TASC Opposes the Gutting of Medicaid

(Chicago) – TASC stands in opposition to the proposed massive cuts to Medicaid under the U.S. Senate’s draft Better Care Reconciliation Act of 2017, which would repeal and replace the Affordable Care Act. We share this opposition with our partners—including the National Association of Addiction Treatment Providers (NAATP), the Illinois Association for Behavioral Health, and the National Council—along with a majority of Americans.

Under the Senate’s proposed bill, the expansion of Medicaid that occurred under the ACA would be reversed, with phase-out beginning in 2021. By making Medicaid expansion much more expensive for states, they will be more likely to end their expansion programs. 

Under the Affordable Care Act, Illinois was among the majority of states that expanded Medicaid, which provides federally funded health insurance for low-income people. By attacking this key provision, both the U.S. House’s American Health Care Act (AHCA) and the Senate’s version of the bill topple the cornerstone upon which significant aspects of Illinois’ interconnected public health and public safety strategies rely.

Additionally, both the House and Senate versions give states the ability to modify or eliminate the ten essential benefit requirements, no longer safeguarding addiction treatment as an essential covered benefit—even as the opioid crisis has caused overdose deaths to skyrocket.

More than three million Illinoisans—almost one-quarter of the state’s population—are enrolled in Medicaid coverage. By diminishing Medicaid coverage, and throwing costs back on the state, the proposed legislation will further burden Illinois’ state budget, already drowning in record deficits. As an example, in behavioral health services alone, the State would have to replace an estimated $80 million per year in federal Medicaid resources to pay for community-based substance use and mental health services that would support alternatives to incarceration and reentry initiatives.

The Henry J. Kaiser Family Foundation, a leading non-partisan source for health policy analysis, reports that, “The majority of the public – regardless of partisanship – hold favorable views of Medicaid, the government health insurance and long-term care program for low-income adults and children.” Three fourths have a favorable view, and 67 percent say the program is working well for most low-income people in their state.

Drew Altman, the foundations’s president and chief executive wrote, “And you cannot cut over $800 billion from Medicaid without adversely affecting health services for the poor.”

 

Collateral Consequences of Convictions

(Chicago) – TASC submitted comments for the May 19 briefing of the U.S. Commission on Civil Rights on Collateral Consequences: The Crossroads of Punishment, Redemption, and the Effects on Communities.

The briefing focused on the barriers to successful community reentry for formerly incarcerated individuals. According to the Commission, “They may face numerous barriers to reentry, including denial of governmental assistance designed to assist with finding employment. These collateral consequences affect families of the formerly incarcerated in a multitude of ways. For decades, communities of color have been disproportionately represented in the rates of felony convictions, and therefore are hardest hit.”

These barriers are mirrored in Illinois, and are experienced by TASC clients, even decades after they have paid their debt to society and resumed a law-abiding life. Barred access to employment and housing opportunities also create added challenges for individuals who are also striving to overcome substance use and mental health disorders.

Below is a synopsis of TASC’s comments, offering observations from decades of experience working to support diversion to community-based behavioral health treatment for men and women involved in the justice system, as well as reentry support following release from incarceration:


[Barriers to reentry and disproportionate minority contact are among] the reasons that TASC actively pursues strategies and opportunities that reduce the number of people entering the justice system. We seek to divert people away at every intervention point, and we promote avenues to health and recovery in the community so individuals do not return to the system.

We worked with and drafted reports on behalf of the Illinois Disproportionate Justice Impact Study (DJIS) Commission and Illinois Racial and Ethnic Impact [REI] Research Task Force) to evaluate and address disparities in the justice system. We conducted several surveys of diversion programs across the country and in Illinois that prevent criminal convictions on record, offering observations and recommendations for improvement and expansion.

We seek ways to improve access to healthcare coverage for those who come in contact with the justice system. Recently we have collaborated with jurisdictions in exploring law enforcement diversion practices for drug-involved individuals, a need that has become even more visible and accentuated in the midst of the opioid crisis.

