Transforming Mental Health Systems Through Affordable Care Act and Justice Population Collaboration

 
M
e
n
t
a
l
 
H
e
a
l
t
h
 
A
m
e
r
i
c
a
July 30, 2013
 
Affordable Care Act
& Justice Populations
Planning
 for Systems Change
 
Foundation: Collaboration
 
Decades of partnership and building programs
Unfortunately, there are thousands more we
don’t reach
Major barrier to expansion has been limited
community resources
That barrier will likely be removed in the next 9-12
months
Unprecedented opportunity
 to reach nearly all people
under justice supervision
 
Where will the resources come from?
 
The Affordable Care Act: January 1, 2014
Expands Medicaid coverage to people making less
than $14,400/year 
(single person)
Create health insurance with premium subsidies for
people making up to $43,300 
(single person)
Enrollment opens October 1
Medicaid Expansion legislation pending
 
The Promise...
 
Significant change on a broad scale
Near-universal coverage for low income adults
Reduce waiting lists
Fill gaps in services
End categorical and grant-based approach to funding
 
1
 
i
n
 
1
0
C
O
V
E
R
E
D
 
9
 
i
n
 
1
0
C
O
V
E
R
E
D
 
Assessing the Service Gap
 
Justice-involved, but community-based
Jail releasees (bond / pretrial)
Probationers / Specialty Courts
Parolees
Prevalence statistics identify need
What services exist?
Mental health, substance abuse, etc.
What’s missing?
 
Service Gap – 17
th
 Circuit
 
Over 15,500 justice-involved in the
community
2,300 with Serious Mental Illness
10,800 with Substance Abuse
 
Impact of Untreated Mental Illness
Across County Systems
 
Much higher rates of serious mental illness in CJS
16% of men
30% of women
Highest cost within the Jail
“Frequent fliers” in the jail
Accumulate lengthy arrest and corrections histories
Highest cost in Medical System
Frequent ER visits and inpatient stays
Most costly diagnoses by far
 
Source
: Steadman & Osher, 2009; CHCS 2010
 
Substance Use Disorders Nearly
Universal in Justice System
 
Criminal justice populations include people who are
addicted to drugs and/or alcohol
As well as people who abuse and misuse these
substances
More than 70% of jail inmates test positive for drugs
47.9% of state prison inmates and 43.7% of local jail
inmates met criteria for substance dependence
This is over 7 times greater than in the general
population
 
Sources
: CASA, "Behind Bars II", February 2010;
DOJ ADAM Report, Adams, Olson & Adams, 2002
 
Increased Coverage Reduces Crime
 
Washington State moved funds from corrections
to substance use treatment 10 years ago:
17-33% reduction in arrests among those who went to
treatment
 
Create access at each point along the justice continuum
 
 
 
 
Align agency resources to facilitate participation:
Universal Medicaid enrollment in all settings
Universal screening / linkage to needed services in all settings
Expanded community capacity to provide substance abuse,
mental health and medical treatment
 
What Will It Take?
 
Law
Enforcement
 
Bond
Court
 
Charges
 
Pretrial
 
Sentencing
 
Supervision
 
Strategy
 
1. Create “on-ramps” for enrollment from each CJS
setting
Jail
Probation / TASC
Specialty Courts
2. Create “big wins” that use the new services to
build public safety, improve health and reduce
costs
 
17
th
 Circuit ACA Planning Process
 
Steering Committee to set direction, priorities
Identification of high-impact points of implementation
Overall implementation timeline
Hosted by Chief Judge
Ensured continued momentum
Working groups with agency operational
leadership
Translate policy to day-to-day operations
 
17
th
 Circuit ACA Planning Process
 
Full continuum of partners / stakeholders
Court
Pretrial / Probation
Jail / Jail Health Provider
Public Defender / State’s Attorney
County Leadership
County Information Infrastructure
Behavioral / medical health providers
Local policy / practice consortiums
Health plan managers (as they emerge)
 
17
th
 Circuit ACA Planning Process
 
Identify opportunities for enrollment
Large numbers of people
Logistically feasible
Minimally disruptive
Predictable clinical profile
Capacity for continuity of care
“Ownership” by stakeholder
Don’t worry about reaching everyone immediately
Build for greatest impact first
Develop “culture of wellness” in CJ system and community
 
17
th
 Circuit ACA Planning Process
 
First meeting in May, already identified “high
impact” points and started to plan for enrollment:
Jail classification
Probation / TASC supervision
Probation orientation
Probation community resource center
 
Contact Information
 
B
r
i
d
g
e
t
 
K
i
e
l
y
,
 
B
A
,
 
C
A
D
C
,
 
C
C
J
A
P
Administrator
TASC, Inc. (Treatment Alternatives for Safe
Communities)
401 W. State Street, Suite 700
Rockford, IL 61101
815-965-1106 x10228
Fax: 1-312-274-6114
bkiely@tasc-il.org
www.tasc.org
 
 
16
Slide Note
Embed
Share

Addressing the gap in mental health services for justice-involved populations by leveraging the Affordable Care Act, this initiative focuses on expanding coverage, reducing waiting lists, and filling service gaps. With Medicaid expansion and premium subsidies, there is an opportunity to reach individuals under justice supervision and improve mental health outcomes for those with untreated conditions, ultimately reducing costs across county systems.

