Best Practices for Jail Medicaid Enrollment: TASC in Modern Healthcare Article

(Chicago) Modern Healthcare has published an article on best practices for Medicaid enrollment at jail intake, noting approaches which TASC has helped implement in Cook County and is sharing with other jurisdictions around the country.

Harris Meyer writes:

Like inmates throughout the country, most people entering the Louisville Metro Jail lack health insurance and many suffer from long-untreated chronic conditions.

At least partly as a result, some people, particularly those with serious mental illness and drug or alcohol addiction, keep getting re-arrested and returning to jail, increasing costs to taxpayers.

In Louisville, Kentucky, there are processes to sign up people for Medicaid at jail intake, as well as provide support at release for individuals with multiple needs who often cycle in and out of jail. The program is based on initiatives begun at Cook County Jail in Chicago.

In these locations and in a number of jurisdictions across the country, the aim is to increase the number of people who have Medicaid when they are released from jail, so as to improve their access to healthcare in the community and reduce their likelihood of recidivism.

…But there are tough challenges, including poor coordination between local jail authorities and state Medicaid agencies, lack of funding to hire enrollment assisters, and chaotic conditions during jail intake, said Maureen McDonnell of the Chicago-based not-for-profit Treatment Alternatives for Safe Communities. In addition, there is sometimes political opposition to offering public health insurance to accused lawbreakers.

“Typically, these programs start with a motivated jail director, county commissioner or county behavioral health director who sees the writing on the wall about how many people have substance abuse and mental health conditions,” said McDonnell, who advises jail officials around the country in starting Medicaid enrollment programs. “The current national focus on mental health and substance abuse is helping a lot.”

Through these collaborative approaches, and with Medicaid coverage, people with long-untreated substance use, mental health, and other medical conditions may have new means to access healthcare services. Read the full article at modernhealthcare.com.
Modern Healthcare (MH) best practices for helping people in jail get Medicaid, including input from TASC. Source and image credit: Modern Healthcare

Modern Healthcare (MH) best practices for helping people in jail get Medicaid, including input from TASC. Source and image credit: Modern Healthcare

 

Public Support Grows for Criminal Justice Diversion Initiatives

(Chicago) – A recent poll of Illinois voters indicates strong support for criminal justice reform. More than two thirds (70 percent) agree that state prisons are overcrowded and require reform for people with non-violent offenses, and four in five (83 percent) support sending fewer individuals with low-risk, non-violent offenses to prison so that state funding can be used to keep people who have committed violent offenses incarcerated for their full sentences.

The number of people behind bars in the U.S. has grown more than 500 percent over the past four decades, and U.S. incarceration rate tops the charts. In line with public opinion, policymakers are reversing their appetite for tough-on-crime policies that have fueled record incarceration rates. In fact, criminal justice reform stands apart as one of the only issues on which individuals across political parties are unified in their support.

There also is a growing understanding of the extremely high rates of substance use and mental health disorders among people involved in the criminal justice system, and of the need to address these problems earlier in the lifespan as a critical part of criminal justice reforms, before medical and behavioral health problems become advanced, and before the often lifelong collateral consequences of a conviction block individuals’ efforts to reenter communities, lead productive lives, and avoid future criminal behavior, re-arrest, and re-incarceration.

In 2013, TASC’s Center for Health and Justice (CHJ) conducted a national survey of criminal justice diversion programs and practices, to explore the landscape of diversion at the front end of the system—by law enforcement, by prosecutors and pre-trial service agencies, and by courts. CHJ is currently conducting an Illinois survey to explore the use of diversion programs and practices at phases of justice system involvement prior to conviction and sentencing, with a special focus on those operated by prosecutors, and plans to release a report with findings and recommendations later this year.

Poll of Illinois voters shows overwhelming support for criminal justice reform. Source and image credit: U.S. Justice Action Network

Poll of Illinois voters shows overwhelming support for criminal justice reform. Source and image credit: U.S. Justice Action Network

National TASC Conference Showcases Local Diversion Programs

(Chicago) – Several criminal justice diversion programs in Illinois were showcased at the recent annual conference of National TASC, an association of programs that connect justice systems to community-based treatment.

TASC, Inc. of Illinois served as the host organization for the national conference, which took place in Chicago and drew attendees representing programs in states from North Carolina to Hawaii. One of the conference themes was the importance of diverting people with non-violent charges away from traditional criminal justice processing and into services in the community.

Although diversion is not a new concept, public opinion, health coverage brought about by Medicaid expansion, and bipartisan efforts toward criminal justice reform have propelled such initiatives to the forefront of public policy. The goals of such programs vary depending on the jurisdiction, but most aim to reduce the numbers of people going into the justice system, reduce jail stays, strengthen connections to health and supportive services in the community, and reduce recidivism.

