Helping Michigan Parolees With Medical Needs – MPRI Re-entry

1. Helping Michigan Parolees With Medical Needs – MPRI Re-entry A Successful Community Health Pathway Vondie Woodbury – Director, Coordinated Community Benefit Affairs – Trinity Health Corporation Director, Community Benefit – Mercy Health Partners Executive Director, Muskegon Community Health Project

2. Breaking the Cycle of Crime • 95% of all inmates will leave prison • 650,000 released nationally every year • MI - 50,000 inmates living in 42 facilities • MI spends $2 billion annually – one of 4 states that spend more on corrections than on higher education • 12,000 are paroled annually • Half will commit new crimes or violate parole rules • In MI 6,000 return to prison annually at a cost of more than $180 million

3. Breaking the Cycle of Crime • In Michigan prior to MPRI: • Inmates left prison with a $75 bus ticket • 2-week voucher for a cheap hotel • Many lack social security card, birth certificate or a state ID • No help with substance abuse or mental health issues • Parole officers working with 60-80 offenders did not have time to help. • 48% of parolees returned to prison

4. What is MPRI? The Mission of MPRI …is to significantly reduce crime and enhance public safety by implementing a seamless system of services for offenders from the time of their entry to prison through their transition, community reintegration and aftercare in their communities. Michigan Department of Corrections

5. MPRI History • Started in 2005 with 8 pilot counties • Additional counties (including Muskegon) added in 2007 • Went statewide 2008 • Initial funding $12 million • Fy10 $50 million

6. Michigan Re-entry • 18 County re-entry collaborations • $30 M appropriation from State for FY-09 • Increases to over $50 million in FY-10 • Contracts are managed locally – county level

7. Basic Structure and Process of MPRI

8. Typical MPRI Process • A Local Coalition is Established (single or multi-county) • Coalition develops semi-annual Action Plan • Action Plan approved by MDOC – funded • Individual subcontractors responsible for core activities: housing, transportation, job placement/training, mental health and substance abuse • MPRI Coordinator is HUB for Multi-functional Collaborative operation

10. Muskegon’s MPRI Collaborative • Goodwill Industries • West Michigan Therapy • Michigan Rehabilitation Services • Department of Human Services • Muskegon Community Health Project • Department of Corrections & Parole • Orchard View Community Ed • Community Mental Health • Victim’s Services • Shoreline Prison Facility • Local Police Agencies • Faith Based Organizations

11. Parolee Interface • 6 months prior to release “in-reach” team meets with parolee in prison; process is explained. • Immediately prior to release – exit interview; appointments scheduled; • Upon release each contractor coordinates their piece of the puzzle; • Payment is based upon successful completion of each part of process (e.g. job placement; a place to live;)

12. Using Local Health Navigation – Muskegon’s Approach

13. Background MDOC • Michigan Prison System Health Care • $330 million a year for inmate health care (based on a projected number of 48,000 inmates) • Annual health cost per prisoner of $6,600 • 4,000 prisoners estimated to have chronic diseases • 524 estimated to be medically fragile

14. Why Medical Navigation? • 90% of parolees return to community as uninsured without medical home; • No medical records returned with parolee; • Pharmaceutical support for chronic disease terminated after 30-days • Parolees were unaware of medical safety net support structure • Significant level of imbedded chronic disease • Job retention could be affected

15. Muskegon’s Basic MPRI Health Initiative • Incorporated Health Care navigation as part of Muskegon’s MPRI collaborative process in 07 • Only site in state piloting approach • 1,037 parolees have received assistance since 2007 • Designated community health navigator is part of community in-reach and support team for parole; Health Project is HUB for Health Care Initiative • Program expanded 09 to include 11 additional counties

16. Muskegon’s Basic Re-entry Health Initiative Goals • Secure Medical Record • Conduct Health Assessment • Screen for enrollment into Medicaid, FSP, etc. • Identify and schedule first appointment for medical home • Provide for pharmaceutical assistance • Provide chronic disease self management

17. Action Pathway for Medical Assistance – How Does it Work?? • STEP ONE: Individual is identified as eligible for parole and the MPRI program

18. ACTION PATHWAY • STEP TWO: Team schedules/conducts MPRI In-reach at the Prison facility As a Team they meet with and interview each parolee to determine individual need • Review parolee plan – going home? • Are there special considerations – CSC? • Process and individuals are introduced

19. ACTION PATHWAY • STEP TWO (medical only): • Health Navigator Meets Privately with the Parolee • Makes arrangements to get medical records at release; • Conducts health assessment for chronic conditions and medication need • Initiates enrollment screening – Medicaid, SSI, FSP, Lion’s Vision, etc.

