population in Coronavirus Response Efforts

Addressing health care needs of people moving into and out of the criminal justice system and staff who work them is an important component of coronavirus response efforts and protecting and promoting public health within the communities in which correctional facilities are located. This brief provides data on spread of coronavirus within correctional facilities, discusses the health risks for the justice-involved population and the staff who work with them, identifies the role Medicaid can play in response efforts for justice-involved individuals, and highlights other steps correctional systems can take to mitigate risk of coronavirus for the justice-involved population and promote public health. It finds:

Data show confirmed coronavirus cases and deaths within federal and state correctional facilities and immigration detention centers. As of April 14, 2020, there were 694 confirmed coronavirus cases in the nation’s federal prisons, including 446 incarcerated individuals and 248 staff, as well as 14 reported deaths among inmates.¹ Comprehensive data are not available for state and local correctional systems. However, in New York City – one of the epicenters of the COVID-19 crisis – the Board of Correction reported two deaths and 961 confirmed cases of coronavirus among detained individuals (334 cases) and staff (627 cases) as of April 14, 2020.² In Illinois, the Cook County Sherriff’s office reported three deaths and 323 confirmed cases among detained individuals, including 21 that were hospitalized as of April 14, 2020.³ Immigration and Customs Enforcement (ICE) reported 89 confirmed cases of coronavirus in detention centers operated or contracted by ICE, including local jails and prisons; 21 staff in ICE detention facilities; and 80 staff that are not assigned to detention facilities as of April 14, 2020.⁴

The millions of people who interact with the correctional system are at high risk for contracting coronavirus and experiencing serious illness if they become infected. About 2.2 million individuals are incarcerated in prison or jail each year, and millions more interact with the correctional system annually.⁵ In particular, there is rapid churn among the jail population that leads to significant movement into and out of jails. Between July 2016 and June 2017, an estimated 10.6 million people were admitted to local jails and, on average, jails experienced a weekly turnover rate of 54%.⁶ In addition, staff, health care workers, vendors, and visitors regularly move into and out of facilities. Coronavirus may spread easily among individuals who interact with correctional system given the close quarters and shared spaces within correctional facilities and extend into the broader community in which facilities are located. People in jails and prisons are at increased risk for experiencing serious illness from coronavirus due to high rates of underlying health problems. Justice-involved individuals also face a variety of social challenges that are associated with poorer health and increased barriers to accessing health care.

Medicaid coverage can enhance coronavirus response efforts for the justice-involved population. Medicaid facilitates access to care for eligible individuals moving into and out of justice system, particularly in states that have adopted the ACA Medicaid expansion to low-income adults. However, under current rules, Medicaid reimbursement for incarcerated individuals is limited to inpatient care provided in facilities subject to certain requirements. Medicaid coverage among incarcerated individuals will be increasingly important if hospital care needs grow among incarcerated individuals due to the COVID-19 crisis. States can also seek waivers to expand the role Medicaid can play in providing reimbursement for incarcerated individuals to enhance their coronavirus response.

Correctional systems can take a range of other steps to mitigate risks of coronavirus among justice-involved individuals to protect and promote public health. For example, correctional facilities can reduce admissions, increase the number of people released from jails and prisons, and reduce unnecessary contacts within facilities. A number of local jail systems and some state departments of corrections have released or are planning to release nonviolent, low-level offenders.⁷ All 50 states have implemented some form of restriction on visitation to correctional facilities, with 15 states suspending all visitation and 37 states suspending all visitation except for legal visits.⁸ Outside of facilities, courts can grant extensions on deadlines and suspend in-person proceedings and law enforcement agencies can limit arrests and/or expand citations in lieu of arrest policies. For individuals under community supervision, agencies can suspend all in-person reporting and check-ins, lengthen reporting periods, or allow people to connect remotely. Supervision agencies could also recommend early termination of supervision and/or suspend incarceration for noncompliance with supervision terms. Similar to correctional agencies, ICE has authority to curtail civil immigration enforcement and release individuals from custody to minimize public health risks of coronavirus. ICE has reported some changes to enforcement and detention facility operations in response to the COVID-19 crisis, but, to date, has taken limited steps to release individuals from detention facilities.