Illinois Diversion Programs Highlighted

At the conference, held April 25-27 at the Westin Michigan Avenue, experts who have implemented front-end diversion programs in Illinois offered their experiences and strategies for developing these initiatives. Chief Eric Guenther, public safety director for the Village of Mundelein, and Lake County State’s Attorney Michael Nerheim described their collaboration in implementing smart-on-crime approaches. Motivated by the dramatic increase in opioid overdoses and deaths in the area, they are leading the development of a collaborative effort to divert people with drug problems to community-based treatment rather than arrest them. Similar programs are being designed and implemented across Illinois and the country, inspired by the Gloucester, Massachusetts, Angel Program launched in 2015.

“We have been losing a lot of young people to overdose deaths all over our county. We had to come up with a new way of dealing with this [opioid] epidemic,” said Nerheim. “The vast majority of people who come into the system are going to be back with us—back in society—and we want them to be productive members. Everyone should have the opportunity for a second chance.”

Chief Guenther noted the importance of building trust between the community and law enforcement, so that community members feel comfortable coming to the police department for help. He remarked on the police department’s unique ability to engage people any time of day, any day in the year. “A person may decide at 2:00 a.m. that they want out [of addiction], and having to wait until 8:00 a.m. may mean that we lose that window.” Guenther also stressed that planning processes should include people in recovery to ensure that programming and messaging will appeal to individuals who need help.

Mark Kammerer, the alternative prosecution/sentencing unit coordinator at the Cook County, Illinois, State’s Attorney’s Office, described the array of programs in place to divert people out of traditional case processing, noting that his office has been operating diversion programming in some fashion since the 1970s. “We now have interventions for people with the least extensive criminal background to high-risk, high-need individuals. One size does not fit all, so we offer a continuum of interventions. The goal is to identify and screen people to get them into diversion programs sooner, rather than later, in the criminal justice system.”

TASC Vice President George Williams, who offered the conference’s opening remarks, spoke of TASC’s 40-year history in advocating for people who need help, and emphasized that clients, constituents, friends, and family members are at the heart of this work. “Everything we do in this room is for the rights, interests, health, and needs of the men and women who have come through our doors,” he said.

New Opportunities via Medicaid Expansion

“Diversion programs are surging in popularity and evolving in response to current needs,” said Laura Brookes, policy director at TASC. Introducing the panel discussion, Brookes offered that the justice system can divert many people who represent a low public safety risk to programs in the community, stemming the tide of people coming into the system at the front end and throughout it.

“Now is a particularly exciting time to be involved in this work, not only because of the broad support for much-needed reform, but also with the expansion of Medicaid in many states under the Affordable Care Act,” said Brookes. “This means that local and state governments can save justice and corrections costs by establishing connections to Medicaid-reimbursable behavioral health and medical resources in the community. These resources can help increase diversion, as justice systems become confident that many of people they are diverting will be able to access the care they need and reduce offending.”

The benefits of diversion programs were highlighted at the 2016 National TASC conference.

Benefits of diversion programs were highlighted at the 2016 National TASC conference in Chicago.

Congratulations to 2016 Integrated Behavioral Health Interns

(Chicago) – Post-graduate interns with the Integrated Community Behavioral Health Training Consortium (ICBHTC) completed their capstone projects on May 3, having gained skills and knowledge in the treatment of substance use disorders, mental health, and TASC’s interface with the justice system.

ICBHTC is an innovative, multidisciplinary post-graduate internship program designed to develop health care leaders equipped to address the pressing primary and behavioral health needs and disparities of vulnerable, at-risk individuals and groups.

Now graduating its second class of interns, the program was initiated in 2013 through a collaboration of Chicago-area graduate programs, including Governors State University, the University of Illinois at Chicago’s School of Public Health, the Chicago School of Professional Psychology, the Illinois Area Health Education Centers, and TASC. The effort has been guided and supported by the Substance Abuse and Mental Health Services Administration’s Region 5, led by Captain Jeff Coady.

The program places student interns in criminal justice and community-based settings, and facilitates weekly multidisciplinary seminars. Student interns gain clinical, public health, and policy knowledge that offers an integrated experience reflective of the need for person-centered health care inclusive of substance use and mental health treatment and evolving health care delivery systems.

2016 ICBHTC Intern Class (left to right): Amanda Auerbach, Jessica Garner, Cassandra Simmons, Jennifer Chmura, Delilah Portalatin, Anthony Barlog. Not pictured: Rebecca Gonzalez.

2016 ICBHTC Intern Class (left to right): Amanda Auerbach, Jessica Garner, Cassandra Simmons, Jennifer Chmura, Delilah Portalatin, Anthony Barlog. Not pictured: Rebecca Gonzalez.

National Reentry Week Highlights Key Elements of Criminal Justice Reform

The U.S. Department of Justice has designated April 24-30 as National Reentry Week, highlighting efforts to support successful community reintegration for men and women who have been incarcerated.

