Kellen Russoniello Staff Attorney Health and Drug Policy ACLU of San Diego and Imperial Counties Twitter krussoniello November 17 2014 ACLU of San Diego and Imperial Counties We fight for individual rights and fundamental freedoms for all through education litigation and policy ID: 742718
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The Affordable Care Act, Justice-Involved Individuals, and Criminal Justice Reform
Kellen Russoniello – Staff Attorney, Health and Drug Policy
ACLU of San Diego and Imperial Counties
Twitter: @
krussoniello
November 17,
2014 Slide2
ACLU of San Diego and Imperial Counties
We fight for individual rights and fundamental freedoms for all through education, litigation, and policy advocacyFocus areas:Criminal Justice and Drug Policy Reform
Immigrants’ Rights
Voting Rights
Overlap of ACA and Criminal Justice SystemSlide3
Overview
Health Issues of Justice-Involved and VictimsMedi-Cal Eligibility/Coverage
Financial Incentives
Examples:
San Diego
& Imperial Counties
What Does ACA Mean for Criminal Justice Reform?DecriminalizationProposition 47Challenges and OpportunitiesSlide4
Health Issues of Justice-Involved
Compared to the general population, the prevalence among justice-involved populations of:
HIV infection is 8 to 9 times higher
Hepatitis C is 9 to 10 times higher
Tuberculosis is 4 times higher
Serious mental illness is 3 times higher
Substance use disorders is 4 times higher 12 times more likely to die w/in 2 weeks of prison release80% of individuals in jail with chronic medical conditions have not received treatment in the community prior to arrestUp to 90% of people released do not have health insuranceSlide5
Health Issues of Crime Victims
Being a victim of crime increases risk of:Chronic health issuesSubstance use disorders
Trauma/mental illness
Crime victims may have medical bills related to the physical injuries
Victims of violent crime are more likely to be low-income, and therefore less likely to be insuredSlide6Slide7
Essential Health Benefits
Ambulatory patient servicesEmergency services & hospitalizationMaternity & Newborn Care
Mental Health & Substance Use Disorder Services
Prescription Drugs
Rehabilitative &
Habilitative
servicesLaboratory servicesPreventive & Wellness ServicesChronic Disease Management
Pediatric Services, including dental & vision
Medicaid expansion
and all health plans offered through
health benefit exchanges
must cover:Slide8
Preventive Services
Most health plans must cover preventive services for adults without cost-sharing, including:Alcohol misuse screening and counselingDepression screening
Screening for certain chronic conditions
Vaccines
More preventive services available for women, including
:
Screening/brief counseling for domestic violenceScreening for breast/cervical cancerContraceptionSlide9
Medicaid Eligibility/Coverage
About 20% of newly eligible are justice-involvedGenerally, Medicaid does not pay for expenses when person is an “inmate of a public institution”
Exception: individuals admitted as inpatient in non-correctional medical facility for
>
24 hours (e.g. hospital)
Medicaid
eligibility is not affected by incarceration status at federal level, can be suspendedBut most states terminate eligibility upon incarcerationMedicaid is available to those in community, even if under supervision (e.g. parole/probation)
No disenfranchisement!
No open
enrollment period
– can enroll at any timeSlide10
Financial Incentives
Traditional Medicaid match rate between 50% and 74%Rate for newly eligible pop is 100% through 2016, declining between 2017-2020 to 90% for 2020 and beyondIncentive to enroll incarcerated people to pay for hospitalizations
Incentive for people with chronic conditions to receive care in the communitySlide11
Health and Public Safety
Medicaid coverage at release associated with 16% fewer subsequent detentions and more days in the community before next arrest for people with SMISubstance use disorder treatment offered to low-income adults associated with significantly reduced risk of arrest (up to 33%)
Every dollar invested in substance use disorder treatment saves up to $12 in reduced crime, criminal justice, and healthcare costs
Medicaid expansion
is a
public safety issue – but be careful with this argument!Slide12
What’s Happening in San Diego County
About 90,000 jail bookings annually, about 62,000 of which are unique individualsAverage jail population is about 5,900 (majority pretrial)
Public Safety Realignment increased the number of people for whom local law enforcement is responsibleSlide13
San Diego, cont.
AB 720: State Legislation suspending Medicaid upon incarceration (up to 1 year) and allowing jails to offer enrollment assistanceAB 82
: $1.8
million for enrollment assistance over 2
years (private funding)
Four-tiered system
County eligibility workers assist folks with immediate medical needs (e.g. need to be hospitalized, HIV positive, and SMI)MOUs with community clinics to provide assistance with no fundingAmeriChoice (United Healthcare) has hired 10 FTEs RFP for CBOs to provide assistance
in final negotiations
Enrolling in 6 of 7 jails and
two
probation
offices
Over
350
applications received so far in jails
Over 60
referrals by probation officers with 53% no show rateSlide14
San Diego, cont.
