Leveraging Support from County and State Funding Sources

1
Leveraging Support from County and State Funding
Sources

• Leon Evans
• Henry Ireys
• Art Wallenstein
• Moderator Ron Wiborg

Smart Responses in Tough Times Achieving Better
Outcomes for People with Mental Illnesses
Involved in the Criminal Justice System July
15-17, 2009
2
A Community ApproachTo Leveraging Support from
County and State Funding SourcesBexar County
Diversion InitiativesAchieving Better Outcomes
for People with Mental Illness involved in the
Criminal Justice SystemLeon EvansPresident and
Chief Executive OfficerThe Center for Health
Care ServicesSan Antonio, Texas www.chcsbc.org
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Collaboration Its an unnatural act between
two or more unconsenting adults.
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Bexar County Commissioners Court
Criminal Justice
University of Texas
Criminal Courts
Consumers And Families
Connecting Community
GI Forum
DSHS
Probate Courts
Adult Probation
Texas AM
SASH
Mental Health Partners
Sheriffs Office
NAMI
Medical Directors Roundtable
Area Hospitals
CPS
Metro Health
SAPD
Juvenile Probation
APS
FIRE
University Health System
Children's Diversion Collaborative
CHCS
County Judge
Patrician Movement
DA
EMS
Magistration Facility
Law Enforcement
Leveraging Outcomes
SAMM Ministries
Veterans Administration
DAPA
Pre Trial Services
City of San Antonio
Graphic by Seth Godin
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Civil and Criminal
System County City-wide Entry Points
Judicial/Courts Magistrate, County, District
System Level
City-wide
County
Law Enforcement Detention/Jail CIT
Crisis Care Center Jail Diversion Psychiatric and
Medical Clearance Specialty Offender Services
Mental Health Public and Private Providers
Police, Sheriff Probation, Parole
Treatment Continuity of Care
Emergency
Services
Community

• Data exchange through
• Community Collaborative
• Crisis Care Center
• CIT/DMOT
• Jail and Juvenile Detention
• Statewide CARE Match

Dynamic Crisis Jail Diversion Information Exchange
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The Crisis Care Center Psychiatric
Screening Minor Medical Clearance 24/7 Access
for Law Enforcement
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Impact on WAIT TIME for LAW ENFORCEMENT

• Now
• The wait time for Medical Clearance/ Screening at
  the Crisis Care Center is 45 minutes.
• Wait time for Medical Clearance/Screening and
  Psychiatric Evaluation is 60-65 minutes.

• Then (prior to Sept 2005)
• Wait times for Medical
• Clearance/ Screening at
• UHS ER - 9 hours, 18 min.
• Wait times for Medical
• Clearance/ Screening and Psychiatric Evaluation
  was between 12 and 14 hours.

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CIT School Itinerary

• MONDAY
• Purpose and History
• Officer Safety and Tactics
• Introduction to CIT
• Active Listening
• Role Play
• TUESDAY
• Introduction to Mental Illness
• Psychosis Schizophrenia
• Psychotropic Medications
• Developmental Disorders
• Alzheimer's
• Role Players Psychosis
• WEDNESDAY
• Substance Abuse and Dual Diagnosis
• Child Adolescent Issues
• Community Resources

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Public Safety Triage Facility Restoration
Center Grand Opening April 15th, 2008

• Detox Facility
• Community Court
• Outpatient Substance
• Abuse Services

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Restoration Center

• Public Safety Triage
• Detox Facility
• Outpatient Substance
• Abuse Services
• Community Court

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San Antonio Express News
The immediate availability of detoxification
services is priceless. Providing treatment
to those who desperately need help will save
taxpayers millions of dollars over the long
run.  Gloria Padilla, Express News 9/13/2008
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Haven for Hope
The Community Wide InitiativeHaven for Hope and
CHCS collaboration
Goal

• To increase the community capacity for mental
  health, substance abuse and detoxification
  services

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Title of new section
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Behavioral Healthcare Integration with Primary
and Specialty Medical Care

• The patients served by the Center and by the
  local Hospital District (UHS) are the same
  individuals
• We combine functions to integrate care for these
  individuals
• Functional integration is the foundation of the
  best healthcare possible for the people we both
  serve

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New Generation Medication Program

• Contract with UHS initiated in 2002
• CareLink Patients NGM Cost paid by CHCS with
  General Revenue
• CareLink Patients other Medication costs borne by
  UHS
• Savings to CHCS of between 2.4 2.6 million
• Savings funded the Crisis Services and Jail
  Diversion Initiative

