Criminal Justice / Mental Health Consensus Project

1
COUNCIL OF STATE GOVERNMENTS EASTERN REGIONAL
CONFERENCE
Federal Benefits How to Ensure Prompt Access
Upon Release and Tap this Revenue Stream
Effectively Katherine Brown, Re-Entry Policy
Council, CSG Ann-Marie Louison, CASES (NY) April
26, 2005
2
PRISONER RE-ENTRY ACCESS TO BENEFITS
Understanding the Need

• More than 1 out of 3 jail inmates reports some
  physical or mental disability.
• Many are eligible for Medicaid or SSI/SSDI prior
  to incarceration.
• SSI/SSDI is suspended, and Medicaid may be
  terminated, after 30 days in a corrections
  facility.

3
PRISONER RE-ENTRY ACCESS TO BENEFITS
Research Implications
Study on Reentry, Mental Illness, and Public
Safety Congress directed the US Attorney
General to conduct a study to determine the
extent to which participation in public benefit
programs correlates with successful reentry and
improved public safety.
4
PRISONER RE-ENTRY ACCESS TO BENEFITS
Research Implications

• Study cohort people with mental illness released
  from King County (WA) and Pinellas County (FL)
  jails, who were enrolled in Medicaid at some time
  in the study period

5
PRISONER RE-ENTRY ACCESS TO BENEFITS
Research Implications

• Findings
• gained access to services faster

6
PRISONER RE-ENTRY ACCESS TO BENEFITS
Research Implications

• Findings
• gained access to services faster
• accessed significantly more services (in King
  County)

7
PRISONER RE-ENTRY ACCESS TO BENEFITS
Research Implications

• Findings
• gained access to services faster
• accessed significantly more services (in King
  County)
• had fewer detentions and were more likely to
  remain in the community after one year

8
PRISONER RE-ENTRY ACCESS TO BENEFITS
State Strategies and Innovations

• Four interagency state teams TX, PA, NY, MN
• Focus on Medicaid and SSI/SSDI for people with
  mental illness released from prison

9
PRISONER RE-ENTRY ACCESS TO BENEFITS
State Strategies and Innovations

• Elements Common to Successful Approaches
• Interagency agreements (including with federal
  agencies)
• Targeted initiative (agency or staff charged with
  boundary-spanning)
• Timely initiation of enrollment process

10
PRISONER RE-ENTRY ACCESS TO BENEFITS
State Strategies and Innovations

• Texas
• Texas Correctional Office on Offenders with
  Medical or Mental Impairments (TCOOMMI) has
  formal agreement with SSA for processing
  applications for people awaiting release

11
PRISONER RE-ENTRY ACCESS TO BENEFITS
State Strategies and Innovations

• Pennsylvania
• Department of Public Welfare developed COMPASS, a
  web-based application for multiple types of
  benefits, for use by any trained person

12
PRISONER RE-ENTRY ACCESS TO BENEFITS
State Strategies and Innovations

• Continuing Challenges
• Insufficient staff with specialized training
• Wide variation among county systems
• Inadequate follow-up post-release
• Difficulties identify those who need release
  planning or benefits
• Confusion over federal eligibility rules
• Other resource and procedural challenges

13
police chiefs people with criminal records
pretrial service administrators probation
officials state legislators substance
abuse treatment providers workforce
investment chairs judges district
attorneys prosecutors state alcohol and
drug abuse directors county executives
crime victims public housing administrators
victim advocates state corrections
directors public defenders court
administrators workforce development
officials researchers jail administrators
sheriffs supportive housing providers
state mental health directors parole
officials housing development officials
RE-ENTRY POLICY COUNCIL
Council of State Governments
Association of State Correctional Administrators
American Probation and Parole Association
National Association of Housing and Redevelopment
Officials National Association of State Alcohol
and Drug Abuse Directors National Association
of State Mental Health Program Directors
National Association of Workforce Boards
National Center for State Courts Corporation
for Supportive Housing Urban Institute Police
Executive Research Forum
14
RE-ENTRY POLICY COUNCIL
Katherine Brown Tel [phone]Fax (212)
482-2344kbrown_at_csg.org
www.reentrypolicy.org www.consensusproject.org Fu
nding support for the re-entry and benefits
project was provided in part by the Center for
Mental Health Services (CMHS), a division of the
US Department of Health and Human Services
Substance Abuse and Mental Health Services
Administration, and by the MacArthur Foundation.
15
FUNDING SERVICES THROUGH MEDICAID
Overview

• What is CASES?
• Why did CASES become a Medicaid service provider?
• How does it work?

16
CENTER FOR ALTERNATIVE SENTENCING AND EMPLOYMENT
SERVICES (CASES)

• CASES is an alternative to incarceration (ATI)
  agency.
• Mission is to increase the understanding and use
  of community sanctions that are fair, affordable,
  and consistent with public safety.

