Prisoner health is public health: MCSO jails to prepare patients for re-entry.

Maricopa County just got a huge federal grant to do this, so don't think it comes out of the kindness of Joe Arpaio's heart. This kind of intervention is so simple and makes so much sense, but has been a long time coming. Among other things, it means that people who are criminalized for the symptoms of their mental illness may finally be able to get the community care and medication that will allow them to live free, instead of being cycled in and out of our criminal justice system. 

People being released from custody have so many other health risks as well - Hepatitis C infecting about half the population of former prisoners is one of the biggest concerns, as they are routinely released back into the community without any insurance or treatment plans. That's why so many deaths in prison these days are baby boomers dying young from late stage liver and kidney disease, secondary to Hep C. Diabetes complications are also a big killer of prisoners and the formerly incarcerated, because prison food is so loaded with sugar and carbs, and the management of diabetes in custody is so poor.

Here's an interesting study on the issue of health, mental health, and substance abuse impacts on successful re-entry.(PDF)


There's no reason the AZ DOC can't do this for their chronically ill and Seriously Mentally Ill prisoners, too, instead of just dumping them out the door with nothing but a prison ID card, a check for $50, and an appointment with a PO. It takes more a change in policy and priorities than maney to implement the practice. The DOC is able to get their prisoners' outside medical bills covered by AHCCCS while they're in custody, so there's no excuse for releasing sick people from prison without signing them up for insurance and referring them to appropriate caregivers first. Anyone expecting to have a loved one released from custody who needs medical or psychiatric care in the community should be pressuring the prison staff to help them with enrollment before they leave.

"health is a human right"

prisoners justice day 2012: Phoenix Art Museum

--------------local news: KJZZ------------

Maricopa County To Help Inmates Sign Up For Health Insurance

KJZZ.com

By: Steve Shadley on 08/20/2013 

 

Maricopa County will begin helping inmates sign up for health care insurance when they leave the jail system. It is part of the campaign to get 1 million uninsured people in Arizona coverage next year.

Arizonans who do not currently have health insurance or feel they are underinsured can purchase policies under the new federal affordable health care program starting in October. That is also when the state will add hundreds of thousands of lower income people to its Medicaid rolls.

Maricopa County Supervisor Mary Rose Wilcox said the county’s corrections workers will begin helping  prisoners sign up for insurance right before they leave jail.

“It’s going to be to our advantage, because as they leave this system, and if we are treating them for diabetes or whatever we are treating them for, they will be able to continue their treatment, because they will have insurance, and we think we can also encourage them to get their families enrolled,” said Wilcox.

She said county corrections officials will meet with President Obama’s health care team this week to learn how the prisoners can sign up. Wilcox made the announcement in Mesa where federal grants were awarded to groups helping people enroll in the insurance programs.

-------The Bigger Picture behind this news, from the PEW Charitable Trust---------

Ex-Felons Are About to Get Health Coverage

STATELINE

April 5, 2013

By Michael Ollove, Staff Writer

Newly freed prisoners traditionally walk away from the penitentiary with a bus ticket and a few dollars in their pockets. Starting in January, many of the 650,000 inmates released from prison each year will be eligible for something else: health care by way of Medicaid, thanks to the Affordable Care Act.

A sizeable portion of the nearly 5 million ex-offenders who are on parole or probation at any given time will also be covered.

The expansion of Medicaid, a key provision of the health care reform law, is the main vehicle for delivering health insurance to former prisoners.

Researchers and those who advocate on behalf of ex-convicts hail the change as monumental, saying it will help address the generally poor health of ex-offenders, reduce medical costs and possibly keep them from sliding back into crime.

“It potentially revolutionizes the criminal justice system and health system,” said Faye Taxman, a health services criminologist at George Mason University. “We now have a golden opportunity to develop and implement quality interventions to both improve health outcomes for this population and also reduce the rate of criminal activity.”

Expanding Coverage

 

Medicaid is the federal-state health insurance partnership for the poor. Under federal law, states must provide Medicaid to children, pregnant women and disabled adults who fall below certain income thresholds. The states are not now required to extend Medicaid to adults under 65 who are not pregnant or disabled. A small minority of states does so; most states do not.

Since most recently released prisoners are not pregnant or disabled, the vast majority of them do not have Medicaid or health insurance of any kind. As a result, studies show, many do not receive treatment for chronic conditions or continue on medications prescribed in prison. They also do not generally see primary care doctors, relying instead on emergency rooms, an expensive way of delivering medical care.

The ACA could change that. Beginning in January, states that agree to the Medicaid expansion will be required to provide Medicaid to all non-elderly low-income adults. For the first time, many of the 5 million ex-offenders on parole or probation will be eligible for the assistance. It applies to those released from either state or federal prisons. The exceptions will be former prisoners living in those states that currently have limited Medicaid eligibility for adults and that ultimately opt out of the Medicaid expansion, a choice accorded the states in the U.S. Supreme Court’s ACA ruling last June.

Ex-cons with jobs who make too much money to be eligible for Medicaid could still qualify for federal tax credits to purchase health insurance through the new state exchanges. Under the ACA, like everyone else, they will be required to have health insurance of some kind starting next January.

A Sicker Population

 

Study: Mortality rates among former inmates of Washington state prisons compared to current prisoners
Cause of Death	number of deaths
	Former inmates	Current inmates
Overdose	181	1
Cardiovascular disease	98	68
Homicide	95	6
Suicide	70	16
Cancer	68	42
Liver disease	40	23
HIV	12	3
Source: New England Journal of Medicine, study followed 30,237 people released from the Washington State Department of Corrections between July 1999 and December 2003.