PartnershipsSheriff’s DepartmentProbation DepartmentDistrict Attorney (victims)
Health and Human Services Agency
Chief Administrative Office
Board of Supervisors
Community clinicsSlide15
San Diego, cont.
Healthy and Safe Communities InitiativeCommunity clinics, reentry service providers, and advocacy organizationsPressure the county to make system run
smoother
Dedicated to reducing criminal justice response to health issues
Accomplishments
Change of process to ensure active case at release
Medi-Cal managed care choice form included in appBrief education about accessing healthcareMaterials at discharge of how/where to access servicesVoter registrationSlide16
San Diego, cont.
Next steps:Ramp up to maximize reachEnsure
people have
benefit
ID
cards at release
Ensure smooth transition to community careScheduling appointments prior to releaseRecord sharing while protecting privacyEngage Medi-Cal managed care organizations Mobilize community to shift money from traditional law enforcement to treatment and other necessary servicesSlide17
Imperial County
10,000 releases from two county jails each yearMOU with CBO for enrollment at Day Reporting CenterMoving to enrollment at booking
Challenges:
T
reatment capacity
Transportation
Employment opportunitySlide18
ACA & Criminal Justice Reform
ACA establishes a framework to build health-oriented responses to substance use and mental health issues
Federal funds can help expand access to community health services
Alternatives to arrest, prosecution, and incarceration more possible and sustainable
Incentive to treat individuals outside of correctional setting
Impetus for reform of sentencing law and practiceSlide19
Proposition 47
Approved by 58.5% of CA voters on Nov. 4th, 2014; Took effect Nov. 5
th
!
Reduces simple drug possession and petty theft from felonies to misdemeanors
Applies retroactively
Reinvests savings into mental health/substance use disorder treatment, K-12 education, and victims’ services (estimated $1 billion in next 5 years alone)Advocacy is just beginningFunding to be decided via grant processesEnsure law enforcement is cooperating with spirit of law
ACA can help ensure folks have coverage for treatmentSlide20
Decriminalization
ACA lays framework capable of addressing substance use disorders as a public health issueExpanded coverage and access to treatment reduces need to rely on criminal justice approaches to substance use
APHA Policy Number 201312 (2013) – Defining and Implementing a Public Health Response to Drug Use and Misuse
“[E]
liminating
criminal penalties for personal drug use and possession is an essential feature of a public health response to drugs and drug misuse, and APHA calls on state and federal governments to remove such criminal penalties.”APHA “[e]ncourages state governments to leverage resources potentially available through the Affordable Care Act toward effective community-based drug treatment, harm reduction, and physical and mental health
services”Slide21
Portugal
Portugal decriminalized personal possession of drugs in 2001People are no longer arrested; instead cited and asked to appear in front of civil commission
Commission determines whether to apply sanctions or recommend treatment
Simultaneous expansion of prevention/treatment funding
Results
Decrease in HIV cases among injection drug users by 71%
Drug-related deaths decreased 28%Youth and injection drug use rate decreasedPeople seeking treatment substantially increasedReductions in prison overcrowdingSlide22
Challenges
Treatment CapacityEnsuring timely access to the right level of care
IMD exclusion and alternatives to residential treatment
Moving health decisions out of criminal justice system
Ensure non-health professionals are not making health decisions (moving away from drug court models)
Investment in other resources
Housing – Inclusion as a Medicaid benefit?TransportationIDsHealth disparities in the communityHealth education/navigation (cultural competency)Slide23
Opportunities
Form/strengthen relationships with both agencies and community partnersProposition 47 implementation
Steer criminal
j
ustice
funding
towards treatment and other necessary servicesPolitics on criminal justice are changing; consensus buildingUsing ACA to bolster harm reduction treatment modalitiesExpansion of covered benefits (e.g., health homes, housing)Slide24
Conclusions
The ACA is a tool to improve the health of justice-involved individuals and crime victimsPartnerships with new allies are possibleMedicaid expansion is a public safety issue
ACA and expansion of treatment is a path towards ending criminalization of drug and mental health-related offenses
Your help is needed to maximize the potential in ACA for improving community health and safetySlide25
Resources
ACLU - ACA: A Primer for AdvocatesACLU & DPA – Healthcare Not Handcuffs: Putting the ACA to Work for Criminal Justice and Drug Policy Reform
CSJ – Health Coverage Enrollment of California’s Local Criminal Justice Populations
CSG – Implications of the ACA on People Involved in the Criminal Justice System
Community Oriented Correctional Health
Services
Russoniello – The Devil (and Drugs) in the Details: Portugal’s Focus on Public Health as a Model for Decriminalization of Drugs in MexicoSlide26
Contact
Kellen RussonielloStaff Attorney, Health and Drug Policy
krussoniello@aclusandiego.org
619-398-4489
Twitter: @
krussoniello