Access to Medicaid & Medications The New York State Medication Grant Program

1. Access to Medicaid & MedicationsThe New York State Medication Grant Program Dan Abreu, M.S.CRC Policy Research Associates DAbreu@prainc.com C. Terence McCormick, MSW, MPA CARES, LLC (www. CARESLLC.com) CARES-TMcCormick@Earthlink.net

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” 2001

3. Medication Grant Program 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. Medication Grant Program 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

5. Medication Grant Program Enrollments

6. Medication Grant Program Participating MGP Counties Potential MGP Coverage

7. Medication Grant Program 2004 MGP Enrollments

8. Medication Grant Program County Jails Releases: 2004 • Total enrollments = 1441 • 793 Used MGP = 55% Utilization • 648 Did not use MGP = 45% • 73% of All MGP Enrollees Received Medicaid

10. Medication Grant Program Prison Releases: 2004 • Total enrollments = 1376 • 498 Used MGP = 36% Utilization • 878 Did not use MGP = 64% • 81% of All MGP Enrollees Received Medicaid

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

13. Medication Grant Program 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 Grant Program 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. Medication Grant Program Pharmacy Benefits Manager • Formulary (essential and augmenting medications) • MGP Fax applications • 3700 Pharmacies • Program Usage Reports

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

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

18. Medication Grant Program 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. Medication Grant Program 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. Medication Grant Program 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 (Primary) Caseload=7730 January 1, 2004

22. MGP Enrollment DiagnosesPrison MGP Prison Enrollees 2968 10% did not report a Diagnosis

23. MGP Enrollment Diagnoses: Jail MGP Jail Enrollees 2907 51% did not report a Diagnosis

24. Medication Grant Program Prescriptions Filled: Prison Releases Jail Releases

25. Medication Grant Program Definitions: MGP Utilizations - % utilizing MGP card post release Medicaid Enrollment - % completing Medicaid enrollment post release Aftercare Studies - % civil inpatient releases keeping follow-up appointments Compliance Studies - % of seriously mentally ill taking prescribed medication

28. Medication Grant Program

29. Medication Grant Program 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

30. Medication Grant Program THE END