Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day...
Transcript of Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day...
![Page 1: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/1.jpg)
Prepared by
Serving the Criminal Justice Population: Reentry & Community Health Programs
Medicaid Health Plans of America, National Conference
November 12, 2015 Steven Rosenberg
![Page 2: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/2.jpg)
Proprietary Companies and Justice Involved Individuals: October 2015 Developments
• “[Molina HealthCare] has agreed to acquire Providence Human Services, LLC, and Providence Community Services, LLC, both wholly owned subsidiaries of the Providence Service Corporation.” For more information on PCC and its practices: http://www.nytimes.com/2015/10/02/us/private-probation-company-accused-of-abuses-in-tennessee.html
• “Corrections Corporation of America [CCA] now also touts itself as the largest domestic owner of community corrections beds after buying Oklahoma-based halfway house operator Avalon Correctional Services… … In September, CCA also bought properties occupied by four community corrections facilities in Pennsylvania for about $13.5 million.” Source: http://www.tennessean.com/story/money/real-estate/2015/10/29/cca-deal-boosts-investment-half-way-houses/71674910/
2 September 2013
![Page 3: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/3.jpg)
Probation 3.9 Parole
0.9
Jail 0.7
Prison 1.5
U.S. Correctional Populations Single-Day Snapshot 2012
(millions)
September 2013 3
11.6
2.2
Jail Prison
Year-Long Snapshot (millions)
Who is involved in the criminal justice system?
3
![Page 4: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/4.jpg)
Health Status of Justice-Involved Individuals
• Justice-involved individuals are disproportionately young, male, persons of color, and poor.
• They have high rates of health problems (chronic and infectious disease, injuries), psychiatric disorders, and substance use disorders (SUDs).
• 80% of individuals in jail with chronic medical conditions have not received treatment in the community prior to arrest.
4 September 2013
![Page 5: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/5.jpg)
Health Status of Justice-Involved Individuals
• Jails have become de facto behavioral health providers in many communities: – Mental Health Problem: 64% of jail inmates. – Serious Mental Illness: 15% for men and 31% for
women. – Co-occurring Substance Use Disorder: 72% of men
and 75% of women.
5 September 2013
![Page 6: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/6.jpg)
Health Status of Justice-Involved Individuals
• 60-80% of arrestees tested positive for at least one illegal substance.
• Fewer than 10% of arrestees at 8 of the 10 sites reported receiving outpatient substance use or alcohol treatment in the prior year.
• 13-38% of arrestees tested positive for multiple substances.
• 13-30% of arrestees said they had been arrested two or more times in the prior year.
The ADAM II 2011 Report
6 September 2013
![Page 7: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/7.jpg)
Disparities in Criminal Justice: The Pipeline to Prison
Source: The Community Coalition
7 September 2013
![Page 8: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/8.jpg)
Most Individuals in Jail Return to the Community
• Nationally, only about 4% of jail admissions result in sentences to prison.
Or, in other terms...
• 96% of jail detainees and inmates return directly to the community from jail, often along with their existing health conditions.
8 September 2013
![Page 9: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/9.jpg)
The Same Frequent Fliers:
Most expensive health care users are also the most likely to be incarcerated • Rikers Island - 400 Frequent Flyers
– 10,000 jail stays; 300,000 jail days in five years – 67% have mental health needs – 99% percent report SUDs – 85% of charges were misdemeanors or violations
9 September 2013
![Page 10: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/10.jpg)
0
50
100
150
200
250
300
Children PregnantWomen
WorkingParents
JoblessParents
ChildlessAdults
Perc
enta
ge F
PL
Source: The Kaiser Family Foundation and the Georgetown University Center for Children and Families, 2012
Medicaid Eligibility, pre-ACA
Prior to ACA, justice-involved population largely unserved.
• Less than 10% of those released from jail had access to insurance
10 September 2013
![Page 11: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/11.jpg)
What does this mean for health plans’ seeking to serve this population in re-entry?
• Two Strategies
– Risk Corridors – Reach-In Efforts
11 September 2013
![Page 12: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/12.jpg)
Risk Corridors
• Increased Capitation Rate for Justice-Involved Individuals
• Twice as likely as general public to be admitted to hospital within first seven, 30, and 90 days following release
0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%9.00%
ReturningPop
GeneralPop
7 Days30 Days90 Days
Source: Wang et. al, 2013, JAMA
12 September 2013
![Page 13: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/13.jpg)
Reach-In Efforts
• Center for Medicare and Medicaid Innovation (CMMI) Grants
• Transitions Clinic Network
• Treatment Alternatives for Safe Communities
13 September 2013
![Page 14: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/14.jpg)
But, we do not know how to treat people with primary diagnosis of SUD
• Very little data on primary SUD
• People in jails have huge rates of primary SUD
14 September 2013
![Page 15: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/15.jpg)
Simply Enrolling Individuals in Medicaid is not Enough
• Ohio mandates Medicaid enrollment upon
entering jail • Bureaucratic timing issues means that an
individual has probably relapsed or had another run in with the law before his Medicaid benefits kick in
15 September 2013
![Page 16: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/16.jpg)
What if we focus more on pre-entry?
Law Enforcement Assisted Diversion (LEAD)
0%
20%
40%
60%
80%
100%
LEADGroup
ControlGroup
Pre-EvaluationPostEvaluation
0%5%
10%15%20%25%30%35%40%45%
LEADGroup
ControlGroup
Pre-EvaluationPost-Evaluation
% with nonwarrant-related arrest % charged with felony
Source: University of Washington Evaluation, March 2015
16 September 2013
![Page 17: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/17.jpg)
Challenges to focus on diversion
• Lack of Connectivity
• Lack of Data about What Works
• Cannot Develop Risk Corridors or Reach-In Strategies
• Lack of Behavioral Health Resources
17 September 2013
![Page 18: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/18.jpg)
Opportunities: New Funding and New Technology
• New population that is covered by federal regulations
opens new funding streams for plans
• Health IT allows for connectivity and behavioral health monitoring
• Focus on behavioral health creating new resources (i.e., Excellence Act)
18 September 2013
![Page 19: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/19.jpg)
Plans should focus on both re-entry and pre-entry
• Develop business systems to coordinate with criminal
justice system
• Integrate behavioral and physical health services
• Coordinate with public safety to develop pre-entry diversion programs
• Hire and train culturally competent practitioners
19 September 2013
![Page 20: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/20.jpg)
New Opportunity: The Excellence Act (2014)
• Creates Certified Community Behavioral Health Clinics (CCBHCs) designed to improve mental health and substance use disorder treatment with many requirements, including:
– Care Coordination – Mobile crisis mental health services – Screening, assessment, and diagnosis – Targeted case management – Peer support and counselor services – Psychiatric rehabilitation services
20 September 2013
![Page 21: Serving the Criminal Justice Population: Reentry & Community … · 2015-11-18 · Single-Day Snapshot 2012 (millions) September 2013 3 11.6 2.2 . Jail. Prison. ... 15% for men and](https://reader033.fdocuments.in/reader033/viewer/2022042911/5f4229f9d55b350cc770efd5/html5/thumbnails/21.jpg)
New Opportunity: 1115 Waiver
• Waiver to allow justice-involved individuals continuing access to Medicaid through: – Allowing states and counties to identify patients in county jails
and maintain their treatment protocols – Allowing Medicaid providers to work with county jails to develop
treatment and continuity of care plans – Allowing states and counties to initiate medically necessary care
and intervention for jailed individuals with opiate addictions. – Allowing states and counties to reimburse peer counselors
21 September 2013