Although extending benefits to ex-offenders may not be the most popular aspect of the ACA, the expansion to ex-cons is seen as significant because this population is generally in worse health than the overall population. They have higher rates of chronic and infectious disease (in particular, asthma, hypertension, tuberculosis, diabetes, hepatitis and HIV/AIDS), addiction and mental illness. Those ailments and the lack of treatment on the outside contribute to the high mortality rate among former prisoners noted in a 2007 study published in The New England Journal of Medicine.

The study found that in the first two weeks after release, the rate of death among former inmates was more than 12 times greater than the rate for the general public. The leading causes of death for the ex-cons were drug overdose and cardiovascular disease.

Health insurance coverage for ex-prisoners by way of Medicaid should help reduce high mortality, researchers say. Given the high rate of addiction and mental illness among ex-prisoners, another vital law that helps them is the federal Mental Health and Addiction Equity Act, which requires health insurers to provide benefits for mental health and substance treatment that are on par with those they offer for medical and surgical services.

The corrections system is obligated to provide prisoners with health care, both physical and mental. New prisoners usually receive health screenings early in confinement. Although the quality of treatment varies across states, prison affords the best health care for many inmates that they’ve received in their lives.

Many of the 650,000 prisoners released next year will be eligible for Medicaid. To ensure continuity of care, researchers and advocates are urging states to help these prisoners enroll in Medicaid and link them to health care providers before they walk through the prison gates.

“When people are on their own, the likelihood of them taking that first step is not high,” said Paul Samuels, president of the Legal Action Center, which advocates for those with histories of addiction, HIV/AIDS or criminal records. “Their lives are very disordered. Many don’t have an ID, so enrolling in programs can be very difficult.”

New York, Oklahoma, Florida, Illinois and California are among the states that already have pre-release programs aimed at connecting at least some outgoing prisoners with Medicaid. Some states, including New York, are also investigating ways of connecting ex-prisoners with full-service medical homes that coordinate health care services to manage patients’ care.

“The states that get out ahead of this, they’re going to have fewer people incarcerated and healthier societies,” said Joshua Rich, a professor of medicine and community health at Brown University, who studies the health of ex-offenders.

The Medicaid expansion will apply to prisoners getting out of jails as well as penitentiaries, although the turnover in jails is much faster with fewer pre-release programs. Those getting out of jail may be eligible for Medicaid, but they may have to find their way to it themselves.

Long-Term Impact

 

Improved health can also afford former prisoners better prospects in the outside world. “Lots of times when people come up on supervised release, part of the conditions for their release is that they find employment,” said Anita Marton, deputy director the Legal Action Center. “We find people who try to engage in job searches but their illnesses prevent them from being able to succeed, whether it’s because of untreated addiction, HIV or mental illness.”

Treatment might not only help them land jobs but also keep them from a return trip to prison. Addicts who no longer use drugs no longer need to be involved in illegal activities to finance their habit. Those with mental illness who are taking medication or seeing therapists are less likely to act out in ways that land them back behind bars. Research has shown that health care, particularly in the areas of substance abuse and mental illness, reduces the likelihood of ex-offenders returning to prison.

Researchers and advocacy groups say the benefits of providing health care to ex-felons do not end with the ex-felons themselves. Prisons have high rates of hepatitis C, HIV and tuberculosis. Untreated former prisoners carry those diseases into communities on the outside and spread those infections.

Health treatment could reduce the infection rates in the areas where ex-felons tend to settle. Since prison populations are disproportionately high in African-American and Hispanic populations, the Medicaid expansion to former prisoners could also reduce the health disparities among those groups.

And finally, if former prisoners are linked up with primary care providers or community health centers, they may turn to emergency rooms less for their health care needs, which would contribute to an overall reduction in medical costs.

Transinstitutionalization continues under Brewercare

Mary K. Reinhart's been doing an awesome job of covering the effects of Brewercare on citizens with psychiatric disorders in Arizona: Access her archived Arizona Republic articles on this here. These budget and AHCCCS cuts will have consequences that extend to our prison crisis in Arizona, as seriously mentally ill adults continue to be denied treatment and medical coverage and end up diverted from the health care system to criminal justice...

-------------------------------

Here's what was lost in mental-health care

by Mary K. Reinhart -

Sept. 21, 2011 12:00 AM
The Arizona Republic

It took decades to build Arizona's mental-health system. It took weeks to downsize it.

In March 2010, attorneys for the state and the mentally ill agreed to a two-year stay in the class-action Arnold vs. Sarn lawsuit. The 30-year-old lawsuit was based on a state law requiring a wide range of community services for people diagnosed with a serious mental illness.

Weeks later, state lawmakers eliminated more than $50 million in state funding and most of the services for people with a serious mental illness who were ineligible for Medicaid.

The state now provides $40 million for generic medication and $16 million for a beefed-up statewide crisis-response system, which fields hotline calls and dispatches mobile teams of counselors when necessary. The medication benefit includes monthly checkups and lab work.

Here's what was lost:

Brand-name drugs

In Maricopa County, about 3,000 people taking brand-name psychotropic medications switched to generic drugs. The most commonly prescribed antipsychotics, including Seroquel, Geodon, Zyprexa and Risperdal, have no generic equivalents.

The generics may not be as effective, tend to be more sedative and have other side effects, such as involuntary tics and tremors, doctors say.

The medication benefit includes a monthly doctor's visit, lab work and a nurse if injections are required.

Case management

Everyone receiving state services for a serious mental illness had a case manager, but the budget cuts eliminated that benefit for people without Medicaid.

More than 300 case managers and support staff in Maricopa County, and hundreds more statewide, lost their jobs as the agencies and clinics adjusted to see fewer patients.

