access to federal benefits for people with mental illnesses leaving jail or prison presentation by...
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Access to Federal Benefits
for People with Mental Illnesses
Leaving Jail or Prison
Presentation by
Elaine Alfano, Policy Analyst
Bazelon Center for Mental Health Law
11/27/07
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“Individuals with mental illnesses leaving jail or prison without sufficient supplies of medication, connections to mental health and other support services and housing are almost certain to decompensate, which in turn will likely result in behavior that constitutes a technical violation of release conditions or a new crime.”
Council of State Governments, Criminal Justice-Mental Health Consensus Project
Why Focus on Re-Entry?
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Clinical Data about Inmates 8-16% have a MI 2-4 times more likely to have SMI
than general population Inmates with MI: 72% have co-
occurring substance use disorder 60% of inmate w/ MI were using
drugs/alcohol when committed their offense
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2006 US Department of Justice Study
43% in jail and 32% in state prison had symptoms of mental illness
21% in jail & 24% in prison were assessed by professional as having a mental health problem in year before arrest
24% of jail inmates and over 15% of state prison inmates had experienced psychotic symptoms in the last 12 months
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Causes of Rising Imprisonment Rates
Percentage of inmates with the most serious disorders - not changed since 1950
Numbers with SMI has risen at the same
rate as the incarcerated population overall.
The problem is length of stay - NOT caused by closing of mental hospitals.
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Mental Health Problems Unidentified
Only 23% of inmates reporting MH problems received treatment for problems in the year before arrest
Many inmates receive an assessment of SMI for the first time when they are incarcerated
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Histories of Incarcerated People with Mental Health Problems
More likely to have a history of physical or sexual abuse
More likely to have lived in foster care while growing up
More likely to be homeless and unemployed in the year prior to arrest
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Greater Trouble Inside
58% of prison inmates with MI are charged with rules violation vs. 43% of those without
20% of prison inmates with a MH problem are injured in fight vs. 10% of those without.
Study in NYS - 23% in solitary confinement have a mental illness. Sensory deprivation, social isolation and idleness worsen condition.
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Length of Incarceration
In 2000, 27% of inmates with mental illnesses released into the community had served their maximum sentence vs. 16% of the general prison population
Among those diagnosed with serious mental illness, 50% served their maximum sentences.
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Recidivism Rates
64% of released inmates with mental illnesses were rearrested and 48% were hospitalized after 18 months.
47% of prison inmates with a mental health problem have served 3 or more sentences (vs. 39% without).
81% of prison inmates with mental illness had prior convictions compared with 79% of other inmates.
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Costs to Society US has highest incaceration rates – 737
per 100,000 people 2nd highest, Russia, is 581 per 100,000 Over $60 billion spent annually on
corrections About 2/3 of prison admissions related to
probation/parole violations - ½ are technical violations, not new crimes
Source: Open Society Institute
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Aims of a Benefits’ Initiative
Through pre-release planning, individual leaves facility with:
Benefits & bridge assistance
Identity documents
Connection to community services & supports
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Benefits Provide Safety Net Medicaid
Medicare
SSI/SSDI
Veterans Benefits
TANF
Food Stamps
Housing asst.
General Assistance
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Bazelon Work on Benefits
Consensus Project Publications Model law and policy 3-state project -MN,MD,VT Federal legislation
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Jail and Prison Differentiation Jails have mix of pre-trial detainees, misdemeanants &
parole violators. Short stays, generally less than 1 year
Prisons have people already sentenced Jails under local or county gov’t. Policies, practices, &
resources vary by locality
Prisons governed by state
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SSI/SSDI Income-Support Programs
SSI (Supplemental Security Income) is paid to low-income, disabled individuals
SSDI (Social Security Disability
Insurance) is for disabled workers who have paid Social Security taxes for a minimum number of years
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SSI Benefits After 1 full calendar mo., SSI suspended
<12 months, SSI can be reinstated
12+ months, re-apply and new disability determination needed
SSI key for income support & Medicaid
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Restoring SSI
Suspended benefits can be re-instated prior to release, payable upon release.
New applications for SSI may be filed while the individual is in jail or prison.
New benefits are payable back to the date of application (or in the case of a person in jail or prison, back to the date of release).
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SSI: New Application
Need to provide evidence of disability and low income and resources.
Medical documentation requires a physician’s or clinical psychologist’s report.
Application may take 3 or more months for review. Important to begin process well in advance of release.
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Pre-Release Agreements with SSA SSA encourages local SSA offices to
enter into “Pre-Release Agreements.” Facility agrees to
Designate a facility-liaison to work with SSA
Provide needed medical/non-medical info to support claim.
Provide anticipated release date and notify SSA if anticipated release date changes.
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Social Security Disability Insurance (SSDI)
SSDI monthly benefits, based on past earnings.
Automatically eligible for Medicare 2 years after they qualify for SSDI.
Cash payments are suspended one month after a conviction; benefits can resume on release
New applications for SSDI can be timed so inmate receives payment upon release.