We recognize that there are many individuals in the justice system who are less likely to return to the system if they have access to behavioral health services, and we know that a criminal record acts as a barrier to recovery, restored citizenship, and community reintegration. Improving access to and connecting justice-involved populations to community-based services may help reduce the racial disparities that exist throughout the criminal justice system. It is good health policy. It is good justice policy. It is good public policy.

In our decades of work in these fields, we have made a number of observations about the state of safe, responsible criminal justice diversion that we hope will inform the Commission’s work.

  • The criminal justice system has become a de facto societal response to substance use and mental illness. Across the U.S., criminal justice systems are managing record numbers of people, with rates of substance use and mental health disorders that are much higher than those among the general public. More jurisdictions are focusing efforts to leverage resources toward management of these disorders in the community instead of the justice system, seeking to prevent taxpayer costs associated with incarceration and recidivism, as well as to support restored citizenship and second chances.
  • Numerous factors have led to broad-based calls for criminal justice reform. In recent years, a confluence of factors has created fertile ground for broad-based improvements to criminal justice policy and practice. These factors have included overburdened courts, crowded jails and prisons, strained government budgets, advances in the science of drug use intervention and recovery, shifting public attitudes about drug policy, awareness of the negative and residual impacts of justice involvement on families and communities, attention on the disparate burden of justice policies on racial/ethnic minority communities, and a preponderance of research on the effectiveness and cost efficiency of alternatives to incarceration.
  • Diversion policy should be focused on systems rather than programs. Modern justice policy is beginning to adopt public health strategies, focusing on broad-based, systemic intervention, and the application of the minimum but appropriate amount of supervision, sanctions, accountability, services, and resources to achieve the intended result.
  • Meaningful diversion can happen at any point before conviction. Initiatives can occur at points of contact with law enforcement, prosecutors and public defenders, pretrial services and probation, the judiciary, and even the jail. In cases where diversion before conviction isn’t an option, treatment-based alternatives to incarceration can prevent recidivism, taxpayer costs, and deleterious effects of confinement.
  • Evidence-based practices should inform decision-making. The most effective response to justice-involved individuals with substance use and mental health issues is a locally defined balance of supervision, accountability, and community treatment and support. What is deemed appropriate should be driven by the ever-expanding base of research and data regarding which intervention models best serve a given population at a given point of justice involvement. A risk-needs-responsivity (RNR) approach offers particular promise in this context. Considered a best practice for criminal justice populations, this approach assesses both the risk of recidivism as well as needs related to substance use, mental health, and other social and environmental conditions, and determines the appropriate type and dose of treatments and other services necessary to maximize justice and health outcomes.
  • Responses should be data-driven, which may mean changes in methods and resource allocation related to data collection. Justice, health, and community resources should be allocated to those programs that demonstrate the greatest capacity to reduce recidivism, protect public order and safety, promote public health, and promote equal and fair access to alternative options, while also mitigating the need for costly justice supervision. These determinations will be most successful if uniform data are collected and used—including measures related to the race/ethnicity of participants—and if programs take formal steps to develop standardized outcome measures (cost-, public safety-, and public health-based), and measure, analyze, monitor, and share results.
  • Arbitrary prohibitions on eligibility are counter-productive. Many jurisdictions still set limits on participation in diversion programs based on offense history or type, such as accepting only people with first-time or “low-level” offenses. Instead, jurisdictions can adopt strategies and interventions that focus on those individuals most likely to recidivate, and that consider factors other than just current charge and criminal history in determining an intervention plan (for example, through the use of individualized risk and needs assessments). The next generation of diversion programs should be able to determine and provide the appropriate level of services and justice supervision for each individual.
  • The field is continuing to evolve. The development of a common, shared language to discuss diversion and alternatives to incarceration is still in process. The need for clarity and specificity around the description of programs and models will be of increasing importance in the growing exchange of ideas, innovations, and best practices.

We are committed to continuing our work to connect people involved in or at risk for involvement in the justice system with community-based treatment and services for behavioral health conditions, to promote and support diversion and alternative options that prevent criminal convictions on record whenever appropriate and possible, and to advance policies and practices that reduce disproportionate minority contact with the justice system.

