Monday, July 14, 2008

Reducing Jail Costs, Reducing Recidivism

I spent the weekend at the National Association of Counties annual conference in Kansas City (don't worry--I paid my own way). It was a great way to learn how counties across this country are dealing with the same challenges we are. And it's safe to say that we're not unique in facing economic and budgetary woes, overcrowded and expensive jails, and all sorts of other issues.

One big issue came up that we can do something about right away.

It turns out, the federal government works very hard to save money at the expense of counties like our's, not to mention of our most troubled citizens, by its policy of terminating Medicaid shortly after a person enters our jails. This policy has major implications:

1. It eliminates a critical benefit even before a person has been judged guilty of a crime, violating the basic principle that people are innocent until proven guilty.

2. It represents a massive cost shift from federal Medicaid to county taxpayers to pay for the medical costs of those in jail waiting for trial (if an inmate is not covered, the county is required by law to pay for the medical costs, and we pay millions per year to do so).

3. When a person leaves our jail (whether after serving a sentence, or even after being found innocent), he or she leaves without Medicaid. This has dramatically negative consequences on our effort to reduce recidivism, particularly for those with mental illnesses who rely on medical and drug care to keep them from repeating criminal behavior. Without Medicaid, they leave jail with no way to pay for their medicines. It also costs Hamilton County taxpayers because rather than Medicaid, the care of such individuals will be paid through our County indigent care levy.

Fortunately, there's something we can do about this problem.

First, a bipartisan bill recently proposed in Congress would end the policy of terminating federal Medicaid benefits for those who are in county jails awaiting trial. A letter my office is drafting along with Commissioner Portune and Sheriff Leis will be sent this week to our Congressional delegation urging them to support this critical change in the law. It will save County taxpayers millions of dollars in property taxes every year.

Second, while we wait for this legislation to pass, states have begun to pass their own laws that "suspend" Medicaid benefits on initial incarceration, as opposed to terminating them outright. Minnesota, New York, Florida, and others have passed such laws. This means that when inmates leave jail, the suspension on their Medicaid benefits is automatically lifted (which is much less complicated than "restoring" benefits after they have been formally terminated). Again, because citizens return to the community with their Medicaid benefits intact, it helps reduce recidivism, and saves County taxpayers millions. I will work with our local delegation to push for such legislation here in Ohio.

Third, while we wait for both those laws to pass, we have created a local working group that will pursue whatever steps are necessary to restore Medicaid benefits as quickly as possible as inmates leave our Justice Center.

A little common sense here could save county taxpayers millions of dollars while improving safety and reducing recidivism.

For more information on the bill presented in Congress, go to http://www.naco.org/Template.cfm?Section=Publications&template=/ContentManagement/ContentDisplay.cfm&ContentID=27176

8 comments:

The Dean of Cincinnati said...

How can an innocent person have their medical benefits terminated?

Doesn't that sound like a lawsuit waiting to happen?

Aren't there some local lawyers who may wish to advocate for this through the courts, by taking up the case of someone who was found innocent, or who is considered innocent pre-trial?

Paul Komarek said...

Apparently Ohio has this termination policy primarily because of limitations in the computer system that is used to track Medicaid clients. The ODJFS system reportedly has no capacity to simply "suspend" benefits!

The following is from a January 2006 publication of the Ohio Association of County Behavioral Health Authorities (available at http://www.bcmhb.org/documents/MedicaidTerminationPolicy.pdf)

"Interestingly, under federal law, there is no requirement that individuals be “terminated” from Medicaid when they are institutionalized. In fact, on May 25, 2004, Glenn Stanton, the Acting Director of the U.S. Department of Health & Human Services’ Centers for Medicare & Medicaid Services (CMS), issued a memo to all State Medicaid Directors encouraging states “to suspend and not terminate” Medicaid benefits for individuals who are housed in a public institution, whether it be a juvenile correctional center, state prison, or mental health hospital. The memo goes on to state that: “once discharge from
the facility is anticipated, the state should take whatever steps are necessary to ensure that an eligible individual is placed in payment status so that he or she can begin receiving Medicaid-covered services immediately upon leaving the facilities.”

"So why does Ohio continue this costly practice? In correspondence to Supreme Court Justice Evelyn Stratton, the Ohio Department of Job and Family Services (ODJFS) explains: “Ohio currently does not suspend coverage for any population group. To do so, would require changes to two of the department’s legacy management information systems, the Client Registry Information System-Enhanced (CRIS-E eligibility system) and the Medicaid Management Information System
(MMIS claims adjudication system). [ODJFS] has plans underway to replace the MMIS and CRIS-E systems. The MMIS transformation is scheduled to go into production in SFY 2008, and the CRIS-E system will be replaced shortly after the MMIS, and we will address the issue of access to Medicaid coverage for individuals recently released from incarceration as we replace the CRIS-E system.”

