Helping Michigan Parolees With Medical Needs – MPRI Re-entry

A Successful Community Health PathwayVondie Woodbury – Director, Coordinated Community Benefit

Affairs – Trinity Health CorporationDirector, Community Benefit – Mercy Health Partners

Executive Director, Muskegon Community Health Project

Breaking the Cycle of Crime

95% of all inmates will leave prison 650,000 released nationally every yearMI - 50,000 inmates living in 42 facilitiesMI spends $2 billion annually – one of 4 states that spend more on corrections than on higher education12,000 are paroled annuallyHalf will commit new crimes or violate parole rulesIn MI 6,000 return to prison annually at a cost of more than $180 million

Breaking the Cycle of Crime

In Michigan prior to MPRI:

Inmates left prison with a $75 bus ticket 2-week voucher for a cheap hotel Many lack social security card, birth certificate

or a state ID No help with substance abuse or mental health

issues Parole officers working with 60-80 offenders

did not have time to help. 48% of parolees returned to prison

What is MPRI?

The Mission of MPRI

…is to significantly reduce crime and enhance public safety by implementing a

seamless system of services for offenders from the time of their entry to prison through their transition, community reintegration and aftercare in their

communities.Michigan Department of Corrections

MPRI History

Started in 2005 with 8 pilot counties

Additional counties (including Muskegon) added in 2007

Went statewide 2008

Initial funding $12 million

Fy10 $50 million

Michigan Re-entry

18 County re-entry collaborations

$30 M appropriation from State for FY-09

Increases to over $50 million in FY-10

Contracts are managed locally – county level

Basic Structure and Process of MPRI

Typical MPRI Process

1. A Local Coalition is Established (single or multi-county)

2. Coalition develops semi-annual Action Plan3. Action Plan approved by MDOC – funded4. Individual subcontractors responsible for core

activities: housing, transportation, job placement/training, mental health and substance abuse

5. MPRI Coordinator is HUB for Multi-functional Collaborative operation

Muskegon’s MPRI Collaborative

Goodwill IndustriesWest Michigan TherapyMichigan Rehabilitation ServicesDepartment of Human ServicesMuskegon Community Health ProjectDepartment of Corrections & ParoleOrchard View Community EdCommunity Mental HealthVictim’s ServicesShoreline Prison FacilityLocal Police AgenciesFaith Based Organizations

1. 6 months prior to release “in-reach” team meets with parolee in prison; process is explained.

2. Immediately prior to release – exit interview; appointments scheduled;

3. Upon release each contractor coordinates their piece of the puzzle;

4. Payment is based upon successful completion of each part of process (e.g. job placement; a place to live;)

Parolee Interface

Using Local Health Navigation – Muskegon’s Approach

Background MDOCMichigan Prison System Health Care

$330 million a year for inmate health care (based on a projected number of 48,000 inmates)

Annual health cost per prisoner of $6,600 4,000 prisoners estimated to have chronic

diseases 524 estimated to be medically fragile

Why Medical Navigation?

90% of parolees return to community as uninsured without medical home;No medical records returned with parolee;Pharmaceutical support for chronic disease terminated after 30-daysParolees were unaware of medical safety net support structureSignificant level of imbedded chronic diseaseJob retention could be affected

Muskegon’s Basic MPRI Health Initiative

Incorporated Health Care navigation as part of Muskegon’s MPRI collaborative process in 07 Only site in state piloting approach

1,037 parolees have received assistance since 2007

Designated community health navigator is part of community in-reach and support team for parole; Health Project is HUB for Health Care Initiative

Program expanded 09 to include 11 additional counties

Muskegon’s Basic Re-entry Health Initiative Goals

Secure Medical Record

Conduct Health Assessment

Screen for enrollment into Medicaid, FSP, etc.

Identify and schedule first appointment for medical home

Provide for pharmaceutical assistance

Provide chronic disease self management

Action Pathway for Medical Assistance – How Does it Work??

STEP ONE: Individual is identified as eligible for parole and the MPRI program

ACTION PATHWAY

STEP TWO: Team schedules/conducts MPRI In-reach at the Prison facility

As a Team they meet with and interview each parolee to determine individual needReview parolee plan – going home?Are there special considerations – CSC?Process and individuals are introduced

ACTION PATHWAY

STEP TWO (medical only): Health Navigator Meets Privately with the Parolee

Makes arrangements to get medical records at release;

Conducts health assessment for chronic conditions and medication need

Initiates enrollment screening – Medicaid, SSI, FSP, Lion’s Vision, etc.