OP-ED: Revamping of Health Law Could Be Costly to Illinois

As Congress prepares to replace the Affordable Care Act, it is essential that the Medicaid expansion provision of the law be protected.

Any rollback of federal Medicaid coverage would be particularly harmful to Illinois, especially as our state grapples with budget deficits, an opioid epidemic, and an overburdened criminal justice system.

Under the ACA, Illinois was among the majority of states that expanded Medicaid, which provides federally-funded health insurance for low-income people. In a January letter to congressional leaders, the Rauner administration expressed concern about potential changes to Medicaid, pointing out that 3.2 million Illinoisans—almost one-quarter of the state’s population—are enrolled in coverage. 

Reducing Medicaid coverage would deprive Illinois of millions of dollars per year in federal support. As an example, in behavioral health services alone, the state would have to replace an estimated $80 million per year in federal Medicaid resources to pay for community-based substance use and mental health services that would support alternatives to incarceration and reentry initiatives.

Second, such changes would fly in the face of efforts to address the opioid epidemic that is devastating Illinois communities. Nineteen Illinois sheriffs, prosecutors, and police chiefs recently signed a letter to Congress urging action against any policy changes that would make it even harder for low-income individuals to access addiction and/or mental health treatment. Lack of treatment access impairs law enforcement’s ability to prevent overdose deaths and to make our communities safer.  

Finally, rolling back Medicaid coverage would hamstring Illinois’ successful bipartisan progress toward reforming the criminal justice system. Coverage for addiction and mental health services is essential to the state’s strategy for preventing crime, reducing recidivism, and avoiding the $41,000 per person annual average cost of incarceration for those whose non-violent offenses stem from untreated health conditions.

It is well recognized that there are aspects of the Affordable Care Act that must be overhauled. However, as changes are made, and to expound on what the Governor’s administration and criminal justice experts have written, it would be foolhardy and counter-productive if those changes include an attack on Medicaid coverage. Illinois can ill afford such a loss.

Pamela F. Rodriguez, President & CEO of TASC

TASC President Pam Rodriguez


Pamela F .Rodriguez is president and CEO of Treatment Alternatives for Safe Communities (TASC, Inc.) and a member of Governor Rauner’s Illinois State Commission on Criminal Justice and Sentencing Reform.

Addiction Policy Forum and National Criminal Justice Association Partner to Translate Opioid Research to Practice

[On Monday, August 8 from 1:45-3:15 PM EDT (12:45-2:15 PM Central), the National Forum on Criminal Justice will livestream a panel discussion on Strategies for Combating the Opioid Epidemic. TASC President Pam Rodriguez is among the speakers. Register for livestream.]

The Addiction Policy Forum and the National Criminal Justice Association have announced a new partnership, the Translating Science into Practice Project, which will focus on translating the current research on opioid addiction and treatment into policy and practice in the field.

TASC is an active partner with the Addiction Policy Forum, which is comprised of organizations, policymakers, and stakeholders committed to comprehensive approaches to addiction prevention, treatment, recovery, and criminal justice reform.

The first step in the Translating Science into Practice Project is a livestream session on alternatives to incarceration during the National Forum on Criminal Justice in Philadelphia on August 8.  TASC President Pam Rodriguez, a leading voice in advancing front-end criminal justice diversion strategies, is among the expert panelists in this session. TASC has been involved in both studying diversion and in implementing innovative programming nationally as well as in its home state of Illinois.

The forum will be followed by a five-webinar series in the fall of 2016 that will provide policymakers and practitioners with details about policies that are working to reduce and treat addiction, including to prescription drugs, heroin and other opioids.

The Addiction Policy Forum has identified 11 practices across six key elements of addressing addiction: prevention, treatment, overdose reversal, recovery, law enforcement, and criminal justice reform. The state criminal justice administering agencies represented by the National Criminal Justice Association conduct comprehensive statewide planning and fund innovative, data-driven criminal justice policies and practices. They are engaged in finding and funding solutions to the opioid epidemic.

