Addressing the Re-entry Needs of Inmates with Serious Mental Illness Council for State Governments St. Petersburg, Florida July 8, 2008
Criminal Justice & Mental Health: Some Key Facts In Florida, on any given day, there are: 16,000 prison inmates with serious mental illnesses (SMI); 15,000 local jail detainees with SMI; and 40,000 individuals under correctional supervision in the community with SMI. Most are charged with minor misdemeanors and low level felonies that are a direct result of their SMI. Source: Report of the Florida Supreme Court Steering Committee on Families & Children in the Court Transforming Florida s Mental Health System, November 7, 2007 (2007 FSC Report)
Key Facts Continued People with SMI who come in contact with the criminal justice system are typically: Poor Uninsured Homeless Members of minority groups Experience co-occurring substance abuse disorders Source: 2007 FSC Report
Re-entering mentally ill inmates Approx 5420 severely mentally ill inmates were released from FDOC into the community last year. Due to a lack of community resources and inadequate pre- and post-release service planning and coordination, many individuals with mental illnesses who are released from prisons are unable to access basic supports needed for successful community re-entry, such as housing and medications. Ironically, as many as half of these individuals are re-arrested not for committing new offenses, but for violating conditions of their probation or parole, such as failing to report to treatment or to maintain stable housing or employment (Council of State Governments, 2002).
Florida Re-entry Initiative for Inmates with Disabilities FDOC assists some inmates nearing release with their applications for disability benefits. FILS receives copies of these applications and follows up with these inmates when the inmates are released. FILS represents these inmates in Social Security and Veterans appeals. FILS provides information about federal and state benefits and resources available to inmates approaching release through outreach to these inmates.
Re-entry Recommendations Screen for prior benefits upon entry to prison or jail; Establish transition teams and community collaborations for re-entry; Help prisoners complete applications for federal and state benefits; Arrange expedited review and processing of applications for federal and state benefits; Ensure that inmates have valid IDs prior to release.
Medicaid & Community Mental Health Services Re-entry strategies must include access to comprehensive community mental health (CMH) services. 2005 FHHI Department of Corrections Continuity of Care Study: A significant number of persons released from Florida prisons experienced adverse behavioral health events prior to receiving an adequate period of outpatient treatment; Persons who were enrolled in Medicaid were more likely to receive outpatient mental health services after their release than those who were not. A 2005 DOC/DCF Workgroup convened and made several recommendations to improve the process for facilitating Medicaid enrollment for persons being released from prison.
2004 CMS Memo A memo from federal CMS to State Medicaid Directors stated that: Persons released from institutions are at risk for homelessness; thus access to mainstream services upon release is important in establishing a continuum of care and ongoing support that may reduce the demand for costly and inappropriate services later.
CMS Memo CMS emphasized that Medicaid payment exclusions for incarcerated individuals do not affect their eligibility. CMS encouraged states to adopt a policy of suspending rather than terminating Medicaid eligibility for individuals entering correctional facilities and other public institutions.
New Medicaid Statute HB 1456 House Bill 1456 (Chapter No. 2008-217, Laws of Florida) was approved by the Governor 6/24/08. It provides that: For any prison or jail inmate who received Medicaid immediately prior to being incarcerated, their Medicaid shall be suspended (instead of terminated) while an inmate; Upon release, Medicaid eligibility is continued until the person is determined to no longer be eligible; The time period for incarceration shall not be included in any calculation of when the person must recertify his or her eligibility. Successful implementation of HB 1456 will require ongoing coordination and policy changes for three distinct state agencies FDOC, DCF & AHCA.
HB 1456 Implementation Recommendations FDOC should screen each inmate upon entry for whether they received Medicaid. FDOC should flag the files of inmates who received Medicaid immediately prior to admission. Immediately prior to release, FDOC should inform each of these inmates that their Medicaid benefits are reinstated upon their release (as well as inform them about any process implemented by DCF or other agencies to facilitate this statute).
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