The case managers were a lifeline for many of Arizona's most fragile citizens. They helped navigate complex paperwork and provided a sounding board for daily aggravations. They met people upon their release from jail or psychiatric facilities. They tried to head off suicide attempts and psychotic episodes and made hospital visits.

Two case managers remain at each of the county's 18 clinics to make reminder calls and coordinate appointments for non-Medicaid patients.

Housing

The budget cuts put 255 people with serious mental illness in danger of losing their housing, which in some cases included 24-hour supervision and had been their home for decades. Most had to move.

DHS officials forbid Magellan Health Services and the other regional administrators from evicting anyone or moving people into shelters, hotels, halfway houses or other transitional housing, as well as unlicensed "board and care" or supervisory care homes.

Dozens moved into apartments or assisted- living facilities, while others moved in with family. Some who have since been hospitalized, jailed or evicted have ended up in shelters and boarding homes.

Transportation

If there was one benefit she would restore among those lost, Peggy Hoefling says it would be transportation.

Without free bus passes or cab rides, people miss appointments, fail to pick up their prescriptions and may stop going out in public, said Hoefling, a clinical social worker at Connections AZ, a psychiatric urgent-care center. Symptoms typically worsen when people stop taking their medication and isolate themselves, she said.

The heat makes the lack of transportation a particular challenge. Psychiatric medications put patients at increased risk of heat stroke and heat exhaustion.

Therapy

Thousands of people lost access to group and individual therapy, severing relationships they may have had for decades with counselors, group members and support staff.

Regular group therapy helped people such as Shawn Harris of Peoria better understand and cope with his illness and learn from others who cut or otherwise injure themselves.

This type of cognitive behavioral therapy, which research has shown to benefit self-injurers, helped Harris learn ways to relieve internal pain, cope with stress and anxiety, and express his emotions.

Drop-in centers and job training

Those without Medicaid also no longer have state-funded job training or access to community drop-in centers, along with the friendships, support and self-esteem that came with them.

Agencies like the Marc Center in Mesa train the seriously mentally ill to take jobs in hospitals and grocery stores or do assembly-line work at the center's warehouse. They learn computer and interview skills, as well as time management and budgeting. The center lost about 120 people to the budget cuts.

Peer-support groups at non-profit centers across the Valley offered outings, life-skills and support groups, and opportunities for social interaction.

Transinstitutionalizing the mentally ill: still filling the prisons.

Nationally, 4 times as many mentally ill people are now in prisons than in hospitals.
Arizona ranks as one of the worst offenders...

(image from Correctionsone.com)

I've seen this journalist doing research in the field - excellent reporting. Between her and Bob Ortega, the prisons have been getting a close look at by the AZ Republic these days. What's about to happen here is catastrophic. The Arizona Department of Corrections is the last place we should be sending people with mental illness - and it's the next place many will be heading. Someone has to fill all those new private prison beds, after all...the good prisoners will go to them, and the mentally ill will be kept in the fire traps they call state prisons.

Paul Rubin's Phoenix New Times article about the murder of Shannon Palmer comes to mind when I think of people who never should have been in prison to begin with - and wouldn't have, if our mental health system wasn't already so damaged and our communities so gutted of basic resources. Phoenix is so certain that more police are the answer that they're taking it out of the food tax - thank God we have the resources to arrest the poor when they steal to feed their families now.

Anyway, if we don't spend our tax dollars in the community folks - BEFORE people feel the need to call the police - we'll be spending it keeping a lot of these folks in horrendous conditions behind bars. We already are, sadly - for every one mentally ill person we hospitalize in Arizona, we put over nine more in jail or prison. Only Nevada is more brutal to their mentally disabled.

Needless to say, our disability rights advocates in this state have a lot of catching up to do if they're going to protect these folks all the way to prison and back. Most seem to stop at the courtroom door, I'm afraid...

---------from the Arizona Republic-------

Mental-health cuts: Experts fear long-term costs

Mary K. Reinhart - Sept. 22, 2011 12:00 AM
The Arizona Republic

Arizona taxpayers are providing fewer services to fewer people with serious mental illnesses than they were last year, for annual savings of roughly $50 million.

But the short-term savings from state budget cuts threaten to have long-term consequences for patients, providers and the community, mental-health experts say.

The budget reductions eliminated services for about 12,000 Arizonans who don't qualify for Medicaid, removing the foundation of a system intended to keep the seriously mentally ill, healthy and out of emergency rooms, hospitals, jails and prisons.

State lawmakers instead provided money for generic medication and additional funding to beef up a statewide crisis-response system to help prevent people from falling through the cracks. But in the 15 months since this population lost case management, brand-name prescription drugs, therapy, transportation and other benefits, more than 2,000 people have stopped receiving any state-funded services and are unaccounted for.

Local and county jails, emergency responders and hospitals often shoulder the costs when people with untreated serious mental illness, such as schizophrenia and bipolar disorder, fall into crisis.

The precise financial costs to those entities are unknown, but health professionals do know that it's far more expensive to treat people who have spiraled into crisis than to keep them stable. And once in crisis, health professionals say, it's more difficult for people to rebound, which means those higher costs continue to recur.

"It's a penny-wise and pound-foolish approach," said Bill Kennard, former executive director of the National Alliance on Mental Illness' office in Phoenix. "More people in jail and prison with mental illness, more time that law enforcement spends dealing with a health issue as opposed to a public-safety issue."

The costs

The state has not conducted an analysis that compares ongoing treatment with crisis costs.

But a March 2011 study that examined proposed mental-health cuts in Texas put the average daily cost of services at $12 for adults, compared with $401 a day in the state's mental hospital, $137 a day for a jail inmate with mental illness and $986 for an emergency-room visit.

