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Criminal justice issues among individuals with mental health and substance use conditions is a growing problem. After the wide deinstitutionalization of state hospitals, jails and prisons have seen an increase in the number and percentage of individuals with mental health and substance use conditions who come through their doors. MHA is dedicated to addressing the many issues states, communities, and criminal justice systems in order to reduce the number of individuals who must needlessly suffer by rotating in and out of jails and prisons. For more information on criminal justice issues, see MHA's policy statements on criminal justice.
Benefits for Prisoners with Mental Illness
Despite no federal law mandating Medicaid termination for prisoners, ninety percent of states have implemented policies that withdraw inmates' enrollment upon incarceration.
This leaves a mentally ill and vulnerable population uninsured during the months following release. It is a time period during which former inmates are vulnerable to increased risk of medical problems and even death.
It is of critical importance that when former inmates return to the community, they should become immediately eligible for Medicaid.
With the expansion of Medicaid under federal healthcare reform starting on January 1, 2014, all parolees should be covered with private insurance or Medicaid.
The main features of healthcare reform include increased enrollment in health care plans and an influx of new federal funds to enroll all indigent adults in Medicaid, all of whom will have full parity for mental health and substance abuse.
But challenges will remain through 2013 to fund mental health programs for parolees and former inmates.
In nearly every state, many communities face overcrowding of their jails and prisons. They also face court orders to reduce overcrowding and must resort to releasing inmates before their sentences are completed.
The courts have also ordered jurisdictions such as California to improve the quality of mental health care of their inmates. California, for instance, is currently in the process of the early release of 36,000 to 45,000 inmates into the community during the next two years.
If former prisoners seek psychiatric help and are not covered by Medicaid or other financial assistance programs, they will end up in the emergency room. Most emergency rooms are not equipped to handle people who are mentally ill. In addition, most of the mentally ill have a co-occurring disorder that needs treatment. The high-cost of emergency room treatment ultimately falls upon the local taxpayer.
To put in perspective how many people we are talking about, some experts have estimated that over ten million people cycle in and out of corrections each year. Recent studies suggest that at least 16 percent of inmates in jails and prisons have a serious mental illness. Three decades ago, the percentage was 6.4 percent.
Studies also report that 40 percent of individuals with serious mental illnesses have been in jail or prison at some time in their lives.
Moreover, it is now extremely difficult to find a bed for a seriously mentally ill person who needs to be hospitalized. In 1955, there was one psychiatric bed for every 300 Americans. In 2005, there was one psychiatric bed for every 3,000 people. Even worse, the majority of the existing beds were filled with court-ordered cases and thus not really available.
Although the federal regulations are sometimes difficult to wade through, opportunities exist for former inmates to obtain federal entitlements upon release.
Mental Health America has not taken a position on benefits for prisons. However, it has adopted a White Paper entitled: "Position Statement 52: In Support of Maximum Diversion of Persons with Serious Mental Illness from the Criminal Justice System." The statement is silent on the issue of Medicaid for inmates.
The Judge David L. Bazelon Center for Mental Health has suggested a number of policies that state and local governments can adopt. If you want to see any of these implemented in your state, you should first survey the laws and regulations in your state regarding prisoners and Medicaid. If you believe changes are needed, then you should advocate for changes with your state or government.
- Screening for mental illness upon entry to prison or jail.
- Screening for prior benefits upon entry to prison or jail.
- Suspending rather than terminating Medicaid benefits for inmates.
- Establishing transition teams and community collaborations for re-entry.
- Helping prisoners complete applications.
- Arranging expedited review and processing of applications.
- Ensuring that inmates have valid IDs prior to release.
- Providing coverage for services and medication after release, while
applications are pending.
- Providing specialized parole supervision (Note: some states are releasing
inmates without parole supervision, called Nonrevocable Parole).
- Appointing a single agency to coordinate release planning.
- Sharing information across agencies, including through interagency
agreements and task forces.
- Using web-based applications, combining benefit applications and
eliminating in-person requirements for applications.
- Working with the Social Security Administration on pre-release benefit
Summarized below are some state and local initiatives that adopt such policies.
Screen for mental illness
In Montgomery County, Maryland, Department of Correction and Rehabilitation staff use a set of seven questions to screen jail inmates for suicide risk at three points of intake: at central processing, upon institutional intake, and as part of medical screening.
In Minnesota, all prison inmates are eligible for three separate screenings by correctional medical staff and by a mental health professional.
Screen for benefits
In Oklahoma, prison officials are developing a system that flags incoming offenders who are already receiving SSI benefits.
Suspend (not terminate) benefits
In Maryland, incarcerated Medicaid participants remain on the enrollment list, even if incarcerated longer than 30 days. In Washington, Medicaid enrollment is suspended rather than terminated for people in jail less than 30 days.
In Hampden County, Massachusetts, jail inmates are assigned a treatment team that addresses treatment, housing, and other concerns prior to release.
Assist prisoners in completing applications for benefits
In Los Angeles County, the Sheriff's Department screens jail inmates and then sends the names of those who are veterans to the VA's Community Re-Entry Program.
In Boston, Massachusetts, a formal re-entry program initiates an application for Medicaid 30 days prior to an inmate's discharge from prison. All application paperwork is completed in advance so that the individual is poised for approval upon discharge. A similar process is in place in Maryland prisons.
Provide expedited service for processing of inmates' benefits applications
Lane County, Oregon Medicaid puts jail inmates' applications on a fast track for processing and most are processed in a day or two. Medicaid staff then fax temporary Medicaid cards back to the jail, ensuring that inmates have immediate access to Medicaid services upon release.
Ensure that inmates have a valid ID prior to release
The Louisiana Office of Motor Vehicles is piloting a program at several prisons where state ID cards and license renewals are made on-site for inmates. The Maryland Motor Vehicle Administration details its mobile van to prisons to enable production of state ID cards for inmates who are awaiting release.
In California, inmates who are released in a nonrevocable parole status are given a 30-day supply of medication. In Minnesota, released inmates receive a ten day supply of medication and a written prescription for a 30day supply with one refill of all necessary medications. Maryland mandates a 30 day medication supply upon release for both prisons and jails.
Post-release follow up
The Wisconsin Department of Corrections staff review benefit application disapprovals and assist prison inmates in appealing the decision.
Simply a complicated process
In Texas, health services agencies share information on individuals receiving health-related services. A waiver from the federal government was necessary.
In California, the Department of Corrections and Rehabilitation created an Inmate Transitional Protocol Working Group consisting of state correctional staff that handle mental health issues and community mental health advocates to discuss procedures and policies concerning the release of inmates with a mental illness
The Pennsylvania Department of Public Welfare developed a web-based application that eliminates the need for face-to-face contact when filling out an application.
Work with Social Security Administration
In Texas, each local SSA office has a pre-release point person to work with prison coordinators on SSI/SSDI and Supplemental Nutrition Assistance Program (SNAP) applications. SNAP used to be called Food Stamps.