Transcript Correctional Policy and Planning: Preparing for National

RSAT Correctional Policy and
Planning: Preparing for National
Health Reform
Lisa Braude, Ph.D.
[email protected]
Lisa Braude, Ph.D.
Senior Health Policy Consultant
Advocates for Human Potential
www.ahpnet.com
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Learning Objectives
After completing this webinar, participants will be able to:
 Understand basic components of national health reform
and its application to correctional populations;
 Identify steps RSAT staff can take to plan for national
health reform for correctional populations and
reentering inmates; and
 Discuss potential benefits and challenges national health
reform presents for RSAT correctional administrators and
staff.
7/17/2015
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Lack of Insurance
 Most people in justice systems don’t have health
insurance; only 10% do.
 Medicaid/disability, CHIPS, Family Care, Private
Insurance
 State Medicaid rules may exclude most childless adults
 Those with Medicaid may get unnecessarily dropped
while incarcerated
 Once released, little assistance reinstating benefits
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Fragmented funding streams...
 Public SA/MH supported largely by federal block grants &
categorical Medicaid eligibility (MH)
 Federal Justice and Human Services funding streams/
initiatives
 State and County-level funding
 Pursuit of non-block grant funding requires long RFA
processes for only incremental increases
 Uncoordinated funding creates isolated pockets of
service, not seamless continuums of care
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Overview of the ACA
What is National Health Reform?
(The Affordable Care Act)
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The Affordable Care Act
The Affordable Care Act, which becomes fully enacted
in 2014, is the expansion of Medicaid eligibility to all
individuals at or below 133% of the federal poverty
level, regardless of their parental or marital status,
disability determination, age level or justice-system
involvement.
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The Affordable Care Act
Law enacted in March 2010:
Expand access to under-served populations
Regardless of disability (up to 133% FPL)
Improve health outcomes
Maximize efficiency of public health expenditures
Opportunity to shift from programs to system-level
interventions
Create comprehensive linkages between criminal
justice and community behavioral health
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The Affordable Care Act

The Surgeon General’s report of priorities for
national healthcare:


Justice population cost containment opportunity to
Medicaid and Medicare of tremendous magnitude.
At least 35 percent of new Medicaid enrollees under
the Affordable Care Act will have a history of
involvement in the justice system.
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Potential Outcomes

As RSAT releasees receive better healthcare in the
community, technical violations and new offenses
will decrease as behavioral health factors
contributing to reoffending are reduced.

National health reform presents an opportunity for
RSAT programs to improve efficiency and reduce
duplication in information collection.
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Status of Implementation
 The Federal and state govt. are currently in the planning
process, implementing early phases (e.g. pre-existing
condition provisions)
States are in varying stages of implementation
 Building health insurance exchanges & enrollment
procedures
 Federal “essential benefit” plan expected within the next
year – Note: decision shifted to states (2011)
 Medicaid expansion takes effect January 1, 2014
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The Benefits for RSAT Inmates
1) A comprehensive network of services
Unique opportunity for significant change on a broad scale
Near universal coverage
Eliminate long waiting lists
Address gaps in services
Ending piecemeal approach to application of public
funding
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The Benefits for RSAT Inmates
2) Service Integration
Physical and behavioral health needs will be treated in
tandem
3) Cost reduction
Expanded capacity as happened in 12 states that have
already expanded Medicaid coverage
WA State results: 17- 33% reduction in arrests after
treatment WITHOUT CJS LEVERAGE
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Notable Issues

“Inmates” will still be ineligible for Medicaid
reimbursement, but can be screened, assessed, and
create an application during incarceration.

For individuals who do not meet this threshold, it
governs participation in a state-run health insurance
exchange.

The only exception is undocumented immigrants, which
will impact different communities differently depending
on how large the population.
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The Benefits for RSAT Programs
1) Increases access to and retention in behavioral health
services upon release.
Former RSAT inmates seek medical care upon release
however they often lack health insurance and do not seek
preventative or reactive health care services, rendering
them at risk for future justice involvement (Freudenberg, et.
al., 2005; Visher, LaVigne, Travis, 2004).
2) Opens up Medicaid to adult, childless males.
Former RSAT inmates who may be Medicaid-eligible may
not be identified and linked to public benefits.
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The Benefits for RSAT Inmates
3) Assists corrections in prioritizing the highest risk,
highest need populations.
 RSAT inmates: known release date and a specified length
of programmatic engagement.
 Prison and jail administrators have an opportunity to
improve linkages to community health centers so that
people who receive medical workups in jail can continue
their treatment without having to start over after
release.
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The Benefits for RSAT Inmates
In summary:



