Federal Benefits: How to

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. Coordinated by Project Partners 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: (212) 482-2320Fax: (212) 482-2344kbrown@csg.org www.reentrypolicy.org www.consensusproject.org Funding 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 individual’s course of treatment based on an assessment of the client’s 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 (212) 553-6325 alouison@cases.org