Access to Medicaid Medications The New York State Medication Grant Program

1. Access to Medicaid & MedicationsThe New York State Medication Grant Program

2. Authorizing Authority Kendra’s Law: “To provide medications and other services necessary to prescribe and administer medications to treat mental illness during the pendancy of a medical assistance eligibility determination…..for persons who have received services services from a …. Mental health unit of a correctional facility”

3. Eligibility Criteria have received mental health services in a correctional facility have a mental illness prescribed psychiatric medications applies for Medicaid prior to or within one week of release from a correctional facility

4. Program Components Transition Managers Funding for Medications and Related Expenses Benefits Manager and Pharmacy Access Medicaid Applications Local Mental Health MGP Coordinator State Mental Health Financial Oversight

6. Participating MGP Counties

7. 2004 MGP Enrollments

8. Total enrollments = 1441 793 Used MGP = 55% Utilization 648 Did not use MGP = 45% 73% of All MGP Enrollees Received Medicaid

10. Total enrollments = 1376 498 Used MGP = 36% Utilization 878 Did not use MGP = 64% 81% of All MGP Enrollees Received Medicaid

12. Transition Management 80 jail transition managers 24 prison “pre-release coordinators”

13. Medication Funding Funds guarantees payment for providers for participants found ineligible for Medicaid Medications Augmenting medications Clinical services necessary to prescribe medications Administration of the MGP program

14. Medication Related Expenses screening visits with a mental health professional medication evaluation/diagnostic visits with a physician, provision of injectable medications by nurse, follow-up visits to monitor for medication side effects and/or to adjust dosages and laboratory tests.

15. Pharmacy Benefits Manager Formulary (essential and augmenting medications) MGP Fax applications 3700 Pharmacies Program Usage Reports

16. Social Services Medicaid Applications Training: Jail Transition Planners Social Service/Mental Health MOU

17. Local Mental Health MGP Coordinator Jail Transition Planner Application for reimbursable services Social Service/Mental Health MOU

18. Local Mental Health MGP Coordinator Oversees entire local MGP program Receives Medicaid applications from Transition Managers Verifies reimbursement requests for medications and services to Medicaid “ineligibles” Receives program usage reports from Benefits Manager Submits termination notices to Benefits Manager

19. State Mental Health Distributes discharge planning funds Negotiates contract with Benefits Manager Approves MGP plans submitted by counties Approves payment for services to applicants found ineligible for Medicaid Negotiates coordination between State prison discharge planners and local mental health MGP Coordinators Provides oversight and technical assistance

20. Technical Aspects Developing a pharmaceutical formulary Creating a coding system for referrals from jail/prison unit How to handle “Medicaid ineligibles” Prescription refill time limits

21. CNYPC Outpatient Diagnoses

22. MGP Enrollment DiagnosesPrison

23. MGP Enrollment Diagnoses: Jail

24. Prescriptions Filled:

29. Lessons Learned Many Participants receive Medicaid prior to release or within the time of their 2-week supply of medications from corrections has run out Medication non-compliance reduces numbers of program participants MGP utilization rates consistent with the compliance of other populations with mental illness Prisons need guaranteed access to all established MGP programs Application packets for all local programs need to be uniform for prison referrals

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