As budget negotiations continue (though it appears today that there will
likely be no mental hygiene budget committee meetings), there have been a
lot of issues that have appropriately gotten attention. One significant
piece introduced by Assemblyman O’Donnell highlights the need for Medicaid
coverage thirty days before release from jail and prison for individuals
with behavioral health needs. Too many individuals with behavioral needs
released from jail and prison end up as recidivist because they never
receive timely and appropriate services immediately after release.

The ability to allow for Medicaid coverage thirty days before release
along with appropriate health home linkages will provide an immediate
service response to individuals who have been incarcerated. Along with our
colleagues at NYAPRS and the Legal Action Center, we are calling for
support in the budget for this important initiative. Listed below is a
statement from our organizations on this issue as well as an article in
today’s Crain’s highlighting the need for this inclusion in the budget

Ensuring Prisoners with Mental Illness and Chemical Dependency Issues
Receive Treatment to Avoid Relapse and Recidivism

NYAPRS and MHANYS share a long commitment to supporting initiatives that
help divert New Yorkers with serious behavioral health conditions from
avoidable incarcerations, ensure appropriate treatment and prison
conditions when incarcerated and in support of effective re-entry
strategies and successful community transitions to reduce avoidable
relapses and recidivism.

That’s why we have worked to achieve recent and current legislative
proposals to expand Crisis Intervention Teams as well as landmark prison
reforms associated with the passage of SHU (solitary confinement) Exclusion
legislation.

And that’s why we are in strong support of a current proposal, included in
this year’s Assembly budget bill, to support successful re-entry strategies
for people with ‘high needs’ associated serious mental health and addiction
related conditions.

While the Governor has given robust attention to these issues via last
year’s OMH transitional support initiatives and the creation of DOH
criminal justice focused health homes, such reforms are incomplete,
insofar as incarcerated individuals who are Medicaid-eligible cannot
receive Medicaid-covered services prior to release under current state and
federal law. As result, individuals are not able to get the medications and
services that best enable them to transition to the community and avoid
relapse and recidivism.

We are joining with the Legal Action Center and other groups in our strong
support of a change in the Social Services Law and a waiver or other
authorization from the Federal Centers for Medicare and Medicaid Services
that would allow Medicaid coverage of such services, and reduce unnecessary
health care, criminal justice and related costs for such individuals, as
well as the likelihood that they will commit additional crimes

This change would achieve the essential goal of extending Medicaid coverage
to “high needs” individuals 30 days immediately prior to release for
incarceration for services required as part of successful transition plan
to the community, while also accruing state and local savings from avoided
relapse and hospitalization of justice-involved individuals, and from
federal Medicaid matching funds for care provided prior to release.

Furthermore, the vast majority of those who are incarcerated would be
eligible for the increased federal Medicaid match, which will eventually
rise to 90% as a result of the Affordable Care Act. As a result, the
upfront cost to the State would be very small, thereby increasing the size
of the savings to the State

The proposal would directly support New York State’s ongoing effort to
provide high-quality, comprehensive care to New Yorkers who need it the
most.

Proposed Amendment to Social Services Law Section 366(1-a)

In order to implement this proposal, state law would need to be amended to
allow Medicaid coverage to be provided prior to release. This could be
accomplished by the following language:

Social Services Law sec. 366(1-a):

1-a. Notwithstanding any other provision of law, in the event that a
person who is an inmate of a state or local correctional facility, as
defined in section two of the correction law, was in receipt of medical
assistance pursuant to this title immediately prior to being admitted to
such facility, such person shall remain eligible for medical assistance
while an inmate, except that no medical assistance shall be furnished
pursuant to this title for any care, services, or supplies provided
during such time as the person is an inmate; provided, however, that
nothing herein shall be deemed as preventing the provision of medical
assistance for inpatient hospital services furnished to an inmate at a
hospital outside of the premises of such correctional facility OR
PURSUANT TO OTHER FEDERAL AUTHORITY AUTHORIZING THE PROVISION OF MEDICAL
ASSISTANCE TO AN INMATE OF A STATE OR LOCAL CORRECTIONAL FACILITY, to the
extent that federal financial participation is available for the costs of
such services. Upon release from such facility, such person shall
continue to be eligible for receipt of medical assistance furnished
pursuant to this title until such time as the person is determined to no
longer be eligible for receipt of such assistance. To the extent
permitted by federal law, the time during which such person is an inmate
shall not be included in any calculation of when the person must
recertify his or her eligibility for medical assistance in accordance
with this article. THE STATE SHALL SEEK FEDERAL AUTHORITY TO PROVIDE
MEDICAID COVERAGE FOR TRANSITION SERVICES FOR HIGH NEED INMATES FOR 30 DAYS
PRIOR TO RELEASE.

Please feel free to contact us about these issues,

Harvey Rosenthal
NYAPRS Executive Director

Glenn Liebman
MHANYS CEO

Medicaid rules for inmates may change

Medicaid benefits are generally suspended for people who are in prison or
jail, but a state health home project targeting the criminal-justice
population has led some advocates and legislators to push for new
exceptions to the rules.

Since late 2012, a handful of health homes across the state have been
involved in a pilot project to identify and connect with members who are
incarcerated so that they can begin to coordinate their housing and health
services prior to their release. The idea is for health homes to
collaborate with local correctional facilities to serve some of the
hardest-to-reach people on their lists of Medicaid beneficiaries while
reducing the rate of recidivism.

But the state Health Department didn’t release the $5 million that was
dedicated to the program in last year’s budget because of concerns about
violating federal and state Medicaid laws. The money is in the budget again
this year, with new language aimed at creating a loophole, said Sebastian
Solomon, director of New York state policy at the Legal Action Center,
which coordinates the state’s work group on health homes and criminal
justice.

The Brooklyn Health Home, led by Maimonides, has been able to advance with
the pilot project through grant funding, including an award of $100,000 in
September 2014 from the New York Community Trust. The health home has been
working with DOHMH to find Rikers inmates on its list, most of whom have
had Medicaid at one point and will need it reactivated upon release.

“Finding [health home members] has been so difficult for everybody,” said
Hannah Loeffert, the criminal-justice director at the Brooklyn Health Home.
“You have to work within the confines of that person’s actual life. For a
lot of people, that is the justice system.”

The health home was finding about 10% of its members through Rikers,
Loeffert told the state work group in April 2015.

There has been talk among state officials about the possibility of seeking
a federal waiver from CMS that would allow Medicaid funding to be used for
the program, said Solomon.

DOH did not respond to a request for comment.

Following lobbying efforts by the Legal Action Center, the Assembly
introduced a bill (A. 9320) last month that would require the state to
“seek federal authority to provide Medicaid coverage for high-need inmates
30 days prior to their release from incarceration.”

The Senate has not followed suit, but both one-house budgets included the
$5 million for the program.

Health officials have been renewing calls for Medicaid dollars to flow to
inmates for other services as well.

“A key funding opportunity could involve Medicaid waivers to reimburse
[the] provision of chronic care inside jails and prisons that was initiated
in a community setting,” wrote Homer Venters, chief medical officer and
assistant vice president of the Division of Correctional Health Services
for New York City Health + Hospitals, in a report published in the latest
issue of the American Journal of Public Health.

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