Access to Federal Benefits for People with Mental Illnesses Leaving Jail or Prison

1. 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

2. Why Focus on Re-Entry? “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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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.

9. 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.

10. 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.

11. 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

12. Aims of a Benefits’ Initiative Through pre-release planning, individual leaves facility with: • Benefits & bridge assistance • Identity documents • Connection to community services & supports

13. Medicaid Medicare SSI/SSDI Veterans Benefits TANF Food Stamps Housing asst. General Assistance Benefits Provide Safety Net

14. Bazelon Work on Benefits • Consensus Project • Publications • Model law and policy • 3-state project -MN,MD,VT • Federal legislation

15. 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

16. 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

17. 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

18. 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).

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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

25. 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

26. 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.

27. 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.

28. 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

29. 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

30. 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.

31. 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.

32. 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.

33. 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

34. 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

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

36. Resource needs Training needs Monitoring & Documentation Outcome Measures Intake screening Eligibility tracking Re-entry planning Sustainability of initiative Other Key Decisions

37. 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.

38. What is Needed? • The right partners • MOUs, interagency collaborative agreements • Training and leadership • Systematic planning &implementation

39. 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

40. 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

41. 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

42. Best Practices On-going training for staff Document steps Develop forms, checklists, protocols to operationalize process On-going monitoring & feedback

43. Best Practices • Collect process & outcome indicators • Stay involved. Keep champions involved/informed • Use success for new re-entry efforts

44. Priorities Identified • Support for CMHC in-reach • Focus on housing • Peer support/mentoring • Focus on state psychiatric institutions

45. Contact Info Elaine Alfano, Policy Analyst Bazelon Center for Mental Health Law 1101 15th Street, NW, Suite 1212 Washington, DC 20005-5002 Phone: 202 467-5730, ext. 123 E-mail: elaine@bazelon.org Website: www.bazelon.org