ACTION PATHWAY

STEP TWO – Health Navigator Schedules Medical Appointment

Contacts FQHC’s, Migrant Clinics, Free Clincs, Private Physicians;

Prioritizes parolees with medical conditions Identifies need for medication assistanceWithin two weeks of release….

ACTION PATHWAY

STEP THREE – Team Schedules and Implements Exit Interview before Release

Affirm date of medical appointment Will transportation be an issue? How will medication be handled?

ACTION PATHWAYSTEP FOUR –Medical Navigator meets with parolee – post release.

Complete and sign all enrollment applications if necessary (CHW use)

Review assessment document – complete if necessary

Review pharmaceutical assistance program (Pharmacy CHW use)

Re-confirm medical appointment plus any additional medical services warranted (Specialty care, Chronic Disease Self Management, Clinical-AIDs, etc.)

ACTION PATHWAY

STEP FIVE –Medical Navigator confirms that medical appointment kept.

Yes?No? – What barriers indicated? If No – follow-up with parolee on

rescheduling

ACTION PATHWAY

STEP SIX – Resolution Step

Parolee has medical access.

Disease State of Participants Health Navigation Participant

Demographics

1037 Helped through Health Project since MPRI inception

70% of MPRI clients have a medical issue at release

47% need pharmacy assistance

Disease State of Participants (BEGINNING WITH HIGHEST FREQUENCY)

Asthma/Respiratory DiseaseHypertension/High CholesterolMental Illness: Depression, Anxiety, PsychosisPain: Chronic, Arthritis, Knee, Back, AnkleOther: Hepatitus C, HIVDiabetesGastrointestinal: Crohn’s Disease, Ulcerative Colitis, Acid Reflux

Disease States Managed by Medication

(pharmacy assistance program)

Mental Illness – 52%

Asthma – 33%

Diabetes – 35%

Heart Disease – 26%

The Value of Health Services for Basic Re-entry

Uninsured individuals who are high risk or who have chronic conditions have medical care to improve or sustain health

The ability to keep a job can be related to unmanaged health problems

The community benefits when parolees succeed in transitioning from prison to home

Reduction in recidivism results in lower state costs (28% statewide/11-12% annually in Muskegon)

MPRI Challenge

State has recently announced accelerated release processIntention is to save $180 million of $2 billion state corrections budget15-member parole board handles 375 cases a monthVolume and economy places pressure on placement capacity – health, jobs, housing, etc. Opposition to accelerated release process by Prosecuting Attorneys (public safety concerns) may impact process

Assisting the Medically Fragile Parolee

Why Prisons Need a Medically Fragile Program

Medically Fragile prisoners cost an average of $72,500 annually for health care

524 medically fragile prisoners cost $29M/yr.

Community placement cost - $20,000 each

The cost savings is $52,500 per prisoner

Total savings could be $21M annually

Most medically fragile prisoners would have been paroled if there was an appropriate community placement

Muskegon’s Medically Fragile Re-entry Health Initiative

Assists medically fragile individuals who pose little or no risk to communities Individuals who are close to or past their

earliest parole dates, or have sentences commuted by the Governor

Provides community placement in appropriate care settingProvides Medicaid eligibility and other entitlementsProvides transitional funding to health care providers until Medicaid begins

Compassion and fiscal responsibility can work together

Kenneth Anderson, 80, of Iron County was one of the earlier community placements, moving from prison to a nursing home.

The Unique Needs Required for Community Placement of Medically

Fragile Prisoners

Population has medically-centered needs: SSI eligible to trigger Medicaid coverage Appropriate medical services must be near by Housing with medical support: Nursing

Homes; Hospice; etc. Higher end meds CHORE services Family support Parole supervision

The Medically Fragile Program Services

Conducting Prison In-reach interviewCollecting the Medical RecordProviding the Benefit Eligibility ScreeningAssisting with entitlement applicationsContracting for the appropriate Medical HomeProviding Corrections with the post-release community placement planCoordinating with the Parole Office agentsCompliance monitoring for 6 months

Muskegon’s Medically Fragile Health Profile

End stage kidney and liver diseasesMultiple SclerosisChronic Obstructive Pulmonary DiseaseCancersSevere hypertensionMental illness / DementiaCongestive heart failureCoronary artery diseaseSevere ArthritisHuntington’s ChoreaParkinson’s Disease

Cost to Prison is unsustainableHealth care setting is inappropriateProvides dignity at the end-of-life

The Value of Health Servicesfor Medically Fragile Re-entry

Additional Information

Vondie’s phone number and email –

231-672-3201 at the Health Project

woodburv@mchp.orgMail letters to:

Muskegon Community Health Project

565 W. Western Avenue

Muskegon, MI 49440