Promoting smart justice for the mentally ill

Two bills introduced during the Texas 84th Legislature, both currently in committee, present a basic yet significant solution that could help lower recidivism rates among the mentally ill in our Texas jails.

SB 1777 by Senator José Menéndez and HB 2523 co-authored by Representatives Nicole Collier, Garnet Coleman, and Elliott Naishtat both relate to the continuation of certain public benefits, including medical assistance, for individuals after release from confinement in a county jail.

The bills seek to amend the Human Resource Code that suspends or terminates Medicaid eligibility for certain individuals confined in a county jail. If enacted, the amended code would require the Health and Human Services Commission to automatically reinstate the individual’s Medicaid eligibility within 48 hours after being notified of the person’s release, providing the individual’s eligibility certification period is still active.

Why is this change to the code so important?

Statistics show that individuals with untreated mental health and substance use disorders are 8 times more likely to be incarcerated, often due to lack of access to appropriate crisis services and ongoing care. A large percentage of individuals entering county jails have a diagnosed mental health disorder. According to the Texas Department of Criminal Justice, 35 percent of Texas inmates have a mental health need and most have substance use disorders.

Many of these individuals rely on federal aid such as Medicaid, Supplemental Security Income, and Social Security Disability Insurance benefits.

When an individual is arrested, jail administration reports the incarceration to the Social Security Administration. Consequently, the incarcerated individual's benefits are terminated regardless whether or not he or she was charged with an offense. A person released on bond or released because charges were dismissed, is left without health care or financial assistance. It takes months to restore a person's eligibility, during which time the individual is left without the essential therapy or medications necessary to maintain mental health and wellbeing.

Too frequently these individuals are treated in emergency rooms without healthcare coverage or end up on the streets without means of support. As a result, counties and municipalities bear much of the cost of housing and health care, including behavioral health care. 

 The Solution: Allowing Continuity of Care

Continuity of care is essential to keeping individuals living with mental health needs from returning to jail. SB 1777 and HB 2523 provide a mechanism by which certain public assistance benefits can be suspended and reinstated, rather than terminated, should a person receiving benefits be confined in a county jail.

Both bills accomplish this by giving local sheriffs the option to participate in a program to notify the Health and Human Services Commission (HHSC) of an individual's confinement and/or conviction. HHSC then, after a full calendar month, as appropriate will terminate or suspend an individual's benefits.

If an individual's benefits are suspended, HHSC has within 48 hours after release to reinstate benefits. SB 1777 and HB 2523 also give sheriffs the option to enter into an agreement with a third party to assist with reintegration and reinstatement efforts.

There are economic advantages to the legislation. In the current system when a confined individual receives inpatient hospital treatment, the sheriff's office bears the cost. If an individual's benefits are suspended, rather than terminated, the burden of cost shifts to Medicaid. Additionally, this legislation seeks to lower recidivism rates among individuals with mental health disorders. If an individual's benefits are reinstated within 48 hours after release, then he or she can continue receiving essential health care without interruption.

SB 1777 and HB 2523 are examples of how our state can promote Smart Justice for the mentally ill in our jails by helping them continue the care needed to keep them out of jail.  We hope to see these bills make it through their respective committees and onto the floor for passage.


Tom Luce, chief executive officer of the Meadows Mental Health Policy Institute, has been engaged in public service for more than 30 years. Among his five major public appointments, he served as U.S. Assistant Secretary of Education for Planning, Evaluation and Policy Development during the George W. Bush administration and Chief Justice pro tempore of the Texas Supreme Court. He has co-founded and led various nonprofit entities including the National Math and Science Initiative.

Tom Luce, Meadows Mental Health Policy Institute

The Meadows Mental Health Policy Institute is a nonpartisan, nonprofit organization that supports the implementation of policies and programs that help Texans obtain effective, efficient mental health care when and where they need it. The Institute’s vision is for Texas to be the national leader in treating people with mental health needs.