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Medicaid
Benefits vary by state, but all states cover outpatient services for mental illness.
Medicaid will not pay health care of individuals who are incarcerated, but (at state option) individuals can retain Medicaid eligibility while incarcerated.
Qualified individuals are eligible for benefits immediately upon release.
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Medicare
Federal SSDI linked to eligibility for Medicare subject 2-year waiting period.
Inmates 65 or older also eligible. Does not pay for health care in CJ
facility. Can resume upon release but the
individual will need Medicare card.
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Restoring Medicare
Part A (hospital) restored at release Outpatient & medication (Parts B & D)
end if no premiums are paid Failure to pay premiums: Will have to
wait to re-enroll during general enrollment period (annually Jan. - March) & pay higher premium
If incarceration will be >90 days, inmate should contact SSA
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Veterans Benefits
Disability payments can resume upon release with timely notification to VA
Service-connected disability payment reduced 60 days after felony conviction
Non-service-connected disability stops 60 days post-conviction—felony & misdemeanor
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VA Benefits
Veterans’ cash & health benefits can re-start if timely notice is provided to VA.
Prior to release, veterans should contact the VA to request benefit restoration.
To reinstate benefits, the VA needs written confirmation that the individual has been released.
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Temporary Assistance to Needy Families (TANF)
TANF cash assistance/services for needy families w/ dependent children in the home.
Cash assistance is only paid to a custodian of dependent children
TANF-funded services can go to non-custodial parent, but only if related to economic self-sufficiency
TANF recipients are also eligible for Medicaid.
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TANF Applications
Information individuals need to know in order to apply for TANF:
A recent income history is required in all applications.
Individuals with incomes that are considered too high may not eligible for a TANF cash payment but may still be eligible for: Services Medicaid
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Food Stamps
For low-income, based on income and assets
Work requirement waived for caretaker of child under 6 or person w/disability.
Federal law bans Food Stamps for life for people convicted of drug felonies, although states can opt out
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Federal Food Stamp Rules
Applications for Food Stamps can be submitted with an application to reinstate or apply for SSI The Social Security Administration will then
process the Food Stamp application.
Federal funds are available (50-50 match) for outreach services. Jails/prisons could use these funds to provide
information to inmates so they can apply while incarcerated.
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Identity Documents
Social Security card, birth certificate, citizenship documents, Medicare card
Ensure that valid IDs held by facility are returned upon release or:
Can be held in trust by a community agency. Held by a family member the inmate trusts.
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New Identification Documents
Establish process so inmates obtain official, photo ID upon release. Most state DMVs provide official photo-IDs for non-drivers.
Interagency agreements and planning needed to achieve aim.
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Getting Started Research
Outreach to key informants and likely advocacy partners
Outreach to state and local officials
Assessing interest and buy-in & interagency leadership
Legislation, admin policy, executive orders are the vehicles for making needed policy changes
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Partnerships and Coalitions
Include partners that collectively have the range of knowledge/sphere of influence needed
Interagency planning, leadership and sustained commitment needed
More complex undertaking than it would seem
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Major Planning Decisions
Where to start – pilot vs. statewide? Prison/jails? Population – only those with SMI? Eligibility criteria Lead agency Who does benefits counseling?
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Other Key Decisions
Resource needs
Training needs
Monitoring & Documentation
Outcome Measures
Intake screening
Eligibility tracking
Re-entry planning
Sustainability of initiative
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Benefits Counseling Options
Local community mental health agency case managers
State eligibility workers Specially-trained corrections staff Community health center out-stationed
eligibility workers Community Action Agencies, homeless
programs, often also have eligibility specialists.
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What is Needed?
The right partners
MOUs, interagency collaborative agreements
Training and leadership
Systematic planning &implementation
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Summary of Core Elements Screen for mental illness Screen for benefits, IDs, and need for medical records If possible, suspend not terminate Application assistance in facility Expedited review of applications Interagency agreements Coordination of release planning
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Interagency Agreements Medicaid, Corrections, Health, Social
Welf. & Econ.Services, MH/SA, DMV, VR
Fed. Agencies - SSA, VA pre-release agreements
Health Care for Homeless, Comm. Health Centers, Community Action
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Release Planning - Best Practices
Medicaid, Corrections, Health, Economic Services, Mental Health, SSA, VA, DMV, consumer reps in work group planning effort
Start at intake – screen for benefits
Start prep work & applications ASAP
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Best Practices
On-going training for staff
Document steps
Develop forms, checklists, protocols to operationalize process
On-going monitoring & feedback
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Best Practices Collect process & outcome
indicators
Stay involved. Keep champions involved/informed
Use success for new re-entry efforts
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Priorities Identified
Support for CMHC in-reach
Focus on housing
Peer support/mentoring
Focus on state psychiatric institutions
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Contact Info
Elaine Alfano, Policy AnalystBazelon Center for Mental Health Law1101 15th Street, NW, Suite 1212Washington, DC 20005-5002Phone: 202 467-5730, ext. 123E-mail: [email protected]: www.bazelon.org