Renewed community reentry strategies are part of a wave of criminal justice reforms across the country. These initiatives involve reversing decades-old policies and practices that not only have fueled record incarceration rates, but also have created substantial reentry barriers for people who have paid their debt to society. Such barriers include practices and policies that bar or inhibit people with offense records from accessing rehabilitative care, employment, and affordable housing.

The collateral consequences of a criminal conviction extend beyond the direct consequences issued by a sentencing court. These penalties and disadvantages are now well understood to contribute to stubborn recidivism rates. According to Department of Justice data, half of those released from state prisons returned within three years. Illinois’ recidivism rate mirrors the national trend, with 47 percent of individuals released from prison returning within that time frame.

Compounding the harms of collateral consequences are disproportionately high rates of substance use disorders among incarcerated individuals, and sparse treatment and recovery support within institutions and following incarceration. Research has identified problem substance use as a “criminogenic” need—a dynamic risk factor that can be changed—and it is increasingly recognized by reform efforts that seek to apply evidence-based approaches to reduce recidivism.

Reentry in Illinois

Faced with a prison population that increased by 650 percent since the 1970s and a system built to house 32,095 individuals with greater than ten thousand more than that currently behind bars, Illinois has undertaken efforts in recent years to reverse these trends.

In 2014, the Illinois state legislature convened a bi-cameral, bi-partisan Joint Criminal Justice Reform Committee to examine the current system, study the impact of current sentencing structure, and consider strategies for reform. In 2015, Governor Bruce Rauner issued Executive Order 15-14, creating the Illinois Criminal Justice and Sentencing Reform Commission, and tasking it with a goal of mapping out strategies to decrease the state prison population by 25 percent within 10 years. TASC President Pam Rodriguez is an appointed member of the Commission.

In its work to date, the Commission has affirmed that appropriate substance use treatment not only helps address the health and social problems among those involved in the justice system, but also decreases crime and recidivism:

“Building community capacity to address the criminogenic needs of offenders, such as behavioral health services, job training, and access to social services, is critical to reducing the prison population safely and sustaining the reduction over time.”

“Recommendation 12—Enhance rehabilitative programming in IDOC. Implement or expand evidence-based programming that targets criminogenic need, particularly cognitive behavioral therapy and substance abuse treatment. Prioritize access to programming to high-risk offenders. Evaluate those programs identified as promising and eliminate ineffective programs.”

Successful Reentry Models

Proven, evidence-based, and nationally recognized reentry models already exist in Illinois. The Sheridan and Southwestern prison drug treatment and reentry programs offer drug treatment services, both within the prison facility and in communities after release, and comprehensive reentry services, including TASC reentry case management and recovery support.

The programs have been rigorously evaluated. Individuals in the Sheridan prison reentry program have a 15 percent lower likelihood of return to prison within three years of release than comparable releasees who did not receive these services. Those successfully completing the program had even better recidivism outcomes, with a 44 percent lower likelihood of return to prison. The program operated at Southwestern Correctional Center has demonstrated comparable outcomes. A subsequent evaluation of the Sheridan program found that its recidivism benefits were still intact seven years after release.

Additionally, the programs were found to have generated combined annual savings of $5 million in reduced incarceration costs.

“There is substantial research on what works in reentry policies and practices,” says Rodriguez. “The more that our public systems, communities, and families understand and apply this knowledge, the more successful we can be together in reducing recidivism and restoring men and women to full citizenship in communities.”

Medicaid Expansion: Improving Access to Substance Use and Mental Health Treatment for Justice Populations

(Chicago) – April 2016 marks the third anniversary of Cook County’s groundbreaking jail-based Medicaid application project, through which people detained at the jail have received assistance in applying for health coverage. Some 15,000 detainees have gained Medicaid coverage since 2013, making Cook County’s initiative the nation’s largest and most ambitious projects of its kind to date.

Most of the 11 million admissions to local jails in the U.S. each year—646,000 are detained at any given time—represent people who have untreated medical and behavioral health issues, perpetuating cycles of arrest and incarceration. With health coverage, they have the means to access care in the community, which is far less expensive than corrections-based care and emergency rooms—the predominant healthcare options for uninsured people prior to Medicaid expansion.

What’s happening in Cook County is occurring in many counties and jurisdictions across the country, as local governments seek to reduce the cost burdens of corrections and emergency care, and ultimately improve public safety and public health.

Since Medicaid expansion came about as a result of the Affordable Care Act, TASC (Treatment Alternatives for Safe Communities) has been working with partners in Cook County and across the U.S. to bring aspects of this national public policy from concept to local implementation and results.