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Show me the DATA !!!
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Total 8,758
Total 991
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Total 696
Total 2,002
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Total 953
Total 492
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Total 506
Total 519
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Alternatives to Incarceration

• Crisis Care Center and Restoration Center
• Involuntary Outpatient
• Commitment (IOPC)
• Outpatient Competency Restoration
• Mental Health and Drug Courts
• Veterans Initiatives
• Adult Parole/Probation
• Partnerships

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Thank you !
www.chcsbc.org
Leon Evans, President and Chief Executive
Officer, The Center for Health Care Services
San Antonio, Texas For additional information
contact Leon Evans, Ph. 210 731-1300 Email
levans_at_chcsbc.org
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Medicaid Eligibility At Prison Discharge
Lessons Learned from a Model Program in
OklahomaHenry T. Ireys, PhDSenior Fellow,
Mathematica Policy Research
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The Problem

• States cannot obtain federal financial
  participation (FFP) for Medicaid services
  provided to individuals in correctional
  facilities
• Most states
• Consider these adults as ineligible for Medicaid
• Will not accept Medicaid applications until after
  discharge

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The Problem (continued)

• Working-age adults with mental illness and little
  income leaving correctional facilities need
  access to care
• Medicaid coverage as their only option
• May be eligible for Medicaid or federal
  disability benefits but face significant
  application barriers, delays in coverage
• Are at high risk for re-entry

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Project Goals

• Minimize gap between discharge from correctional
  facility and Medicaid enrollment
• Improve access to treatment for individuals with
  mental illness by helping those eligible for
  Medicaid
• Decrease recidivism

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Key Stakeholders in Oklahoma

• Department of Mental Health and Substance Abuse
  Services (ODMHSAS)
• Department of Corrections (DOC)
• Oklahoma Health Care Authority (OHCA)
• Department of Human Services (DHS)
• Social Security Administration (SSA), State
  Office
• Division of Disability Determination (DDD) in
  Department of Rehabilitation Services

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Disability Determinations

• Average time to decision 4 months (excluding
  consultative exam)
• - Anecdotal reports Adults with MI take longer
• For SSI/SSDI applicants
• - Consent forms
• - Gathering of information re medical and
  functional status
• - Consultative exam if needed

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Operational Challenges

• Dramatic, rapid rise in number of inmates with
  serious mental illness since late 1990
• Since 2000 300 increase in inmates receiving
  psychotropic medications
• Problems in initiating, tracking SSA applications
• Busy clinical staff, lack of training
• Other priorities for discharge
• Hard to track applications
• Pre-release procedures in place but not used
• Need for new links with local SSA, DHS offices

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Inmates with Mental Illness Entering DOC
Facilities, FY2004

• 
  Number Percent
• Total 1,482 100
• Medicaid enrolled
  226 15
• Not enrolled,
• probably eligible
  942 63
• Not enrolled,
• probably not eligible
  314 21
• Sources ICIS, MMIS, OESC, OMS

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Program OverviewDOC Facilities
Intervention Time Nine Months
120 days from release Start SSI/SSDI application
Monitor application status
69 months from release Identify target
population Screen for income, resource
eligibility Request consents
60 days from release Start Medicaid application
Day of release Direct person to local SSA
office Fax certificate of release to local DHS
office
45 days from release Submit Medicaid application
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Post-Discharge Medicaid Enrollment of Study
Inmates
Adjusted Difference-in-Differences Effect
Estimate
Unadjusted Percent Enrolled
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Summary

• SAMHSA-funded project helped build momentum for a
  comprehensive, collaborative mental health
  reentry program
• Analyses suggest
• - The intervention significantly increased
  Medicaid enrollment for inmates with mental
  illness
• - Implementing better discharge planning led to
  better information sharing between DOC and SSA
  and increased the likelihood for SSI/SSDI
  approval

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Questions or Comments?

• Contact
• Henry T. Ireys
• 202-554-7536
• hireys_at_mathematica-mpr.com
• The report on this project should be available on
  the SAMHSA and the MPR websites by late August,
  2009

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Thank you

• For further information conference
  presentations
• please visit
• www.consensusproject.org

This material was developed by presenters for the
July 2009 event Smart Responses in Tough Times
Achieving Better Outcomes for People with Mental
Illnesses Involved in the Criminal Justice
System. Presentations are not externally
reviewed for form or content and as such, the
statements within reflect the views of the
authors and should not be considered the official
position of the Bureau of Justice Assistance,
Justice Center, the members of the Council of
State Governments, or funding agencies supporting
the work.