It's now a couple of years later, and I'm not sure if the computer-driven reason for terminating, not suspending payments still exists.

Even without the computer problem or the legislative problem, it is still possible for the local Job and Family Service to collaborate with the jail on doing medicaid eligibility paperwork in advance of a scheduled release date. This is another recommended practice that can provide a better transition for returning prisoners.

--pk---

David Pepper said...

Thanks for your helpful comment.

In inquiring into the issue today, I learned the same thing: that the state bureaucracy resisted a proposal to change to "suspension" because of the technical inability to implement it.

Given that time has passed, and that other states are now stepping up on this, I don't think that's an acceptable answer at this point.

I will raise this issue to members of our state delegation, and urge them to push for this important change.

I have no doubt that our local JFS will work with us as we reinstate Medicaid after it's been terminated--but that is far from the ideal solution in the long run.

Brian Siegel said...

What types of rehab programs does Cincinnati's jails/prisons systems utilize?

Do we connect with "Restorative Justice Programs"?

See link and info (suggest connecting with Peter Block, can facilitate connection - http://citybeat.com/2003-09-03/cover.shtml

"Restorative justice takes into account victims and community; its paradigm considers crimes to be committed against persons, not the state. In that vein, offenders must sit in circular conference with the victim, family, support group and community.

Circles indicate "a feminine use of power based on relationship, dialogue, engagement, feeling, intuition, a knowing you can't pin down," he says.

That's what makes the conferences so effective.

"People who commit crimes very often don't have a larger sense of accountability to community," Butler says.

Restorative justice tailors sentencing to create meaning and purpose for offenders; someone who breaks a bottle over another's head must work with a head injury unit, for example. It's not suitable for offenders in homicide, sexual assault or child molestation cases, but they comprise only a small percentage of crimes, according to Butler.

Restorative justice works. Of the 500 offenders who have gone through the system in Longmont, only 5 percent have subsequent run-ins with police. Ninety-five percent of victims report that they are "satisfied" or "very satisfied" with the process. "

Also, I have a friend with a great story of overcoming odds by taking accountability, learning, forming a support system with mentors and harnessing his energy/passion = investing it into meaningful projects - can connect you with him and his reform/mentoring program as well!

Ronald Hummons - http://www.visioncaretakers.com/

let me know if these ideas, folks mentioned, and I can be of service.

"...the more people know what's going on in their community, the more involved they'll get." (Peter Block article)

Sincerely,
Brian Siegel

Anonymous said...

Now, this is pretty interesting stuff Pep. They really can get Medicaid (Medicare too) up and running in 1 sitting just by having the "authorized representative" loop hole being used at the Free Store to register people for services.

Also, if the housing type is changed from "jail" to "halfway house" then the facility providing food and medical care would be eligible then.

Another issue might be whether or not veterans can get their care paid for in some way while institutionalized.

And, it seems to me that there is a state pot of money in the formula for hospital shares of their indigent care funds that is supposed to be going to detention facilities for medical care. Aren't we pulling down these funds?

David Pepper said...

Thanks for another set of helpful comments.

Actually, the Free Store is part of the working group we are creating to design the reinstatement process as people reenter the community. (But again, if either Congress or the state fixed their policies, this process would not be necessary--but we will do what we can in the meantime).

The veteran issue is another one I am looking into, because your point is exactly right.

Anonymous said...

So how does one get to be part of this group who is creating the county's rehab program?

Paul Komarek said...

Does Hamilton County Job and Family Services currently have a strategy to overcome the processing delays that afflict our state Medicaid system?

I saw this item today:

"MEDICAID: Backlog of 16,000 Applications Has Delayed Services for Many Ohio Residents.

"The backlog of 16,000 Medicaid applications in Ohio has delayed services for a number of eligible state residents ...

"Ohio residents on average wait 200 days for the state to process their Medicaid applications ...

"In addition, counties often take weeks to complete their part of the applications before the state receives them.

"State officials attribute the backlog to an increase in applications and a lack of adequate funds and staff to process them."

(See the full item at http://www.healthfoundation.org/news/current.html.)

Do we have any performance statistics available showing whether Hamilton County JFS has decent processing times in comparison with the rest of the state, or do they lag behind?

Even more apt:

Do our judges know that sentencing a person to 30 days in jail - or setting a high pretrial bond - automatically sentences the person to 6 months without health care?

--pk---

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