17
CENTER FOR ALTERNATIVE SENTENCING AND EMPLOYMENT
SERVICES (CASES)

• Mental Health Programs
• Nathaniel Assertive Community Treatment (ACT)
  program for felony offenders. Two-year ATI
  program.
• Nathaniel Project Intensive Case Management (ICM)
  program for felony offenders. Two-year ATI
  program
• Jail Diversion case management program for
  misdemeanor offenders. Six-month voluntary
  program.
• Supportive Case Management (SCM) Program for
  technical parole violators. Six-month program.

18
FUNDING SERVICES THROUGH MEDICAID
Overview

• What is CASES?
• Why did CASES become a Medicaid service provider?
• How does it work?

19
BECOMING A MEDICAID SERVICE PROVIDER

• Eliminate Barriers to Care
• The greatest challenge the Nathaniel Project
  faces is locating appropriate treatment services
  in the community. This has been difficult, both
  because of a general lack of services in NYC and
  because of the resistance many providers
  demonstrate toward working with clients with
  criminal justice involvement and/or histories of
  violence. (GAINS Program Brief, 2002)

20
BECOMING A MEDICAID SERVICE PROVIDER

• June 2003 CASES began to operate the licensed
  Nathaniel Assertive Community Treatment (ACT)
  program, two-year ATI with 68 treatment slots
• CASES responded to statewide RPF for ACT to
  sustain demonstration Nathaniel Project.
• Received waivers to provide ACT to criminal
  justice involved population
• Certified by NYS Office of Mental Health as
  licensed provider of ACT services
• Enrolled by NYS Department of Health as
  Medicaid Provider

21
BECOMING A MEDICAID SERVICE PROVIDER

• Plan and develop programs that provide Medicaid
  eligible services.
• Increase capacity in the local mental health
  system.
• Reduce the likelihood of displacement of
  non-criminal justice involved consumers.

22
FUNDING SERVICES THROUGH MEDICAID
Overview

• What is CASES?
• Why did CASES become a Medicaid service provider?
• How does it work?

23
INFRASTRUCTURE OF A MEDICAID SERVICE PROVIDER

• Blended funding mental health, Medicaid, and
  criminal justice
• Nathaniel ACT Team operations are funded by
  Medicaid, NYS Office of Mental Health (OMH), NYS
  Division of Probation and Correctional
  Alternatives (DPCA), and NYC Criminal Justice
  Coordinator.

24
INFRASTRUCTURE OF A MEDICAID SERVICE PROVIDER

• NYS Division of Probation and Correctional
  Alternatives and NYC Criminal Justice Coordinator
• Court Screening and Legal Advocacy Services
• Social Worker Peer Specialist
• Processing Referrals
• Interviewing defendants
• Writing reports to Judges and Prosecutors
• Case conferences with judges and prosecutors
• Liaison with jail-based discharge-planners
• Escorts on release from jail

25
INFRASTRUCTURE OF A MEDICAID SERVICE PROVIDER

• Medicaid and NYS Office of Mental Health (OMH)
• ACT Program Treatment Services
• Service Planning Coordination
• Integrated Treatment for Substance Abuse, Family
  Life Social Relationships
• Case Management
• Health, Money Management Entitlements
• Medication Support
• Wellness Self Management
• writing court reports
• escorts to court progress appearances

26
INFRASTRUCTURE OF A MEDICAID SERVICE PROVIDER

• Hire skilled clinicians committed to the
  population
• Train staff to provide comprehensive treatment
  services
• Establish and maintain clinical records
• Insure on-going quality improvement

27
INFRASTRUCTURE OF A MEDICAID SERVICE PROVIDER

• Treatment Plan
• Reimbursement is made only for services
  identified and provided in accordance with an
  individual treatment plan which develops,
  evaluates and revises an individuals course of
  treatment based on an assessment of the clients
  diagnosis, expressed desires, behavioral
  strengths and weaknesses, problems and service
  needs. (Part 508, Regulations of NYS
  Commissioner of Mental Health)

28
INFRASTRUCTURE OF A MEDICAID SERVICE PROVIDER

• Fiscal Infrastructure
• Hire billing staff
• Maintain standards for medical care and services
  in accordance with Medicaid standards
• Bill Medicaid and monitor revenue
• Develop quality assurance mechanisms to prepare
  for audits

29
INFRASTRUCTURE OF A MEDICAID SERVICE PROVIDER

• Database
• Capability to input participant service
  information, visits, progress notes, medications
  housing, hospitalization, legal data and
  collateral contacts
• Linked to Medicaid requirements and generates
  billing invoices and reports
• Tracks revenue-generating performance

30

• Ann-Marie Louison
• Director Technical Assistance
• 346 Broadway, 3rd Floor
• New York, NY 10013
• [phone]
• alouison_at_cases.org