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

“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?

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

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

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.

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

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

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.

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.

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.

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

Aims of a Benefits’ Initiative

Through pre-release planning, individual leaves facility with:

Benefits & bridge assistance

Identity documents

Connection to community services & supports

Benefits Provide Safety Net Medicaid

Medicare

SSI/SSDI

Veterans Benefits

TANF

Food Stamps

Housing asst.

General Assistance

Bazelon Work on Benefits

Consensus Project Publications Model law and policy 3-state project -MN,MD,VT Federal legislation

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

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

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

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).

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.

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.

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.

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.

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.

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

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

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.

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.

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

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

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.

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.

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.

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

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

Major Planning Decisions

Where to start – pilot vs. statewide? Prison/jails? Population – only those with SMI? Eligibility criteria Lead agency Who does benefits counseling?

Other Key Decisions

Resource needs

Training needs

Monitoring & Documentation

Outcome Measures

Intake screening

Eligibility tracking

Re-entry planning

Sustainability of initiative

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.

What is Needed?

The right partners

MOUs, interagency collaborative agreements

Training and leadership

Systematic planning &implementation

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

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

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

Best Practices

On-going training for staff

Document steps

Develop forms, checklists, protocols to operationalize process

On-going monitoring & feedback

Best Practices Collect process & outcome

indicators

Stay involved. Keep champions involved/informed

Use success for new re-entry efforts

Priorities Identified

Support for CMHC in-reach

Focus on housing

Peer support/mentoring

Focus on state psychiatric institutions

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: elaine@bazelon.orgWebsite: www.bazelon.org