All parolees should be covered with private insurance, a
health insurance exchange plan.
Linkages to community services, which reduce risk
factors and strengthen lessons-learned will increase.
Reduces revolving door. Improves outcomes.
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RSAT Planning
Activities
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Intake
1. Screen for health and behavioral health needs
All RSAT inmates should receive a standardized, evidencebased screening that will provide the initial base of
information regarding next steps. The information should
be considered along with criminogenic risks, protective
factors, the role of substances in the crime, patterns of use,
and motivation/readiness to participate.
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Intake
2. Screen for benefits
The initial screening into RSAT should include questions
about prior and current (pre-incarceration) receipt of public
benefits. Information about income will have to be
provided by inmates to confirm the 133% below poverty
level requirement for Medicaid. A “flag” should be added
to RSAT inmate files to reflect benefit status and eligibility
to assist in enrollment during the pre-release phase.
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Pre-release Planning: Advocacy
3. Suspend (not terminate) benefits (RSAT can advocate)
Federal Social Security policy currently allows states to
suspend, rather than terminate Medicaid coverage for
inmates incarcerated for twelve consecutive months or less.
However, many states terminate Social Security, and
therefore Medicaid benefits for inmates at various points of
incarceration.
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Reentry
4) Enhance reentry services for RSAT inmates who have
had treatment inside correctional centers
 Research shows that pre- and post-release treatment
together have the greatest impact
 Reduce parole violations due to untreated substance use
and psychiatric disorders
 Increased access to community based treatment as an
alternative to re-incarceration
 Gain these results across all parolees, not just in smaller
“demonstration” programs
 Universal access to SUD/MH services on release
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Reentry
4) Identify Medicaid-funded services and develop new
partnerships
 With the expansion of Medicaid, RSAT pre-release staff
should identify services which were not previously open
to RSAT inmates. For example, Medicaid may now
support recovery homes, medicated assisted treatment
and wellness visits.
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Cross-System
5) Engage in information sharing
The success of health reform implementation will
hinge on the extent to which systems share
information with one another and use that
information to improve the efficiency and
effectiveness of service provision
RSAT staff should share information with
community-based providers (to the extent
Allowable by privacy laws)
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Stakeholder Roles
 Wardens, RSAT Program Directors & Parole Chiefs:
Convene planning processes
Partner with correctional and community / health
care providers and funders to bring diversion and reentry initiatives to scale
Represent concerns of public safety and behavioral
health interventions from the CJ perspective
Advocate for treatment resources needed to reduce
recidivism
Ensure sufficient duration & intensity to create
durable recovery
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Stakeholder Roles
 State Funding Administrators/Policy Makers:
Ask questions about health care reform
implementation in your state
Influence direction through department leadership
associations
If you live in one of the 12 states that have adopted
coverage for low-income single adults, you may be
able to do this now
Additional system shaping may be needed
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Challenges
 State Medicaid authority – primary funder/rules
Medicaid managed care & CJS
 Essential services
Need sufficient duration & intensity
 Workforce
Teams: Licensed counselor + CADC + recovery support
specialist (FAVOR)
 Medicaid certification & billing
 Greater individualization of care plans
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Challenges
 “Medically necessary” in justice context:
Incarceration suppresses use
Substance dependence is chronic – symptoms may
disappear temporarily – likely to reappear
Disconnect with how medical necessity is traditionally
determined
Clinical treatment still necessary to manage illness and
build recovery
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Challenges
 “Net-widening” – expansion of intervention program
actually leads to increased numbers in the justice system:
More technical violations
Lower risk offenders placed into more intensive
supervision to ensure access to care
Medicaid may recommend less-intensive levels of
care, judges may be reluctant and impose harsher
sentences
Criminal justice partners need to be involved in
planning for ACA expansion
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Challenges
 Significant expansion of Medicaid managed care in many
states
 Figuring out how to make technological systems and
different partners work together effectively
 Accessing treatment once treatment is funded
 Developing new relationships with providers: community
health centers, who are working hard to expand their
capacity through the addition of and new types of healthcare
providers, such as “physician extenders” or “patient
navigators” to increase efficiency and patient wellness.
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Challenges
The federal government developed a “floor” for services
that must be covered called the essential benefits plan.
States have to pay for any services not included in this plan,
so criminal justice system partners should be providing
input now on what should be considered essential.
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Challenges
 Increasing capacity of community providers. Managing
current budgetary challenges while planning for a new
healthcare environment.
 Struggles between the state legislature and state
agencies. Many of the laws within the ACA require state
legislatures to pass state laws allowing state agencies to
set up new systems, processes, and protocols.
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Health Reform Planning
Who should be at the RSAT
planning table?
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Resources
COCHS Conference Papers
http://www.cochs.org/health_reform_conference_dc/papers
SAMHSA Presentation on HCR from the treatment
provider/system perspective
http://www.saasniatx.net/Presentation/2011/HCRforProvidersNIATX-Julyl2011-RitaVandivort.pdf
Council for State Governments FAQ on HCR
http://consensusproject.org/announcements/new-csg-justicecenter-faq-on-health-reform-legislation
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Next Presentation
Reducing Recidivism and Promoting Recovery: Implications of
National and State Trends for Improving Treatment Programs
October 17, 2012 2:00 – 3:00 p.m. EDT
Research indicates that the reentry programs that are most effective at reducing recidivism focus
on those that are most likely to reoffend, provide continuing care post-release, and incorporate
other key evidence-based treatment practices. Given that scarce resources severely limit the
number of individuals who are able to participate in treatment services, corrections and behavioral
health practitioners must maximize available resources to improve public safety and promote the
health of justice-involved persons with behavioral disorders. This presentation will discuss the
implications of national and state trends that are changing the way practitioners and systems work.
It will also introduce a framework that synthesizes ‘what works’ in behavioral health and criminal
justice in order to help agencies prioritize and address the behavioral health and criminal justice
supervision needs of adults in the criminal justice system. In addition, the presentation will identify
‘lessons learned’ from programs funded by the Second Chance Act about how to support successful
reentry for individuals with behavioral health needs.
Presenter: Alexa Eggleston
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