The study, by Health Management Associates for the Texas Conference of Urban Counties, also showed that gaps in services put those discharged from psychiatric hospitals and jail at greater risk of relapse, readmission and recidivism.

Janey Durham, who is in charge of a workshop program at Mesa's Marc Center, said she lost 120 people to the budget cuts, including a man diagnosed with schizophrenia who deteriorated almost before her eyes. The non-profit agency center provides job training and other services to the mentally ill and developmentally disabled.

Durham said the man, a former alcoholic in his 50s, worked hard at his job in the manufacturing warehouse, at maintaining his sobriety and in treating his mental illness. But soon after the budget cuts forced him to switch to a generic medication, Durham said, he stopped taking his medication, started drinking again and grew increasingly paranoid, plagued by voices in his head.

Over the past year his erratic, disruptive behavior led Marc Center employees to call Mesa police at least once. He is believed to be homeless, she said, but contact with him has been sporadic since last winter.

Clarke Romans, who runs the NAMI office in Tucson, said a once-eager volunteer has been reluctant to leave her house since last summer, when her anti-psychotic Seroquel was replaced with a generic drug. Many of the most commonly prescribed brand-name psychoactive medications have no generic equivalent. Generics in some cases are less effective or have side effects that deter people from taking them, health officials say.

"She's been suicidal. She has not been able to come in and volunteer. She kind of hides in her house," Romans said. "These are people who are suffering in silence."

Before the budget cuts last July, individuals with serious mental illness were entitled to a full array of community-based services, from supportive housing to intensive case management and in-patient hospitalization, regardless of their income.

Mental-health advocates argue that city and county law enforcement, hospitals, jails and homeless shelters have picked up some of the costs of caring for the seriously mentally ill who lost benefits. Over the past year, many of these venues have seen an increasing number of people with severe mental illness.

State lawmakers made the cuts to help close a $1 billion deficit in fiscal 2011. House Appropriations Committee Chairman John Kavanagh, R-Fountain Hills, said the state's financial crisis forced lawmakers to cut $3 billion over four budget cycles, and all of the cuts carried some consequences.

"The question is, are the consequences so dire that it shouldn't be done? We don't believe so," Kavanagh said. "The changes really were not dramatic. . . . We're still providing these people with treatment."

Treatment, recovery

Publicly funded mental-health treatment can be highly effective, and the vast majority of people can improve their quality of life and relieve symptoms, such as hallucinations or depression, with consistent therapy, medication and other support.

But experts say treatment and services must be comprehensive and consistent.

"I don't think these kinds of services are luxuries for people with mental illness. They are part and parcel of their treatment for an underlying disorder," said Dr. Paul S. Appelbaum, a Columbia University psychiatry professor and past president of the American Psychiatric Association. "Unless you provide a package of services, just throwing pills at them isn't going to do it."

Those who work closely with the mentally ill say that is the situation for thousands of Arizonans who are ineligible for Medicaid. And they worry that people who stopped showing up at their assigned clinics may have become incarcerated, homeless, hospitalized or homebound.

Dennis Culhane, a University of Pennsylvania professor and nationally known expert on homelessness, said studies show people with serious mental illness who are not receiving regular, supportive services are more likely to become homeless.

Culhane's own research has shown that it costs less to provide apartments and other permanent housing for people who are homeless than to provide emergency shelter and services. People with serious mental illness who become homeless, he said, "have significant secondary costs," including emergency, hospital and incarceration costs.

Once they have fallen into crisis, the road back to recovery can be much harder.

"Untreated psychiatric illness is just more difficult to treat," said Dr. Jason Caplan, chief of psychiatry at St. Joseph's Hospital and Medical Center. "You have an increased risk of relapse. It's just harder to get you back."

Repeat visitors

Case management was a key benefit lost to the non-Medicaid mentally ill. Among other things, caseworkers helped people who were jailed or hospitalized to transition back into society and tried to prevent their relapse.

People often lose their housing while they're locked up and, if they're on probation or court-ordered treatment, they have a list of rules to follow upon release.

Now, there is no one to meet people as they are released from jail or a psychiatric hospital.

In Maricopa County, 54 people with serious mental illness were released to the street or to a homeless shelter in the past year after being stabilized at one of the Valley's two urgent psychiatric care facilities, according to Magellan, the for-profit contractor that administers behavioral-health care in the county.

Dr. Dawn Noggle, mental-health director for Correctional Health Services, which provides health care at Maricopa County's jails, said the seriously mentally ill are staying in jail longer. And, she said, police have arrested some more than 30 times for a variety of crimes, mostly low-level non-violent offenses, such as trespassing or theft, or probation violations.

Incarceration and prosecution of the mentally ill doesn't just affect taxpayers who foot the bill, she says.

"What happens after they get felonies? And there is an incredible impact on families," she says. "It's not just the immediate financial costs. It's the social costs as well."

There also are repeat customers at the county's psychiatric hospital, where the budget cuts mean court-ordered evaluations must be completely redone for people discharged only weeks earlier. Staff at the county's Desert Vista Behavioral Health Center, which handles involuntary commitments, say it's a new phenomenon.

In the past, people were typically court-ordered to continue treatment for at least a year, long after they were discharged from the hospital. Since the budget cuts, judges have been dismissing court-ordered treatment for non-Medicaid patients upon their discharge, reluctant to require them to participate in services, such as therapy and job training, they no longer have. Within months, some of those people are brought back for a new evaluation, a costly legal and medical process that delays treatment for several days.

"It's taking an enormous amount of resources to redo something that's already been done," said Sherry Fraley, legal-services manager.

Reach the reporter at 602-444-8603.

AHCCCS Transplant funds restored, at a high cost to others.

