Administration Gives Modest Push to Efforts to Provide Access to Health Care to Former Prisoners

According to a Kaiser Health Network report, the U.S. Department of Health and Human Services announced that low-income residents of halfway houses can be enrolled in Medicaid (Badger Care in Wisconsin). Regulations continue to prohibit the enrollment of prison and jail inmates.

Federal and state prisons release more than 600,000 people a year.  A study in Health Affairs found prisons and jails enrolled only 112,5000 emerging inmates between 2013 to January 2015.  The researchers identify four practices that increase rates of enrollment.

Access to health care services can be an important factor in determining whether or not a newly released prisoner’s attempts to navigate life in the community are successful.  Many of them struggle with serious health issues, such as mental illness, drug abuse, diabetes, and HIV and hepatitis C infections.  Without adequate care, they often end up back in prison at great cost to themselves, their families, and society.







Lack of Insurance Coverage Increases Risks for those Leaving Prison

An article in Kaiser Health News,  “Thousands Leave Maryland Prisons with Risky Health Problems but no Coverage,”, describes valiant, but limited, efforts of prison officials to provide health care benefits to a population with acute needs.  Prisoners struggle disproportionately with mental illness, drug abuse, diabetes and HIV and hepatitis C infections.

Yet, often, they have limited or no access to health care upon leaving prison.  When Maryland became a Medicaid expansion state, health and prison officials were hopeful that  the inclusion of single adults with limited incomes in the eligibility pool would improve that access.  Lack of staff, bureaucratic issues, and competing priorities have hampered enrollment efforts.  The result, for example, is that a prisoner on medication for mental illness might find himself upon his release cut off from the drug that is stabilizing his condition.

Wisconsin did not accept Medicaid expansion funds.  However, single adults who meet eligibility requirements are eligible for Badger Care.


Evidence Mounts of Benefits of Medicaid Expansion for Mental Health Services

Wisconsin is one of 19 states that rejected federal funds to pay for the expansion of the Medicaid program, which here is called Badger Care.  Expansion money was made available through the Affordable Care Act of 2010.  The federal government covers 100 percent of the costs of expansion for three years and 90 percent of the costs thereafter.  Governor Walker declined the money, alleging concerns about future costs to the state.

Research is beginning to show that Medicaid expansion can result in cost savings to states, as well as greater access to health care.  “Benefits of Medicaid Expansion for Behavioral Health,” published in March 2016, summarizes numerous studies comparing results in expansion and non-expansion states.  Expansion money improves a state’s ability to address unmet behavioral health needs and frees state funds currently used to provide mental health services to uninsured people for use in efforts such as early treatment.

The report also includes evidence from various studies that document the consequences to society of the failure to treat behavioral health problems and provides useful state-by-state data about the number of people with behavioral health care problems who are untreated.

Participants in a webcast released April 27 discuss the impact on services for the homeless population in Medicaid expansion  and non-expansion states.  See here.






Funding Tips from the Stepping Up Summit

We are fortunate that Dane County was one of 50 counties–out of more than 200 applicants–selected to send a team to the Stepping Up Summit.  The rest of us, however, can follow the proceedings online.  Check them out here.

“Strategies for Financing your Plan” opened with the moderator’s comment that no advice is more frustrating or frequent for advocates in search of money than “leverage your existing resources.”  Existing resources are not enough to meet the need, he acknowledged, and introduced a panel who provided practical advice of how to expand those resources.

Tracy Plouck, Director of the Ohio Department of Mental Health and Addiction Services, told the audience to set up an appointment with the state Medicaid director to explore options and suggested they enroll people in Medicaid who are leaving jail or in a diversion program because health and other entitlement programs might help them avoid future incarceration.  She said that a state’s substance abuse block grant is “more robust” than its mental health block grant.  Many people have a dual diagnosis, so advocates should first explore substance abuse money.

John Wetzel, Secretary for the Pennsylvania Department of Corrections, said that his primary interest is “self-interest.”  He wants to see how expenditure of money from his department for programs ultimately will reduce future costs in housing inmates.  Either programs are feeders, producing more people in prison, or filters, reducing that number, he said.  Advocates must show that they are providing filters and, thus, reducing costs to his department.

Wetzel told the group to talk to the state’s corrections director.  He or she might be “your biggest advocate.”  He also reminded the group that “long-term thinking at the state level is the next election.”

Andrew Keller, CEO of the Meadows Foundation, told the group to regard foundation money as “transformational money,” which can be used to support activities such as planning that are not easily funded by traditional sources. A grant from a well-regarded foundation can lead to grants from other sources and to interest from individual philanthropists. Those individuals are often able to secure political support for the reform efforts.