In collaboration with the Addiction Policy Forum, the Center for Health and Justice at TASC served as a partner in planning and facilitating briefings on addiction treatment and recovery, which contributed to the Comprehensive Addiction and Recovery Act, introduced originally in 2014 by U.S. Senators Sheldon Whitehouse (D-RI) and Rob Portman (R-OH), and signed into law on July 22 by President Barack Obama.

 (Source: Addiction Policy Forum)

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.

 

342,000 Low-Income Illinois Citizens to Have Access to Medical Care, Treatment for Substance Use and Mental Health Conditions, Beginning January 1

(Chicago) – In 90 days, 342,000 low-income Illinois citizens will have access to health care, including many of those involved in the Illinois criminal justice system who require treatment for mental health, substance use, and medical conditions.

On July 22, Governor Pat Quinn signed legislation, Senate Bill 26, that authorized Illinois’ participation in the new national health reform law called the Affordable Care Act.

As one of the outcomes of this legislation, starting on January 1, 2014, adults aged 19 through 64 with incomes below 138 percent of the Federal Poverty Level (about $15,400 per year for an individual and $20,000 per year for a couple) will gain access to Illinois Medicaid coverage.

What this means is that uninsured, low-income adults—describing the majority of individuals in Illinois jails and prisons—will have greater access to treatment for substance use and mental health conditions that often contribute to their criminal behavior. Eighty-six percent of male arrestees in Cook County, for example, test positive for illicit drugs. Nationally, about a quarter of people in jail convicted of property and drug offenses had committed their crimes to get money for drugs.

In addition to improving treatment access for low-income populations, the new law also answers a resounding public call: A Cook County referendum on state funding for substance abuse treatment passed overwhelmingly in 2004, with more than one million voters saying the state should pay for drug and alcohol treatment for any Illinois resident who demands it.

A long time coming, the new health care law begins to answer this public demand by providing the means to fund treatment programs.

Under the legislation, the federal government will pay 100 percent of the costs of the new Illinois Medicaid enrollees from 2014 through 2016. Starting in 2017, the match rate gradually will be reduced: 95 percent in 2017; 94 percent in 2018; 93 percent in 2019; and 90 percent in 2020.

The share paid by the federal government for care in Illinois will never dip below a 90 percent.

Even if the federal government were to change the law’s financing terms, Illinois’ share would never be more than 10 cents on each dollar spent on new Medicaid recipients. The legislation signed by Quinn includes language that would discontinue coverage if the federal government’s share of Medicaid matching funds drops below 90 percent.

Illinois currently receives a 50 percent match from the federal government for health programs under terms of the existing Medicaid program.

For individuals involved in the Illinois criminal justice system, the Illinois Medicaid expansion is critical, because they will be able to access adequate medical care and, equally if not more importantly, behavioral health care such as substance use treatment and mental health care, many for the first time, according to TASC President Pamela Rodriguez.

“TASC strongly supported this legislation because rates of addiction and mental health disorders are disproportionately high in the criminal justice population. Access to care for these conditions can help break costly cycles of crime and recidivism,” said Rodriguez. “Additionally, the new health law will help save counties and the state of Illinois enormous sums of money on justice and uncompensated health care costs.”

Rodriguez pointed out that the national and Illinois record on Medicaid access has been solid, noting that “Illinois has received bonus payments totaling over $50 million over the past four years for meeting enrollment targets and having program simplifications in place for our Medicaid and Children’s Health Insurance Program.”

Additionally, Medicaid cost controls outperform both Medicare and private health insurance. Nationally, the per enrollee cost growth in Medicaid is 6.1 percent, which is lower than the per enrollee cost growth in comparable coverage under Medicare (6.9 percent), private health insurance (10.6 percent), and monthly premiums for employer-sponsored coverage (12.6 percent).

To help criminal justice organizations and agencies establish enrollment processes, the Substance Abuse and Mental Health Services Administration (SAMHSA) has launched an online toolkit entitled, “Getting Ready for the Health Insurance Marketplace.” This narrated presentation describes the health care law, explains how the Health Insurance Marketplace works, and provides communication ideas and materials from the Centers for Medicaid & Medicare Services (CMS) for use in increasing awareness and helping uninsured individuals apply for coverage.

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