Joint Study Committee on Treatment Options
for Offenders who have Mental Illness or
Substance Abuse Disorders (SJR 440)

FEDERAL RULES

SSI

  • Only lost after one full calendar month of incarceration

  • SSI suspended for up to 12 months; terminated 12 months or more

  • Suspended SSI reinstated following (1) release and (2) confirmation of financial status

  • Terminated SSI reinstated following redetermination of eligibility (including assessment of disability)

Medicaid:

  • SSI-link – federal Medicaid not restored until SSI restored

  • Services provided from date of application (or release whichever is earlier) can be retroactively claimed from feds

  • No federal requirement to terminate Medicaid

TANF

  • Individual loses TANF while incarcerated

  • Individual must re-establish eligibility as a custodial parent upon release (but can submit application while in jail)

  • As with SSI, states can suspend Medicaid and restore upon release and claim federal share once individual qualifies

  • Those with drug felonies not eligible for cash assistance unless state has opted out of this provision

  • All are eligible for TANF services – can be furnished in jail

  • TANF services can support re-entry (housing assistance, SA/MH, employment training, etc.)

Veterans Benefits

  • Veterans with service-connected disability benefits who commit misdemeanors can retain cash benefit while incarcerated

  • All Veterans retain cash benefit for first 60-days following conviction

  • Veterans must contact one of 58 regional VA offices for reinstatement
  • VA is slow!
  • No health care payments from VA to jails or prisons: will pay for health/mental health care for Veterans who are:
  • on parole
  • on work release
  • confined in half-way house
  • participating in community control program
  • confined in state hospital

STATE OPTIONS
SSI-ELIGIBLE INDIVIDUALS

  • Suspend, do not terminate, Medicaid-eligibility for individuals in jail who lose their SSI
  • no federal match while in jail
  • no federal match available until SSA re-instates SSI
  • state-funded Medicaid services available upon date of discharge
  • federal reimbursement for all such services available retrospectively once individual is re-instated

  • Individuals do not normally gain significant income or assets in jail–therefore reinstatement virtually assured

STATE OPTIONS:
OTHER MEDICAID-ELIGIBLES

  • Suspend coverage instead of terminating for non-SSI Medicaid eligibles (e.g., low income women, juveniles, medically-needy, etc.)

  • Redetermine Medicaid eligibility immediately prior to discharge

  • Continue state-only Medicaid for those not yet eligible but likely to be medically-needy (i.e., were previously eligible)

FEDERAL PRE-RELEASE AGREEMENTS

  • Formal written agreements between penal institutions and local Social Security Offices

  • Jails agree:
  • notify SSA of inmates to be released in next 30 days
  • provide current medical evidence and non-medical information
  • provide SSA with anticipate release date
  • notify when inmate actually released
  • SSA will:
  • train jail staff about SSI rules and work with them to ensure application procedures go smoothly
  • provide a contact person to assist jail
  • process re-applications and new applications ASAP
  • promptly notify jail of decision

  • SSA will take Food Stamp as well as disability applications

STATE OPTIONS FOR
PRE-RELEASE PROGRAMS

  • Mandate all state prisons to enter into pre-release agreements with Social Security offices

  • Encourage local jails of significant size to enter into pre-release agreements

  • Encourage small local jails to obtain information on federal benefits, application forms for inmates and to post 1/800#s for inmates to obtain further information

  • Establish mechanisms whereby jails can have pre-release programs that include all relevant federal-state benefit programs: SSI, SSDI, Medicaid, Medicare, Food Stamps, TANF, VA

RECENT CASES

  • Brad H in NY City (State court ruling):
  • City cannot release inmates with mental illnesses with just $1.50 and two subway tokens
  • City must provide adequate discharge planning
  • Wakefield, 9th Circuit federal court:
  • Held Eighth Amendment requires states ensure released inmate who has been taking medication leave with "a supply sufficient to ensure that he has that medication available during the period of time reasonably necessary to permit him to consult a doctor and obtain a new supply.
  • Lugo in NY federal district court
  • Imposed a duty on state to provide medical services for a parolee who was receiving continuing treatment at time of release, for a period of time reasonably necessary for him to obtain treatment on his own behalf.

EXAMPLES OF PROGRAMS

  • New York mental health authority:
  • Pays for psychiatric medications for those leaving jail or prison
  • Pays for transition managers to assist former inmates file benefit claims
  • Individual must apply for Medicaid
  • Lane County, Oregon
  • State-only Medicaid is available for first 14-days in jail after arrest
  • Rensselaer County, NY
  • Jail staff trained to help inmates complete entitlement applications
  • Inmates given picture id to facilitate re-entry
  • Inmates can be accompanied to local social security office
  • Massachusetts, Springfield
  • Local community health program staff assist jail inmates and provide services

 

JOINT COMMISSION ON BEHAVIORAL HEALTH CARE

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