Since 2014, when Boone County joined the Stepping Up Initiative, a program sponsored by the National Association of Counties (NACo) and the American Psychiatric Association, our community has worked to address a local problem that exists across the country—the over-prevalence of individuals with behavioral health challenges in our county jail.
The work is important for many reasons:
First, detaining individuals does not treat the core behavioral health issues that landed them under law enforcement’s scrutiny and merely exacerbates those issues.
Second, in times of limited resources for law enforcement, requiring officers to act as mental health professionals diverts them from the jobs for which they have trained and were hired—we are not safer as a community by keeping these individuals in the criminal justice system.
Third, once these individuals are in the justice system, they utilize more resources than those without behavioral health challenges as they re-offend at higher rates and remain detained for longer periods of time.
As we have discovered through our Stepping Up Initiative, diversion coupled with supportive services, is a better model—keeping us safer, utilizing resources more effectively and wisely, and producing better outcomes for the affected individuals.
Our work with NACo has allowed us to influence another piece of the puzzle that has cost Boone County and other local jurisdictions dearly—the Federal Medicaid Inmate Exclusion Policy. In late 2018, I was appointed to a committee jointly comprised of members of NACo and the National Sheriff’s Association (NSA). The purpose of the committee’s work was to determine the impact of this policy on local jurisdictions and then seek a remedy for the impact.
You likely have never heard of this policy. Turns out you aren’t alone—many members of Congress, the very entity that created the policy, don’t know it exists nor do they understand its impact. The policy, as its title suggests, cuts off any individual who is detained for more than 30 days in a county jail from receiving federal benefits (including but not limited to Medicaid).
Although in 2019, Missouri’s state legislature (through the leadership of local Representative Kip Kendrick) changed the cut-off to a suspension of benefits, the impact of the policy is nonetheless enormous. If an individual’s benefits are suspended, it typically takes at least 90 days before they can be re-instated. In that time period, an individual and his or her family can lose housing, lose access to medical care, including prescription medications, and lose access to SNAP benefits. Thus, the incarcerated individual, who was merely detained and NOT convicted, has lost access to the federal benefits to which he or she is entitled.
NACo and NSA joined together to overturn this policy for two main reasons: