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Effects of a Discharge Planning Program on Medicaid Coverage of State Prisoners with Serious Mental Illness

by Audra T. Wenzlow, Henry T. Ireys, Bob Mann, Carol Irvin, & Judith L. Teich (20111).  Psychiatric Services, 62(1): 73-78.

A central concern in the actualization of any release decision, procedure, or process is how community-sentenced, paroled, or simply released offenders connect with necessary, required, or useful community resources, including housing, employment, and financial support. In this study, researchers affiliated with the Oklahoma Department of Corrections, the U.S. Department of Health and Human Services, and Mathematica Policy Research, a private research group, examine data related to discharge planning efforts in three Oklahoma prisons that enroll seriously mentally ill parolees in Medicaid immediately, or shortly, after their release from custody.

Prisoners cannot enroll in Medicaid while incarcerated. As a result, many prisoners, including those with serious mental illness, reenter society without sufficient fiscal support. Medicaid services improve former prisoners' access to health services and undoubtedly reduce the likelihood that they will soon be incarcerated or hospitalized. Accordingly, the Oklahoma Department of Corrections and the Oklahoma Department of Mental Health and Substance Abuse established a steering committee to help remove barriers former prisoners face in obtaining Medicaid upon release. Members of this committee included representatives from the state's corrections, disability, human services, mental health, and Social Security agencies. The aim of this committee was simple: to identify Medicaid-eligible prisoners who could be enrolled on the day of their release or shortly thereafter.

In January 2007, the Oklahoma legislature appropriated funding to hire discharge managers at three state prisons to work with existing mental health treatment teams. As the authors of this article note, "The discharge managers are especially well suited to bridge the gap between prison teams and community-based services because they are employees of the state mental health agency (and therefore have credibility with community-based providers) but also have offices in the Department of Corrections facilities (and therefore have access to clinical information needed to identify the target population and provide them with disability benefit application assistance)." In particular, this discharge planning initiative identifies Medicaid-eligible prisoners 6-9 months before their release, helps them apply for federal disability benefits 4 months before their release, and assists them with other Medicaid applications 2 months before their release.

The three prisons served through this initiative were a 1400-bed medium-security men's prison, a 1000-bed maximum-security women's prison, and a 2000-bed maximum-security men's prison, each of which had one or more mental health units. The evaluation of the discharge planning services used cross-sectional and comparative data on 77 prisoners eligible for the program, and larger groups of prisoners not enrolled in the program. Diagnoses for those eligible for the program include major depression, bipolar disorder, and psychotic illness; eligibility also depended on the need for intensive treatment (although not 24-hour monitoring).

The program had "significant positive effects": 25% of participating prisoners were enrolled in Medicaid on the day of their release and Medicaid enrollment was increased by 15% on day of release and by 16% after 90 days. Wenzlow et al. report that "the program not only increased the likelihood of obtaining Medicaid coverage on release, but people eligible for program services were also more likely to obtain Medicaid-covered mental health care."

The authors of this study note that even new federal health care legislation (so-called "Obamacare") is unlikely to alter the situation of Medicaid-eligible prisoners who will still not be able to access these benefits while incarcerated. Therefore, for prisoners in Oklahoma and elsewhere "special efforts to enroll eligible inmates at discharge will continue to be needed to ensure that these inmates will have access to treatments and services that minimize risk of relapse and recidivism."

For further information, contact Audra T. Wenzlow, Ph.D., Mathematica Policy research, 555 S. Forrest Ave., Suite 3, Ann Arbor, MI 48104, (email)  

Posted Thu, Aug 4 2011 4:56 PM by Tracey Vessels


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