"The dying are taxpayers, too."
AZ State Capitol/Wes Bolin Plaza
February 28, 2011

http://www.azahcccs.gov/shared/Downloads/News/MedicaidReformPlan.pdf

Under the plan that restored the 2010 AHCCCS (medicaid) cuts, over a hundred fifty thousand "childless adults" in AZ won't receive health care coverage when they get ill, "saving" the state $190 million. Folks whose medical bills reduce their spendable income to less than 40% of the federal poverty rate are also screwed ("saving" the rest of us $70 m).

Not only do we lose federal funds for health care now, but it's guaranteed that we'll be spending more than twice as much incarcerating the mentally ill patients who lose their benefits and can no longer obtain the medications or treatment they need when they decompensate - because the people who voted for this woman are much more willing to spend their taxes on prisons (which so many profit from) than health care for the poor...no wonder we have one mentally ill person in our hospitals for every ten we decide top incarcerate, with little or no care.

That's appalling.

Give my Taxes to AHCCCS!

Thanks a lot, Brewer. You're a real swell human being.

----------------

Janice K. Brewer, Governor
Thomas J. Betlach, Director
801 East Jefferson, Phoenix, AZ 85034
PO Box 25520, Phoenix, AZ 85002
Phone: 602-417-4000

AHCCCS
www.azahcccs.gov
Our first care is your health care

ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
DATE: April 7, 2011

TO: Interested Stakeholders
FROM: Marc Leib, MD, Chief Medical Officer

SUBJECT: Transplant Restoration

AHCCCS RESTORES COVERAGE OF PREVIOUSLY COVERED TRANSPLANTS FOR ADULTS

As part of the recently enacted budget, the Arizona Legislature adopted Governor Brewer's Medicaid Reform Plan which restores funding of previously covered transplants for adults that were eliminated effective October 1, 2010. Retroactive to April 1, 2011, AHCCCS will once again cover the following transplants for members 21 years of age and older:
•
Pancreas-after-kidney transplants
•
Liver transplants in patients with Hepatitis C
•
Allogeneic unrelated hematopoietic cell transplants
•
Heart transplants in patients with non-ischemic cardiomyopathies
•
Lung transplants
•
Heart-lung transplants

Transplants that were not covered by AHCCCS prior to October 1, 2010, including pancreas only transplants, partial pancreas transplants and pancreas islet cell transplants, are not affected by this legislation. Those transplants remain non-covered. In addition to the medically necessary transplants covered for adults, AHCCCS continues to cover all medically necessary, non experimental transplants for members under the age of 21 years as required by EPSDT.

Coverage criteria for restored transplants will be the same as the criteria in place prior to October 1, 2010. Physicians with patients they believe meet the criteria for any AHCCCS covered transplant should contact the AHCCCS health plan in which the patient is enrolled to refer the patient for transplant evaluation.

For more information, please see the AHCCCS website at:

http://www.azahcccs.gov/reporting/legislation/sessions/2010/BenefitChanges.aspx#transplantRestoration

Arizona's criminalization of kindness.

AZ State Capitol / Wes Bolin Plaza
Phoenix: February, 2011.

Yesterday the legislature found $5 million for "border security" in a non-border county while still maintaining that we don't have the $1.4 million necessary to restore AHCCCS transplant funding this year. Even the Arizona Republic is appalled - and that's saying a lot. People like Pearce and Kavanagh have been leading the citizens of this state to a collective spiritual death like pied pipers for too long; it's not the "criminal aliens" we have to fear - it's the home-grown terrorists we put into the legislature who endanger what is dear to us the most: our children. We are teaching them to justify cruelty to their fellow beings.


I can't comprehend the sheer brutality of the Arizona state legislature - when are the voters in this state going to wake up? Those people are hardly working in our people's best interests - if they're willing to kill Francisco Felix and coach Tiffany Tate because the chances we can save their lives don't make the expense worth it (according to Rep. John Kavanagh), they'll do the same to the rest of us when the time comes.

The dying are taxpayers too: AZ Families deserve AHCCCS.
AZ State Capitol / Wes Bolin Plaza
Phoenix: February, 2011.

The average citizen here may not be so ill-intended, but they're following their leaders like sheep these days - some with great enthusiasm, in fact - and it's having devastating consequences. The rest of the world is fighting for their freedom, while we're being ground down by more a oppressive government in Arizona at an alarming rate. The Tea Party is hardly about to protect us from tyrrany - they're not just innocent bystanders - they're among the chief perpetrators.


The claim "we can't afford it" when it comes to the People's needs holds no water in Arizona - the elite have effectively redirected resources from the poor to their own pockets through tax code changes and re-appropriations. There's plenty of money to expand the prison system, which we'll be needing to do soon since the state has one of the highest home foreclosure rates in the nation, and it's not getting better. Push even the best families to desperation and cancel their kids' or mother's health insurance, and you'll find economic crime go up for sure. Fortunately, the relationship between crime and poverty works the other way, too.


Apparently the AZ legislature doesn't know or care about how to reduce crime, though - the concept of evidence-based practice in the criminal justice profession has about 20 more years of catching up to do in Arizona, as we do in the areas of public health and mental health services out here (we're incarcerating ten mentally ill people for every one we hospitalize for their psychiatric symptoms - and when we do that they tend to be even further neglected and abused). This regressive, repressive state is more about social control and punishing the poor and deviant (that's me) than ever, in fact - they seem to seek vengeance and power throguh of their exercises of "justice", not community-building, healing for victims, or societal transformation.

AZ State Capitol / Wes Bolin Plaza
Phoenix: February, 2011.