20. ACTION PATHWAY • STEP TWO – Health Navigator Schedules Medical Appointment • Contacts FQHC’s, Migrant Clinics, Free Clincs, Private Physicians; • Prioritizes parolees with medical conditions • Identifies need for medication assistance Within two weeks of release….

21. ACTION PATHWAY • STEP THREE – Team Schedules and Implements Exit Interview before Release • Affirm date of medical appointment • Will transportation be an issue? • How will medication be handled?

22. ACTION PATHWAY • STEP FOUR –Medical Navigator meets with parolee – post release. • Complete and sign all enrollment applications if necessary (CHW use) • Review assessment document – complete if necessary • Review pharmaceutical assistance program (Pharmacy CHW use) • Re-confirm medical appointment plus any additional medical services warranted (Specialty care, Chronic Disease Self Management, Clinical-AIDs, etc.)

23. ACTION PATHWAY • STEP FIVE –Medical Navigator confirms that medical appointment kept. • Yes? • No? – What barriers indicated? • If No – follow-up with parolee on rescheduling

24. ACTION PATHWAY • STEP SIX – Resolution Step Parolee has medical access.

25. Disease State of Participants Health Navigation Participant Demographics • 1037 Helped through Health Project since MPRI inception • 70% of MPRI clients have a medical issue at release • 47% need pharmacy assistance

26. Disease State of Participants (BEGINNING WITH HIGHEST FREQUENCY) • Asthma/Respiratory Disease • Hypertension/High Cholesterol • Mental Illness: Depression, Anxiety, Psychosis • Pain: Chronic, Arthritis, Knee, Back, Ankle • Other: Hepatitus C, HIV • Diabetes • Gastrointestinal: Crohn’s Disease, Ulcerative Colitis, Acid Reflux

27. Disease States Managed by Medication (pharmacy assistance program) • Mental Illness – 52% • Asthma – 33% • Diabetes – 35% • Heart Disease – 26%

28. The Value of Health Services for Basic Re-entry • Uninsured individuals who are high risk or who have chronic conditions have medical care to improve or sustain health • The ability to keep a job can be related to unmanaged health problems • The community benefits when parolees succeed in transitioning from prison to home • Reduction in recidivism results in lower state costs (28% statewide/11-12% annually in Muskegon)

29. MPRI Challenge • State has recently announced accelerated release process • Intention is to save $180 million of $2 billion state corrections budget • 15-member parole board handles 375 cases a month • Volume and economy places pressure on placement capacity – health, jobs, housing, etc. • Opposition to accelerated release process by Prosecuting Attorneys (public safety concerns) may impact process

30. Assisting the Medically Fragile Parolee

31. Why Prisons Need a Medically Fragile Program Most medically fragile prisoners would have been paroled if there was an appropriate community placement • Medically Fragile prisoners cost an average of $72,500 annually for health care • 524 medically fragile prisoners cost $29M/yr. • Community placement cost - $20,000 each • The cost savings is $52,500 per prisoner • Total savings could be $21M annually

32. Muskegon’s Medically Fragile Re-entry Health Initiative • Assists medically fragile individuals who pose little or no risk to communities • Individuals who are close to or past their earliest parole dates, or have sentences commuted by the Governor • Provides community placement in appropriate care setting • Provides Medicaid eligibility and other entitlements • Provides transitional funding to health care providers until Medicaid begins

33. Compassion and fiscal responsibility can work together Kenneth Anderson, 80, of Iron County was one of the earlier community placements, moving from prison to a nursing home.

34. The Unique Needs Required for Community Placement of Medically Fragile Prisoners • Population has medically-centered needs: • SSI eligible to trigger Medicaid coverage • Appropriate medical services must be near by • Housing with medical support: Nursing Homes; Hospice; etc. • Higher end meds • CHORE services • Family support • Parole supervision

35. The Medically Fragile Program Services • Conducting Prison In-reach interview • Collecting the Medical Record • Providing the Benefit Eligibility Screening • Assisting with entitlement applications • Contracting for the appropriate Medical Home • Providing Corrections with the post-release community placement plan • Coordinating with the Parole Office agents • Compliance monitoring for 6 months

36. Muskegon’s Medically Fragile Health Profile • End stage kidney and liver diseases • Multiple Sclerosis • Chronic Obstructive Pulmonary Disease • Cancers • Severe hypertension • Mental illness / Dementia • Congestive heart failure • Coronary artery disease • Severe Arthritis • Huntington’s Chorea • Parkinson’s Disease

37. The Value of Health Services for Medically Fragile Re-entry • Cost to Prison is unsustainable • Health care setting is inappropriate • Provides dignity at the end-of-life

38. Additional Information • Vondie’s phone number and email – 231-672-3201 at the Health Project • woodburv@mchp.org • Mail letters to: Muskegon Community Health Project 565 W. Western Avenue Muskegon, MI 49440