Maury Thompson, Assistant County Manager of Johnson County, KS, spoke about the wariness of county officials to accept federal grants because of their time limitations.  His solution: establish benchmarks and collect data from the beginning that can be used to show the cost-effectiveness to the county of the grant.  He suggested approaching institutions such as hospitals that benefit financially from a reduction in admissions to emergency rooms due to better mental health services.   Similarly, the state benefits from a reduction in admissions to state psychiatric hospitals.








Tell Rep. Mark Pocan to Support Mental Health/Criminal Justice Bill

In a rare display of bipartisanship, 52 Democrats and 39 Republicans in the House of Representatives have signed on as co-sponsors of the Comprehensive Justice and Mental Health Act of 2015 (H.R. 1854).  An identical bill passed the Senate at the end of last year.

The bill would authorize funds for a “sequential intercept” model, which provides interventions for dealing with people with mental illness at various stages of the criminal justice process. It would also provide grants for emergency and crisis services, alternatives to jail, and training for police.

In early January, the bill was reported out of the House Judiciary Committee and headed for consideration by the full House of Representatives.   As of April 20, 2015, Representative Mark Pocan was not listed as a co-sponsor, although the bill would authorize funding for many of the recommendations about criminal justice made to the Dane County Board of Supervisors.  I received an email from his staff expressing general concern about the problems addressed by the legislation but no statement of support. has more information about this legislation and enables users to track any bill.






Is President’s Support for MH Parity Too Little and Too Late?

On March 29 President Barack Obama announced formation of an interagency task force to promote implementation of the mental health and substance abuse parity provisions in the Affordable Health Care.

As reported in  Kaiser Health News, former Congressman Patrick Kennedy said, “…it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”

LA lawyer Meiram Bendat, who has filed lawsuits on behalf of those seeking treatment, said that “another task force is a far cry from much-needed enforcement.”  He added that “bias against those with mental illness frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”

Failure to enforce parity provisions affects all of us. Initially it hurts only a person with mental illness and his or her family members.  But, lack of access to treatment can lead to costly emergency room treatment, loss of earning capability, involvement with the criminal justice system, and more expensive long-term care that is paid by our taxes.





Dane County Reps Invited to DC Summit on Mental Health and Criminal Justice

Dane County is one of 50 applicants selected to attend the Stepping Up Summit in Washington, D.C. on April 18-19.  The summit is an important component of an ambitious effort by the National Association of Counties, the Council of State Governments, and the American Psychiatric Association Foundation to reduce the number of people with mental illness in jails and prisons.

On its  website, the Stepping Up Initiative offers a toolkit to help county governments identify obstacles to reform and learn from successful efforts throughout the country.  You will also find news accounts, research to support proposals, and stories about people involved in the reform efforts.

Applicants invited to the summit had to demonstrate prior commitment to the goals of the initiative and form an inter-disciplinary team that could work together to implement lessons learned.  Dane County’s team includes: Carousel Bayrd, Vice President of the Dane County Board of Supervisors; Kristin Ramon of the Madison Police Department; Mary Grabot of the Dane County Department of Human Services, Dane County Sheriff David Mahoney, and Lindsay Wallace, Executive Director of Dane County NAMI.



Join the Live Webcast of the Stepping Up Summit

Proceedings of the Stepping Up Summit in Washington, DC on April 18-19 will be available as a webcast at  The summit is an important step in an effort to create a long-term movement to raise awareness about the number of people with mental illness in jails and to promote practices and strategies that drive the numbers down. The National Association of Counties, the Council of State Governments Justice Center, and the American Psychiatric Association Foundation created the Stepping Up Initiative in 2015.

Of special interest to Dane County will be these presentations:

  • A Vision for Reducing the Number of People with Mental Illness in Jail
  • Six Questions County Leaders Need to Ask
  • Strategies for Financing Your Plan, and
  • Federal Investment and Support .


Law Suit Alleging Parity Violations Proceeds to Trial

The New York State Psychiatric Association has cleared an important legal hurdle in its suit against United Health Group and its subsidiaries for systematically violating the federal parity law and the Affordable Care Act.

In August 2015, the U.S. Supreme Court declined to review a lower court decision that held that the association was a proper defendant in the case and held standing to represent the interests of its members and patients.  That decision also held that United could be sued even if it acted only as the administrator of a self-insured plan.

As quoted in Psychiatric News (12/10/2015), Seth Stein, general counsel for NYSPA said, “We hope to expand the scope of the litigation to examine existing disparities in reimbursement between behavioral health benefits and medical-surgical benefits…”See article:



How to Fight for Mental Health Parity

Mental health organizations, such as the American Psychiatric Association, the National Alliance on Mental Illness, and Mental Health America, joined together to provide professionals and advocates help in making mental health parity a reality. Check out the resources at Parity Implementation Coalition at The website has answers to frequently asked questions, news about lawsuits and legislation, and an online form for submitting an individual question.  See Make the Insurance Companies Pay on this blog for information on how those companies are circumventing the parity requirements.