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.”

Sheriff Tom Dart, Bill O’Donnell Receive TASC Leadership Awards; Access to Healthcare and Recovery Highlighted at Annual Event

(Chicago) – TASC held its 2015 Leadership Awards Luncheon on December 10, honoring Cook County Sheriff Tom Dart and entrepreneur Bill O’Donnell for their advocacy on behalf of people with mental health and substance use disorders.

“Sheriff Dart has called national attention to the injustice of using county jails to house people with mental health conditions,” said TASC President Pam Rodriguez in presenting TASC’s Justice Leadership Award. “He has supported Medicaid enrollment and other activities to ensure continuity of care for people detained at the Cook County Jail.”

To the applause of more than 300 guests at the Westin Michigan Avenue in Chicago, Dart reported that 12,000 people have successfully signed up for insurance at the jail via the Affordable Care Act (ACA). “People who never had insurance now have insurance,” he said. “It is absolutely amazing what this collective work has done.”

Since 2013, the Cook County Sheriff’s Office, working with TASC and the Cook County Health and Hospitals System, has enabled individuals detained at the jail to apply for health insurance. Prior to the expansion of Medicaid under the ACA, the vast majority of people entering U.S. jails lacked insurance, hindering their access to treatment for chronic substance use and mental health conditions that often contribute to rearrest.

The prevalence of these conditions in the justice system is not new, Dart observed. “These are issues that have been around for a while. And it’s with partnerships, working with TASC, that we’ve been able to make incredible change.”

TASC Public Voice Award Recipient Bill O’Donnell noted that he might well have gone to jail for his behavior while he was in the throes of addiction. Coming from a family driven to “achieve, achieve, achieve,” O’Donnell was a successful businessman who became addicted to alcohol and cocaine in the 1970s.

“It wasn’t until I got into treatment the second or third time… that I ever asked myself the question, ‘Why is it that I even need the marijuana, the booze, the coke, to change the way I felt?’” O’Donnell recalled. “Recovery and life and awareness is an inside job. You get can get help, you can get direction, you can get love, you can get guidance—but it’s an inside job.”

O’Donnell went on to found Sierra Tucson in 1983, an internationally-recognized treatment center that was among the first to involve family members in the recovery process.

TASC Executive Vice President Peter Palanca praised O’Donnell for his openness and high-profile voice for recovery. “Twenty-three million are in long-term recovery in this country and it’s still the most stigmatized illness,” said Palanca. “Bill was one of the first corporate leaders to speak openly about his addiction. He is a powerful voice for recovery.”

The value of helping one another was highlighted in two videos accompanying speakers’ remarks. Dart introduced a video depicting personal stories of people who now have health insurance thanks to enrollment efforts at the jail, and Rodriguez presented a video featuring participants in Winners’ Circles, which are peer-led recovery support groups for people who have been involved in the justice system.

TASC has been engaged in initiatives at the intersection of health and social justice since 1976, explained TASC Board Chair Cecil Curtwright. “I believe that our highest human calling is to help others—directly, if possible, and if not possible, to support those who do, with whatever means and talents available to us,” said Curtwright, who is the associate vice provost for academic and enrollment services at the University of Illinois at Chicago.

Among other dignitaries attending TASC’s event were previous honorees, including Gino DiVito, retired appellate court justice; Melody Heaps, TASC founder and president emeritus; and Toni Preckwinkle, president of the Cook County Board of Commissioners.

Chairing TASC’s 2015 event committee was John Zielinski, vice president and financial advisor at William Blair, who, along with other volunteers and generous donors, guided TASC’s most successful fundraising campaign to date. Zielinski extended special thanks to Blue Cross and Blue Shield of Illinois, the presenting sponsor of the event, along with numerous other generous sponsors and raffle prize donors.

“TASC is successful because we work together,” said Rodriguez. “Thanks to science and treatment parity, thanks to the Affordable Care Act and the efforts of TASC and our community partners, and especially thanks to all of you, more and more men and women are finding the treatment, the support, and the hope and tenacity needed to build and strengthen those delicate roots into lifetimes of recovery.”

TASC 2015 Leadership Awards Luncheon. Left to right: TASC Board Chair Cecil Curtwright, Justice Leadership Award Honoree Tom Dart, Public Voice Leadership Award Honoree Bill O'Donnell, TASC President Pam Rodriguez. Photo by Uk Studio.

TASC 2015 Leadership Awards Luncheon in Chicago. Left to right: TASC Board Chair Cecil Curtwright, Justice Leadership Honoree Tom Dart, Public Voice Leadership Honoree Bill O’Donnell, TASC President Pam Rodriguez.

Supporters filled the Westin Michigan Avenue ballroom for TASC's 2015 Leadership Awards Luncheon. Photo by Uk Studio.

Supporters filled the Westin Michigan Avenue ballroom for TASC’s 2015 Leadership Awards Luncheon. Photos by Uk Studio.

2015 TASC Leadership Awards Luncheon to Honor Cook County Sheriff Tom Dart, Entrepreneur Bill O’Donnell

(Chicago) – With a commitment to reducing incarceration and increasing opportunities for recovery, TASC will honor two leading voices in these movements at the agency’s 2015 Leadership Awards Luncheon on December 10.

Cook County Sheriff Thomas J. Dart will receive TASC’s 2015 Justice Leadership Award and entrepreneur and recovery advocate William T. O’Donnell, Jr. will receive the agency’s 2015 Public Voice Leadership Award.

Blue Cross Blue Shield of Illinois will serve as the presenting sponsor of this year’s event, which supports TASC’s services across Illinois.

Dart is a national leader in calling for an end to the over-incarceration of people with mental health and substance use problems, advocating instead for available treatment and supports in the community.