  • Mental Health
  • Justice-involved Populations
  • Affordable Care Act
  • Systems Change
  • Collaboration

Uploaded on Sep 14, 2024 | 0 Views


Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

E N D

Presentation Transcript


  1. Affordable Care Act & Justice Populations Planning for Systems Change Mental Health America July 30, 2013

  2. Foundation: Collaboration Decades of partnership and building programs Unfortunately, there are thousands more we don t reach Major barrier to expansion has been limited community resources That barrier will likely be removed in the next 9-12 months Unprecedented opportunity to reach nearly all people under justice supervision

  3. Where will the resources come from? The Affordable Care Act: January 1, 2014 Expands Medicaid coverage to people making less than $14,400/year (single person) Create health insurance with premium subsidies for people making up to $43,300 (single person) Enrollment opens October 1 Medicaid Expansion legislation pending

  4. The Promise... Significant change on a broad scale Near-universal coverage for low income adults Reduce waiting lists Fill gaps in services End categorical and grant-based approach to funding 9 in 10 COVERED 1 in 10 COVERED

  5. Assessing the Service Gap Justice-involved, but community-based Jail releasees (bond / pretrial) Probationers / Specialty Courts Parolees Prevalence statistics identify need What services exist? Mental health, substance abuse, etc. What s missing?

  6. Service Gap 17th Circuit Over 15,500 justice-involved in the community 2,300 with Serious Mental Illness 10,800 with Substance Abuse

  7. Impact of Untreated Mental Illness Across County Systems Much higher rates of serious mental illness in CJS 16% of men 30% of women Highest cost within the Jail Frequent fliers in the jail Accumulate lengthy arrest and corrections histories Highest cost in Medical System Frequent ER visits and inpatient stays Most costly diagnoses by far Source: Steadman & Osher, 2009; CHCS 2010

  8. Substance Use Disorders Nearly Universal in Justice System Criminal justice populations include people who are addicted to drugs and/or alcohol As well as people who abuse and misuse these substances More than 70% of jail inmates test positive for drugs 47.9% of state prison inmates and 43.7% of local jail inmates met criteria for substance dependence This is over 7 times greater than in the general population Sources: CASA, "Behind Bars II", February 2010; DOJ ADAM Report, Adams, Olson & Adams, 2002

  9. Increased Coverage Reduces Crime Washington State moved funds from corrections to substance use treatment 10 years ago: 17-33% reduction in arrests among those who went to treatment % Arrested (any crime) # Arrested (Felonies) 60 2000 1500 40 1000 20 500 0 0 Yr before Tx Yr after Tx Yr before Tx Yr after Tx

  10. What Will It Take? Create access at each point along the justice continuum Law Bond Court Charges Pretrial Sentencing Supervision Enforcement Align agency resources to facilitate participation: Universal Medicaid enrollment in all settings Universal screening / linkage to needed services in all settings Expanded community capacity to provide substance abuse, mental health and medical treatment

  11. Strategy 1. Create on-ramps for enrollment from each CJS setting Jail Probation / TASC Specialty Courts 2. Create big wins that use the new services to build public safety, improve health and reduce costs

  12. 17th Circuit ACA Planning Process Steering Committee to set direction, priorities Identification of high-impact points of implementation Overall implementation timeline Hosted by Chief Judge Ensured continued momentum Working groups with agency operational leadership Translate policy to day-to-day operations

  13. 17th Circuit ACA Planning Process Full continuum of partners / stakeholders Court Pretrial / Probation Jail / Jail Health Provider Public Defender / State s Attorney County Leadership County Information Infrastructure Behavioral / medical health providers Local policy / practice consortiums Health plan managers (as they emerge)

  14. 17th Circuit ACA Planning Process Identify opportunities for enrollment Large numbers of people Logistically feasible Minimally disruptive Predictable clinical profile Capacity for continuity of care Ownership by stakeholder Don t worry about reaching everyone immediately Build for greatest impact first Develop culture of wellness in CJ system and community

  15. 17th Circuit ACA Planning Process First meeting in May, already identified high impact points and started to plan for enrollment: Jail classification Probation / TASC supervision Probation orientation Probation community resource center

  16. Contact Information Bridget Kiely, BA, CADC, CCJAP Administrator TASC, Inc. (Treatment Alternatives for Safe Communities) 401 W. State Street, Suite 700 Rockford, IL 61101 815-965-1106 x10228 Fax: 1-312-274-6114 bkiely@tasc-il.org www.tasc.org 16

Related


More Related Content

giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#