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 people who cycle through the nation’s jails annually—646,000 are detained at any given time—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.

Twitter @TASC_CHJ

Association Recognizes Senator Dick Durbin, Congressman Danny Davis, and IL Senators Mattie Hunter and Kwame Raoul for Racial Justice Efforts

(Chicago, IL) —The Illinois Association for Criminal Justice (IACJ) presented awards on March 18 to U.S. Senator Dick Durbin, Congressman Danny K. Davis and Illinois State Senators Mattie Hunter and Kwame Raoul for legislative leadership in criminal justice policy.

Left to right: Illinois State Senator Kwame Raoul; IACJ Chair Diane Williams; Clarisol Duque on behalf of U.S. Senator Dick Durbin; Congressman Danny Davis; Illinois State Senator Mattie Hunter; IACJ Vice-Chair Pamela Rodriguez. Photo by David Ormsby.

The association’s inaugural event, held at the Safer Foundation in Chicago, featured a room filled to capacity with audience members who lauded legislators for their commitment and sponsorship of key legislation to advance fairness in the justice system.

The association recognized Senator Durbin for authoring the Fair Sentencing Act, which was signed into law in 2010 and reduces the sentencing disparity in the mandatory penalties for possession of crack versus powder cocaine.

IACJ awarded Congressman Davis for sponsoring the Second Chance Act, which provides federal seed grants for programs that assist individuals released from prison to successfully reenter society

Senators Hunter and Raoul also received the group’s recognition for state legislative drug crime reform efforts in Springfield. Hunter successfully sponsored the Illinois Disproportionate Justice Impact Study Commission law that addresses racial disparities in justice system’s response to drug crimes.

Raoul won approval for Illinois Crime Reduction Act, a measure that invests in community-based solutions to non-violent, drug-related crime.

“At the heart of our mission, our goals are to advance criminal justice reforms that guarantee equality for all under the law, create safer communities, and reduce the financial burden of expensive and unnecessary incarceration on taxpayers,” said IACJ President Diane Williams. “Congressman Davis and Senators Durbin, Hunter and Raoul embody those goals.”

“Our mission is to ensure that services and public policies are in place that will reduce crime and restore individuals to stability and productivity in their communities,” said Pamela Rodriguez, president of TASC (Treatment Alternatives for Safe Communities). “We’re here today because it’s vital to recognize legislative leaders when they take courageous stands in matters of fiscal responsibility and social justice. We care about these issues, we understand the impact of public policy in our communities, and we’re paying attention to what happens in Springfield and Washington.”

Founded in 2010, the mission of the Illinois Association for Criminal Justice (IACJ) is to ensure quality, comprehensive and coordinated services for people with criminal histories through the education of the public, advocacy, and community capacity building. TASC and the Safer Foundation are founding member organizations of IACJ.

IACJ to Honor U.S. Senator Dick Durbin, Congressman Danny K. Davis, IL Senator Mattie Hunter and IL Senator Kwame Raoul for Criminal Justice and Racial Justice Legislation

(Chicago, IL) —  Supporters of criminal justice reform are invited to join the Illinois Association for Criminal Justice (IACJ) in honoring legislators who have demonstrated key leadership in advancing racial and criminal justice.

IACJ’s awards will be presented at the Safer Foundation, 571 W. Jackson Blvd. in Chicago on Sunday, March 18, 2012 at 3:00 p.m.

  • The association will recognize the work of:U.S. Senator Dick Durbin, for sponsoring the Fair Sentencing Act, signed into law in 2010, which reduces the sentencing disparity in mandatory penalties for possession of crack versus powder cocaine. (Clarisol Duque, Chicago Director for the Office of Senator Durbin, will accept the award on the Senator’s behalf.)
  • U.S. Congressman Danny K. Davis, for sponsoring the Second Chance Act, originally signed into law in 2008, which provides federal seed grants for programs that assist individuals released from prison to successfully reenter society.
  • IL State Senator Mattie Hunter, for leading the Illinois Disproportionate Justice Impact Study Commission, which addresses racial disparities in the justice system’s response to drug crimes.
  • IL State Senator Kwame Raoul, for sponsoring the Illinois Crime Reduction Act, which invests in community-based solutions to non-violent, drug-related crime.

