County Health Coverage Enrollment Survey


California Counties Working to Enroll People in Jail, on Probation in Health Coverage to Stop Cycles of Crime

Expanded Medi-Cal Under the Affordable Care Act Provides Federal Dollars to Insure, for the First Time, Thousands of People in Local Justice Systems

SACRAMENTO – At a briefing today at the California State Association of Counties, Californians for Safety and Justice ( released survey findings that show California counties are leading the way in extending health care coverage to people exiting jail or on probation in order to reduce repeat crime and its subsequent costs to counties. 

A large share of the people in county jails and on probation have drug addiction, substance abuse disorders and/or mental health problems that, if unaddressed, can contribute to their recidivism. Approximately 75% of people on probation in the U.S. lack health insurance, and uninsured rates for people in jail can reach as high as 90%, preventing people with health needs from accessing the proper treatment.

The enactment of the federal Affordable Care Act in January 2014 has expanded the number of people who can now receive coverage through Medi-Cal or through Covered California, the state’s insurance exchange.

“The Affordable Care Act presents counties with a major opportunity to leverage federal funds to connect people in the justice system with treatment that can stop cycles of crime,” said Jenny Montoya Tansey, Director of Californians for Safety and Justice’s Health Matters program, which works directly with county officials on enrollment efforts. “Californians overwhelmingly support providing health solutions for health problems, making health care enrollment not only a smart public health strategy but also one that improves public safety.”

Californians for Safety and Justice issued a survey to all 58 counties in June-July 2014, receiving responses from 44 counties (comprising more than 96% of the state population). The survey found that:

  • 75% of counties (that responded) are currently providing enrollment assistance, and the other 25% plan to in 2015 or before.
  • 70% of county jails and 70% of probation departments are providing enrollment assistance.
  • Counties are using a variety of funds to support these efforts, particularly funds from AB 109 (Public Safety Realignment). Of the counties currently providing enrollment assistance, 7 in 10 are funding part or all of their efforts with AB 109 dollars – the most of any funding source cited.
  • Counties are already seeing results, both in enrollment and savings. For example, Yolo County, which has focused on leveraging Medi-Cal to pay for treatment for people on probation (treatment previously funded entirely by the county), has saved more than $100,000 so far this year.

Central to all these efforts is collaboration across different county entities, from law enforcement to health agencies to community clinics and community-based nonprofits.

“By working collaboratively, county agencies greatly increase their ability to improve public safety and health,” said Matt Cate, Executive Director of the California State Association of Counties. “This is an exciting opportunity to leverage new funds and new local partners to fight the factors behind repeat crimes, including unaddressed mental health and substance use disorder problems.” 

Partnerships have also focused on more than more than enrollment alone. The Sacramento County Probation Department is working with county public health nurses to ensure anyone leaving jail or on probation is connected to health services after being enrolled. Similarly, Alameda County is contracting with community clinics to connect people leaving jail directly to treatment providers in their communities.

Other innovative county efforts include:

  • In Shasta County, people in county jail receive two days’ reduction of their sentences for completing a Medi-Cal application.
  • Merced County not only works to enroll people in jail for longer stays but also provides direct referrals to social service agencies for those released sooner and awaiting trial.
  • In Los Angeles County, home to the nation’s largest jail and probation populations, nurses help people in jail prepare for release by connecting them to community treatment services.

To read more about the survey, click here.

About Californians for Safety and Justice

Californians for Safety and Justice, a project of the Tides Center, is a nonprofit bringing together crime survivors, business and community leaders, policymakers, law enforcement, health professionals, educators and crime-prevention experts to replace prison and justice system waste with common sense solutions that create safe neighborhoods and save public dollars. Partnering with experts from around the state, our Local Safety Solutions Project provides direct support to counties interested in using innovative approaches to increase safety and reduce justice system costs. This includes our Health Matters program, which is dedicated to supporting counties in learning how health reform can reduce justice system costs and increase public safety, specifically how they can increase health coverage enrollment and access to care for jail and probation populations.



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