Jail Program Helps Inmates Avoid Health Care Gap

Before 1998 employees at the Corrections Division of the Lane County, Ore., sheriff’s office were frustrated because many inmates—including some who were only incarcerated several days—were terminated from the Oregon Health Plan (OHP), the state’s Medicaid demonstration project. Employees also had difficulty enrolling inmates in the Medicaid plan, said Richard Sherman, M.S., mental health supervisor for the corrections division.

Sherman explained this situation to administrators of the Oregon Mental Health Division and Oregon Office of Medical Assistance Programs, and after a series of discussions with state officials, convinced them to adopt a policy stating that inmates incarcerated for 14 days or fewer will not be disenrolled from the health plan.

“This is the only state I know of that has such a policy,” said Collie Brown, senior director of criminal justice programs at the National Mental Health Association (NMHA). “And as other jurisdictions look to replicate this policy, hopefully they will expand the time frame to more than 14 days.”

But this was only part of the efforts by the jail’s mental health staff. They also have started an initiative to ensure that inmates in their jail diversion program—all of whom are diagnosed with severe and persistent mental illness—can access their state health plan benefits upon their release.

Here is how the initiative works:

First, these inmates receive help from jail employees in filling out the plan application. Then staff members fax each application to the Senior and Disabled Services (SDS) Office a day or two before the inmate’s release. (The office will not accept inmates’ applications any earlier.)

Then, in contrast to the time it often takes for governments to process forms, the applications are processed in a day or two. Prior to developing this initiative, inmates had to wait several weeks for their applications to be processed, during which time they were without health care coverage.

Finally, the SDS Office faxes the jail back the inmates’ temporary cards, which can be used immediately to access all health plan benefits. A permanent card is sent after the inmate has chosen a managed care organization. Furthermore, in case there are any problems or inmates need help with other issues, the jail staff stays in regular contact with former inmates.

Missing ID?

When asked what happens if an inmate doesn’t have ID for the application, Sherman replied, “Inmates don’t need to have identification. We identify inmates with their fingerprints. We know better than any other agency who someone is.

“When we fax the application, the SDS Office takes our word for it that the person is who we say he is. In the majority of cases these are not people who are new to the system. They are people who we know from their other visits to the jail and their involvement in the mental health system.” However, he noted, “Unless we can positively identify someone, they will not be eligible for our program.”

This is particularly impressive because the SDS Office used to require several forms of identification. Because many of their inmates diagnosed with severe and persistent illness didn’t have any ID, this was a huge problem.

First, the inmates needed ID to get ID. In addition, many didn’t have the money to purchase IDs and were unable to navigate the system to get necessary documents, Sherman said.

Reflecting on the overall effect of all these changes, Sherman said that more inmates have stayed in treatment and have not returned to jail than was the case before the program was implemented.

In contrast, to apply for Medicaid in Rensselaer County, N.Y., released jail inmates need a shelter verification, birth certificate, picture ID, and Social Security card. Most must have a drug and alcohol evaluation, said Michelle Ahearn, forensic mental health discharge planner for the county mental health department. “It’s a nightmare. No one will give you a birth certificate without a picture ID, but you can’t get picture ID without a birth certificate. . . . It’s a catch-22,” she said.

Sherman said that the key to developing the Oregon initiative was that “we went to the Senior and Disabled Services office and developed a rapport with the employees. It really does help. We told them about the work we are doing and that it is really important to have inmates on the health plan upon their release, so they can continue with their medication and remain stable. This saves everyone time and money.”

Hamden County Experience

When any of the 1,700 inmates residing at Hamden County Correctional Center in Ludlow, Mass., are incarcerated more than 30 days, their MassHealth enrollment is terminated. (In Massachusetts, Medicaid is called MassHealth.)

To counter this, the correctional center’s administrators have developed an innovative program to ensure that eligible inmates receive MassHealth benefits upon their release.

“Before we had this program it was a nightmare. You have people in jail, stable, doing better than they ever have done in their lives, and you release them, and they fall on their face, because there was nothing out there to pick them up,” said Sandy Gallagher, vice president of forensic services for Behavioral Health Networks. Behavioral Health Networks is a community mental health agency whose forensic division provides services in the jails and courts in Western Massachusetts.

Here is how the program works for inmates diagnosed with serious mental illness: Two to three months before the inmate’s release, the correctional center’s mental health discharge planner screens the inmate for eligibility—almost all are eligible. Inmates who are U.S. citizens do not need to furnish any identification; however, they must write their Social Security number on the application, said Richard McGreal, director of external affairs for the Massachusetts Division of Medical Assistance. “Those who are not U.S. citizens need to provide documents showing their immigration status.”

After helping the inmate complete the application, the discharge planner flags the application with big stickers stating, “Pre-release Incarcerated” and includes a letter with the planner’s name and telephone number.

When the application is received by MassHealth’s Central Processing Unit, the information is entered into the computer system. This generates a letter stating that the application was rejected because the individual is in a correctional facility. It also cites any additional reasons for rejection.

However, all the information from the application stays in the system.

Upon an inmate’s release, his or her file is activated. A mental health worker at a local community mental health center (CMHC) does this during a session with the inmate. The session is scheduled within five days of the individual’s release, because inmates only receive a five-day supply of psychiatric medication.

On the day of release, the inmate is given a letter addressed to a local CMHC stating that his or her application is on file. Also, the correctional center faxes a letter to the regional MassHealth enrollment center notifying it of the individual’s release.

Upon arriving for his or her appointment at the CMHC, the former inmate gives the mental health worker the letter from the correctional center. Then the mental health worker calls the local MassHealth enrollment office and tells staff there that the individual’s application is on file and provides any necessary information. The former inmate can select a medical plan and physician over the phone.

The inmate’s account becomes active immediately. Not only is the charge for the CMHC appointment covered, but the ex-inmate can also fill the 30-day prescription for psychiatric medication furnished by correctional center medical staff.

Reflecting on the program, Gallagher said, “The Medicaid office has not turned down a single application. And since this initiative has been in place, former inmates are able to receive mental health services and medication far more easily than in the past.” ▪