Recognizing that corrections reform is at the top of state and federal policy agendas, IACJ will honor legislators whose leadership has been instrumental in improving policy. The awards will be presented by Diane Williams, chair of the IACJ board and president of the Safer Foundation, and Pamela Rodriguez, vice-chair of the IACJ board and president of TASC (Treatment Alternatives for Safe Communities). The Safer Foundation and TASC are among the founding members of IACJ.

To confirm your attendance, please send an email with your name, title, and organization/affiliation to: Jon.Kaplan@SaferFoundation.org.

 

Congress Restores Second Chance Act Funding

(Chicago, IL)— Federal funding for Second Chance reentry programs, which had been cut by the Senate in September (see Sept. 16 post), has been restored. The House originally had approved $70 million for the Second Chance Act, but the Senate had eliminated the funding, leaving programs across the country in jeopardy for the 2012 fiscal year that began October 1.  

As reported in an electronic press release by the Legal Action Center on November 18, “In a dramatic victory for advocates and stakeholders who support smart approaches to reentry that reduce recidivism and improve lives and communities, the House and Senate negotiated the differences between the two bills and today passed legislation, signed into law by the President, that includes $63 million in funding for Second Chance in FY 2012. The funding level is remarkably close to the $70 million high-water mark set by the House…”

Persistent phone calls and emails from reentry advocates across the country made a difference.

“The restored funding is not only a testament to the value and necessity of evidence-based reentry services, but it’s also a reminder that our voices are heard in Washington,” said TASC President Pamela Rodriguez.  “We commend the members of Congress and our colleagues and fellow citizens across the country who recognized what’s at stake and insisted on the funding restoration.”

For details of the legislation, including funding for other criminal justice programs, please visit the Council of State GovernmentsKnowledge Center.

 

Congressman Danny Davis, White House Drug Policy Director Gil Kerlikowske Headline Oct. 17 Forum on Drug Prevention, Treatment, and Adjudication Programs

(Chicago, IL) – Congressman Danny Davis (D-IL) will convene a forum featuring Gil Kerlikowske, director of the White House Office of National Drug Control Policy and local drug prevention and treatment advocates to discuss the impact of Federal and local initiatives to combat recidivism and substance misuse.

The forum will take place at A Safe Haven, 2750 W. Roosevelt Road in Chicago on Monday, October 17 beginnin at 9:00 A.M.                 

The criminal justice system is the largest single source of referrals to substance abuse treatment in the U.S., comprising 37 percent of those in treatment. Criminal justice referrals are less likely to drop out of treatment and more likely to complete treatment than all other referrals (U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration). Illinois has implemented several alternative-to-incarceration models that redirect eligible people into community-based treatment from all points in the justice system (e.g., prosecution, court, and sentencing), thereby reducing substance misuse and recidivism while maintaining supervision and accountability.

The forum will feature two panels with Federal officials and local advocates. The first panel will discuss Federal initiatives available in the Chicago area, including civilian and veteran drug prevention programs and drug courts, and the second panel will highlight the success of local drug treatment and adjudication programs and their impact on the health and safety of local communities. 

Congressman Davis is the Ranking Member of the Subcommittee on Health Care, District of Columbia, Census and the National Archives, and lead sponsor of the Second Chance Act, which authorizes federal grants to entities that provide drug treatment, mental health care, housing and jobs for people newly released from prison.

Who:                Panel 1

  Panel 2

TASC, Inc. is an advocate of cost-effective alternatives to incarceration and is a member agency of the Illinois Alcoholism and Drug Dependence Association, represented on Panel 2.  

Members of the media and the general public are welcome to attend the forum.