Don't underestimate the power of racism, xenophobia, and fear to drive policy and funding priorities in this soul-sick place. All aid to people who can't provide documentation of their state-legitimized presence in Arizona is being criminalized at a rapid pace by Russ Pearce's Me Party Senate: from educators to health care providers to ordinary citizens, we're all expected to turn our Latino neighbors in as suspects for the police to clear before we extend a hand.


AZ State Capitol / Wes Bolin Plaza
Phoenix: March, 2011.


I can only imagine what a delightful bunch of kids Arizona's voting public is raising to lead us into the future. If you're a person of color here and in dire straits (or even just doing your job) look for Sheriff Joe's goons to come your way - and hope they don't mistakenly arrest you - or beat or kill you once you're taken prisoner. Give me an "anchor baby" from Mexico over a self-interested sociopath descended from Anglo immigrants any day - at least those children and their parents would have the courage to stop at the side of the road and help my family if we were in trouble...and they don't tend to grow up to be Nazis.

AZ State Senator Russell Pearce's son, Joshua, in a mugshot.
That's a neo-Nazi tattoo he sports...is it any wonder?

----------------------------

Arizona Senate Committee Wastes Time and Resources on Misguided Legislation
Wednesday, February 23 2011 14:03 Legislators target all Arizonans with six sweeping measures instead of addressing state’s real problems

Phoenix, Arizona--Yesterday, the Arizona Senate Appropriations Committee passed sweeping legislation to put federal immigration enforcement in the hands of K-12 schools, community colleges, universities, hospitals, motor vehicles, police, landlords, and business owners. The 12-hour hearing where the six related bills were discussed was packed with community organizations, health professionals, business leaders, faith leaders and others who voiced their strong opposition to the bills.

The bills were passed despite more than 20,000 emails sent to Appropriations Committee members from Arizonans outraged at these widespread attacks on our state in the four days leading up to the hearing.

The bills passed yesterday by the Committee include:

SB1611-- “Immigration Omnibus” or the “Throwing Arizona Under-the-Bus” bill –Sponsored by Senator Russell Pearce, this bill is a 30-page, measure requiring business owners, police officers, apartment renters, school employees, and others to verify citizenship, notify immigration and in some cases, failure to do so could result in loss of licenses, certification or imprisonment.

SB1308 and 1309 – “Eroding Children’s Futures and the Constitution” bills. Two bills introduced by Senator Ron Gould to create a new Arizona Citizenship that excludes children born to parents in the U.S. without immigration authorization. The bills are an attempt to ignite a national legal battle challenging the 14th amendment of the Constitution’s recognition of birthright citizenship.

SB1407 and 1141 – “Schools as Immigration Checkpoints” bills. Two bills introduced by Senator Steve Smith that would require K-12 schools to report on the immigration status of their students. Failure to comply would result in loss of funding.

SB1405 –“Turning Health Providers into Health Deniers” bill. This bill introduced by Senator Steve Smith would require hospital employees to verify the citizenship of people seeking emergency and non-emergency medical attention and to notify immigration agents if someone cannot prove they are authorized to be in the U.S.

The following is a statement from Border Action Network’s Executive Director, Jennifer Allen regarding yesterday’s passage of these sweeping measures:

“Despite the many legislators who campaigned against big government on their election soap boxes, the Arizona Senate Appropriations Committee approved six bills yesterday that would result in big government prying eyes in hospitals, schools, community colleges, universities, motor vehicles, housing, and businesses.

These bills would negatively impact all Arizonans who drive or buy cars, rent apartments, hire employees, attend elementary school or community college, give birth, or get sick and seek medical attention. It’s ludicrous to think that if you want to share an apartment with a roommate or go to the hospital to give birth, you would have to prove your citizenship, but under these bills, such would be our state’s reality.

As Arizona’s $2 billion deficit continues to grow, the Committee responsible for appropriating our funds has approved increasing the cost burden on hospitals, schools, motor vehicles, cities and counties, and on business owners. These bills are a waste of our time, our money and our resources, and it’s time for our legislators to focus on making Arizona strong, and to implement the real solutions for our state and our children’s futures: health care, jobs, education and public safety.

Business owners, faith leaders, law enforcement, health care workers, school and university employees and everyday community members are speaking out and pushing back, and we will continue to put pressure on the legislature every step of the way until these bills are defeated. Only then can Arizonans be proud to have leaders that actually lead our state.”

###

Border Action Network formed in 1999 and works with immigrant and border communities in Arizona to ensure that our rights are respected, our human dignity upheld and that our communities are safe and healthy places to live. We are a membership-based organization that combines grassroots community organizing, leadership development, policy advocacy and litigation.

Hitting Home: International Women's Day.

"Thank you Neuro ICU: We Heart Mom."

Those of you who get these blogs automatically fed to them will recognize that this is a revision of an earlier post. I'm still working this stuff out, and just wanted to clarify where I'm at these days...


This was the thank you that I left on the sidewalk last night at Scottsdale Healthcare's campus on Osborn, where my mother is being treated for an extremely aggressive form of brain cancer. We thought she may have had one or more stroke last month because she suddenly lost her vision in her left eye and began falling a lot, but the CT scan in the ER at the time barely even showed the shadow that consumed her right occipital lobe within just weeks; Mom was diagnosed with a sinus infection and put on antibiotics instead of being sent for an MRI.


Had she not fallen and incurred a new head injury last week, Mom's tumor may not have been discovered in time to do surgery. It has yet to be seen whether or not the surgery was in time to save her life or prevent her from prolonged misery. Because this particular cancer is so devastatingly quick to kill, they're starting her on both radiation and chemo even though they removed all visible traces. I guess no matter how good your surveillance, people and equipment are, by the time you see it again it's generally too late. This is what killed Ted Kennedy.