Early Adopters: Cook County and Medicaid Expansion

Before Medicaid expansion, nine out of 10 people entering jails lacked health insurance. At the same time, justice-involved populations have high rates of substance use disorders, mental health conditions, and chronic medical conditions requiring treatment during detention and immediately after release. For decades, large and small counties have struggled to meet these needs with very limited resources. The expansion of coverage to low-income adults provides new and welcome means to address this perennial challenge.

Cook County has been a national leader in implementing processes for Medicaid application assistance at the jail, having obtained a waiver in 2012 for early expansion of Medicaid. Transformation has come about through coordinated planning and collaboration between the Cook County Health and Hospitals System, the Cook County Sheriff’s Office, and TASC, aided by significant public and private support from the Cook County Justice Advisory Council, The Chicago Community Trust, the Michael Reese Health Trust, and the Polk Bros. Foundation.

A National Sea Change

TASC President Pam Rodriguez: We have "an unprecedented opportunity to shrink the oversized justice system."

TASC President Pam Rodriguez: We have “an unprecedented opportunity to shrink the oversized justice system.”

Building on the Cook County experience, the Center for Health and Justice at TASC works with counties and states to leverage available federal health care funding in order to create linkages to care, divert people from the justice system, and improve individual and community health. To these ends, and in partnership with the National Association of Counties, TASC provides national consulting, which also is supported by the Open Society Foundations and the Public Welfare Foundation.

Working in more than a dozen states, TASC has observed the following trends with regard to Medicaid expansion for justice populations:

  • The proportion of people entering large county jails with Medicaid coverage has increased from 10% to 40-60% since 2014;
  • Most jails in large urban counties are assisting some of their detainees in applying for coverage;
  • Jails vary as to where applications are taken. It is relatively rare to take applications at jail intake (as in Cook County). It is increasingly common for medical providers to assist with applications and for applications to be taken at release;
  • Jails in rural communities are less likely to have application processes in place, though there are notable examples of small and rural community jails taking Medicaid applications routinely; and
  • States such as New Mexico and Indiana have passed legislation that enables or requires state and county corrections to facilitate applications. These states are leading the way in building statewide infrastructure and processes that institutionalize access to coverage and care for people under justice supervision.

As coverage becomes more common, counties and states can build reentry systems and expand diversion from jail to services in the community. Elements of success in building these processes include:

  • Understanding the impact of coverage on people’s use of treatment for substance use disorders and psychiatric conditions after release and on subsequent arrests;
  • Building comprehensive systems that provide seamless bridges to care upon release from jail;
  • Expanding substance abuse and mental health capacity in the community to support safe reentry; and
  • Building jail diversion projects that take full advantage of these new health care services.

Ultimately, these systems changes are intended to bring about not only cost savings and the more efficient use of public resources, but a healthier society as well, where quality treatment and other health services are accessible in the community. “For decades now, jails have been inundated with people who have severe substance use and mental health conditions,” said TASC President Pam Rodriguez. “Medicaid expansion offers the means to change that. Together with our partners in the public and private sectors, we are leveraging an unprecedented opportunity to shrink the oversized justice system.”

U.S. Senate Passes Comprehensive Addiction and Recovery Act (CARA), Bipartisan Bill Moves to House of Representatives

On March 10, the U.S. Senate overwhelmingly approved the Comprehensive Addiction and Recovery Act (CARA). The legislation embodies a comprehensive response to addiction and the opioid crisis, earning the support of over 130 organizations—including TASC—in the fields of prevention, treatment, recovery, law enforcement, and state and local governments.

CARA garnered strong, bipartisan support in the Senate, passing on a vote of 94-1. Among the bill’s strong leaders and supporters were Senators Sheldon Whitehouse (D-RI), Rob Portman (R-OH), Amy Klobuchar (D-MN), and Kelly Ayotte (R-NH), as well as both Illinois Senators, Dick Durbin (D-IL) and Mark Kirk (R-IL).

More people died in 2014 from drug overdoses than in any previous year on record, according to the Centers for Disease Control and Prevention. The vast majority of people who need addiction treatment do not receive it. The Substance Abuse and Mental Health Services Administration estimates that only 2.6 million of the 22.5 million people across the country who needed help with a substance use disorder got it in 2014. The treatment gap also exists for people in prisons and jails, where an estimated 85 percent have been found to be substance-involved, but only 11 percent received any kind of treatment.

CARA’s key provisions include:

  • Expanding the availability of naloxone—an overdose antidote—to law enforcement and first responders to help save lives.
  • Expanding resources to identify and treat incarcerated individuals with addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence­based treatment.
  • Launching an evidence-­based opioid and heroin treatment and intervention program to expand best practices throughout the country.
  • Launching a medication-assisted treatment and intervention demonstration program.

Appropriations to implement the bill were not included in the legislation.

For more information about CARA, visit here, and to ask your U.S. Representative to support the bill, click here.