Cook County Sheriff Tom Dart, TASC's 2015 Justice Leadership Award Honoree

Cook County Sheriff Tom Dart, TASC’s 2015 Justice Leadership Award Honoree.

Elected sheriff in 2006, Dart is responsible for the nation’s largest single site jail, which daily detains thousands of individuals who have mental health and substance use disorders. Until a few years ago, nine out of 10 jail detainees lacked healthcare coverage, thereby significantly hindering their access to community-based treatment. When Medicaid eligibility was expanded in 2013 to cover previously uninsured adults, the Cook County Sheriff’s Office, in partnership with TASC and the Cook County Health and Hospitals System, created processes for all individuals coming through the jail to apply for coverage. Since 2013, more than 25,000 people who have come through the Cook County Jail have applied for healthcare coverage, increasing their opportunities to access community-based care before they reach the justice system.

Dart continues to promote collaborative, community-based partnerships and linkages to care for people with complex health issues. Most recently, the sheriff’s office, along with TASC and Heartland Alliance, received a $1M grant from the University of Chicago Urban Labs to develop a Supportive Release Center for people with mental health issues who are exiting the jail.

“Sheriff Dart understands that the criminal justice system was never designed to be a health care provider,” said TASC President Pam Rodriguez. “We support and applaud his commitment to creating more sensible, effective, and dignified societal responses to behavioral health problems.”

Entrepreneur Bill O'Donnell, TASC's 2015 Public Voice Leadership Award Honoree

Entrepreneur Bill O’Donnell, TASC’s 2015 Public Voice Leadership Award Honoree.

Creating pathways to recovery has been the longtime mission of Bill O’Donnell, who will receive TASC’s Public Voice Leadership Award. A native of Chicago, O’Donnell resides in Wilmette and is managing director of ODE, LLC, an investment and development firm. He began his career with Bally Manufacturing and quickly ascended the corporate ladder, but addiction took its toll. O’Donnell’s subsequent personal journey and rejuvenation in recovery, combined with his business development expertise, led him to found Sierra Tucson in 1983, which he built into a world renowned addiction treatment center and dually licensed psychiatric hospital.

In 1995, O’Donnell also founded Miraval Resort, which has consistently received the highest ratings by industry publications. Along with a being a prominent business leader, he remains a voice for others who struggle with addiction, and also an advocate for family involvement in the treatment and recovery process.

“We are thrilled to be able to recognize Bill as a renowned leader in the treatment field,” said TASC Executive Vice President Peter Palanca. “From the outset of his work in the field, he understood that addiction is far beyond an individual struggle; it’s a family disease too. By creating clinical programs that include family members in the process, he not only has helped countless people achieve and maintain recovery, but he has helped families become stronger and healthier as well.”

TASC’s 2015 Leadership Awards Luncheon will take place at the Westin Michigan Avenue Chicago on Thursday, December 10 from 11:30 AM – 1:30 PM. Registration is requested by November 19. For sponsorship opportunities and additional information, please click here.

2015 Urban Labs Innovation Challenge Winners: TASC, Cook County Sheriff’s Office, Heartland Alliance Earn Grant for Supportive Release Center

(Chicago) – The University of Chicago announced the winners of the Urban Labs 2015 Innovation Challenge grants on October 12, including a $1M grant to TASC, the Heartland Alliance, and the Cook County Sheriff’s Office to support people with mental illness as they are released from the Cook County Jail.

Timothy Knowles, the Pritzker Director of Urban Labs, and Chicago Mayor Rahm Emanuel made the announcement during a Chicago Ideas Week event, which included a panel discussion with WomenOnCall.org founder and President Margot Pritzker, Philadelphia Mayor Michael Nutter, and host Cheryl Corley of NPR.

The 2015 Urban Labs Innovation Challenge focused on the areas of health, poverty, and energy and the environment. Advisory committees comprising civic leaders, practitioners, funders, and academic experts selected the grant winners from a pool of more than 100 applicants.

The grant will enable the launch of a Supportive Release Center to help individuals with mental illness transition to services in their communities following their release from the Cook County Jail. It also will include rigorous evaluation—conducted by the Health Lab—to empirically examine outcomes and better inform practitioners and policymakers about its effectiveness, cost-efficiency, and potential scalability in the long run.

“We are honored to partner with the University of Chicago Urban Labs, Heartland Alliance, and the Cook County Sheriff’s Office to develop solutions to the issues faced by people with mental illness who are leaving the jail,” said TASC President Pam Rodriguez. “This will help us create a safe, supportive environment to facilitate access to care. The project also will be closely evaluated, using a random controlled research design, so that it has the potential to become an evidence-based practice that could be replicated nationwide.”

The Urban Labs’ collaborative approach recognizes that many long-term challenges in cities are related, and require unified responses. Public-private partnerships are central to the approach of the project, and in fact Blue Cross Blue Shield of Illinois already has made a $50,000 commitment toward the Supportive Release Center.

The Cook County Jail admits approximately 100,000 men and women annually. Among the average daily population of 9,000, 20 to 30 percent are estimated to have a mental illness.

The project builds upon other collaborative strategies to improve access to health care for people leaving the jail. These aligned and reinforcing efforts include the Justice and Health Initiative funded by The Chicago Community Trust, the Justice Advisory Council, and the Cook County Health and Hospitals System, as well as the planning and pilot project funded by the Michael Reese Health Trust, and the service network innovation collaborative funded by the Polk Bros. Foundation.

For additional coverage of the announcement, see articles in the Chicago Tribune, Chicago Inno, DNAChicago, UChicagoNews, and social media posts at #InnovationChallenge.