Some folks may be wondering why I'm still running around protesting and chalking the town while my mom may well be dying - I think I'm just trying to hold on to normal life as best I can through this; I'm afraid that if I put it down I may not be able to pick it up again for a long time. Besides, Mom isn't dying - she's fighting for her life. One of the reasons is so she can continue to be a part of mine. That means I need to keep living it.


My art and politics are a part of me, anyway, not activities I do in my free time. I won't be able to maintain my same level of activism, though - or prisoner support. My mail is flowing again, and I'm back up to my neck in letters from people in trouble. I'll write a post begging the community for more help on that count soon - after which, my blogs may well fall silent for awhile. If you try to contact me from here on out with little initial success, just be persistent. I've got my hands full now, but I'm not planning on going anywhere; I'll still help if I can do so, however this turns out. Mom would want me to.


In the meantime, if you have any good energy to send into the universe for Mom and the people treating her, please do. She's not only a primary source of my own social conscience and fire, but she's generously supported my unpopular causes over the years, even when she barely had enough to live on herself. She's the person that my prisoner friends ought to be thanking and praying for the most today - she helps keep me going when I risk succumbing to both poverty and despair, so that I in turn can be there for them. She is who makes most of my work possible. She saved my life, in fact.


So, my mom, Jean Boatman, is my Woman of the Year. She's a retired teacher from Fountain Hills, and a member of the current school board there. She's actually a registered Republican and has been an officer of the Mayflower Society (yes, I'm a Pilgrim) - but don't let that fool you. She's really an insurgent liberal and lives somewhat vicariously through my radical politics (which the people who love and respect her know already, so her "cover" isn't really blown). Please think good things for us - and do something pro-active to stand up for collective bargaining, public education, and health care rights this week.


Finally, I hope it dawns on Mom's community as they learn of her extraordinary medical needs that if the Republican and Tea Parties had their way right now, she would have been left to die like those AHCCCS transplant patients - and all the other Medicaid patients the state wants to cut off of medical care (but is more than willing to shell out $20,000+/year to imprison). Mom's life would be no less worth saving if she had no health insurance than it is now. Why is anyone else's?


Send that message to the the chair of the Az House Death Panels - also known as the Appropriations Committee - if you're a friend of my mom's. He's the man that Fountain Hills chose to represent their interests: John Kavanagh. Since most teachers are struggling to survive out there - and a lot of kids are hurting, too - I'd say he's doing a lousy job of representing anyone but the rich in that town.


He can be reached at:


John Kavanagh
AZ House of Representatives
1700 W. Washington
Room 114
Phoenix, AZ 85007
Phone Number: (602) 926-5170
Fax Number: (602) 417-3108
jkavanagh@azleg.gov

"Give my Taxes to AHCCCS: Health care is a human right."

"Give my taxes to AHCCCS: Health care is a human right!"
Get well card for Mom/1st Amendment lesson for AZ students.
Arizona State Capitol/Wes Bolin Plaza.
PHOENIX (March, 2011)

Brewercare is killing us! DREAM of LIFE Walk!!!

Saturday's DREAM of LIFE Walk for the surviving patients on the AHCCCS transplant list was amazing - these are my photos with a brief news piece from ABC15.com at the bottom. Here are the video clips.

Along those same lines, here's the article from Russ Pearce's Me Party Senate Appropriations Committee this week, which voted 8-5 to eliminate the MEDICAID for Arizonans altogether, so our friends awaiting transplants will soon have much more company among the people the state has decided to allow to withhold life-saving medical care for.

Ironically, no matter how ill or disabled a person is in this state, we still end up paying the government a hell of a lot through the very sales taxes that are supposed to be spent on the welfare of the people....and I want my taxes to go to AHCCCS before anyone else needlessly dies. I'm sick of the legislature extorting me for their salaries while they kill my people by pissing away my money on suing the feds over immigration and setting up committees to pick and choose which federal laws Arizona wants to nullify because they give too many people rights and health care and other essential things.

No wonder people are talking about seceeding from the state. What ignorant, self-righteous dolts we have running this show. If I knew it was that easy to nullify laws, I would have written my own constitution and criminal code a long time ago and told the feds and state where to go myself.



















































'Dream of Life Walk' aimed to raise awareness about AHCCCS funding cuts

ABC15.com
Posted: 5:55 PM
March 5, 2011


* By: Mike Pelton

PHOENIX - A Valley man who needs a new liver, along with dozens of others, marched to the state capitol Saturday, in hopes of raising awareness about the importance of funding the state’s Medicaid program, Arizona Health Care Cost Containment System (AHCCCS).

Francisco Felix has cancer and needs a liver transplant. He is one of the 98 people who lost coverage when Governor Jan Brewer approved cuts to AHCCCS, a move that aimed to help solve the state’s massive budget deficit.

“We are asking for the funds for the transplants,” said Felix, whose cousin, Lulu translated for him.

People from all across the Valley gathered at a Phoenix church this morning for a ‘Dream of Life Walk’. They marched to the capitol in hopes of raising awareness about the issue. Governor Brewer, however, isn’t in Arizona. She sent out a message on Twitter late Friday night that said she is in Alaska on vacation.

The cuts to AHCCCS were made last year as part of the new budget. It left 98 people who needed transplants without funding from the program. Two have died since the cuts were made.

“By subtracting this funding from them, these 96 remaining people will die,” said Dr. Richard Darling, who attended Saturday’s march. “It won't be that long either because some of them are very, very ill.”

State leaders have said the cuts were necessary because of the dire budget issues.

But for Felix, he and his family have resorted to selling food at local events to help raise money. They sell hot dogs, chips and drinks, in hope of getting enough money to pay for the transplant. They said they need about $500,000 and including donations, have raised about $100,000.

“I’m going to be fighting, I’m not going to give up,” Felix said.

AHCCCS Transplant Watch: The Dying are Taxpayers, too.

"The Dying are Taxpayers, too: Restore AHCCCS Transplant Funding."
Arizona State Capitol / Wes Bolin Memorial Plaza
Phoenix, AZ (February 21, 2011)

Saturday, March 5
9:00am - 12:00pm


St. Matthew Catholic Church 2038 W Van Buren St.
TO: Arizona State Capital 1700 W Washington St. Phoenix, AZ


Dream of Life Walk

A Project of the Dream of Life Coalition:
Intervening to Help Critically Ill Patients to Receive Healthcare

Saturday March 5, 2011

Stand in solidarity!

Join AHCCCS transplant waiting list patients and their families:
Show Arizona Legislators that taking lives is not an option for budget cuts.
Help restore Medicaid cuts and reinstate life saving tissue and organ transplants.

Rally Cry!

Keep Your Promise, Governor Brewer!

Agenda:

Guest Speakers Including:
Representative Anna Tovar,
Representative Richard Miranda,
and Bill Remak

9:00 AM St. Matthew Catholic Church
2038 W Van Buren St.,
Phoenix, AZ

10:15 AM Briefing & March to State Capitol

11:00 AM Arizona State Capitol
1700 W Washington St.

View March Route
http://classic.mapquest.com/mq/7-m*tHmopt0yh_HFrQaZX3


Sign Online Petition: Stop Taking Lives for Budget Cuts
http://hepcop.org/


DLIC/saveAZ98Petition.asp


Refreshments Available

FEDS OK AZ to cut more AHCCCS patients.

The following alert came in yesterday from the advocacy chair of the AZ Alliance for the Mentally Ill.

Thanks, Rachael.

---------------------------------

It is not a happy Wednesday for those of us who were trying to urge the federal government to deny the waiver that would allow Arizona to cut thousands from our community to access to adequate healthcare. The secretary of Health and Human services has made it clear to Arizona that they DO NOT need a waiver to cut 250,000 from AHCCCS. This is 30,000 thousand less than what the governor had hoped for because Arizona will be required to cover the parents of children on AHCCCS.

For what we can do now is below this article. Calling our representatives and telling them to oppose the budget for FY11... Get your voice heard. The federal government has washed their hands clean for these cuts and we as residents of Arizona with friends and family who will be affected are the only ones who can stand up. Get your voices heard and have your friends and family send these messages to the State telling them how this will affect us, as humans, NOT the budget.

We will keep the fight alive and continue to watch what is happening. IF these cuts are approved we will brace ourselves and keep our eyes and ears open for what we can do.

No matter how bad it may seem to be, we must never lose our drive, our passion or the fight. We must persevere and together we can make our dreams a reality.


Thank you guys for being awesome!

Rachael

-------------------------------------------------------------

Sebelius: Arizona doesn’t need waiver to cut 250,000 people from AHCCCS
AZ Capitol Times
By Jeremy Duda
jeremy.duda@azcapitoltimes.com

Published: February 15, 2011 at 7:14 pm

Arizona officials who spent nearly a year railing against the federal government for not allowing the state to cut its Medicaid rolls got some startling news Tuesday: Federal permission isn’t necessary for the state to drop 250,000 people from the Arizona Health Care Cost Containment System.

In a letter to Gov. Jan Brewer on Tuesday, U.S. Health and Human Services Secretary Kathleen Sebelius said Arizona could simply choose to not renew the agreement under which the feds provide matching funds for 250,000 childless adults in the system, known by the initials AHCCCS. The end of the agreement would effectively allow Arizona to drop those patients from AHCCCS on Sept. 30, when the agreement expires.

However, the news from the federal government does not mean Arizona has a clear path to cut patients from the program. A lawsuit probably will follow any attempt to make such cuts.

In her letter, Sebelius said the cuts would not violate the maintenance-of-effort provision in the Patient Protection and Affordable Care Act, the landmark health care law passed by Congress in 2010, which prohibits states from reducing Medicaid eligibility.

The revelation comes as Brewer was awaiting word from HHS on whether Sebelius would approve the state’s request for a waiver to allow the state to drop 280,000 people from AHCCCS. Brewer’s budget plan includes a $541 million cut from dropping the AHCCCS patients starting on Oct. 1.

But because Arizona is operating under a waiver that began when voters approved Proposition 204 in 2000, the state does not need a waiver to drop most of those people from AHCCCS. The ballot measure expanded AHCCCS coverage to include all childless adults who make up to 100 percent of the federal poverty level.

“I do want to make you aware that the (maintenance-of-effort) provision in the Affordable Care Act does not require Arizona to renew its demonstration as is, beyond its expiration date on Sept. 30, 2011,” Sebelius wrote. “Any reduction in eligibility associated with the expiration of your demonstration … would not constitute an MOE violation.”

In a press release, Brewer called the letter “an encouraging development” for the state as it seeks flexibility from the Affordable Care Act.

“Secretary Sebelius’ letter clearly indicates that Arizona may take the steps it requires to manage its Medicaid program and balance its budget without violating MOE requirements,” Brewer said. “I appreciate the timeliness of the secretary’s correspondence, as well as her pledge for continued cooperation as Arizona seeks the best means to serve its citizens while meeting its fiscal obligations. I look forward to meeting with Secretary Sebelius in the near future.”

It was not clear why state officials did not realize earlier that a waiver was unnecessary, nor why HHS did not inform the state sooner that the waiver was unnecessary. Brewer submitted her waiver request to HHS on Jan. 25, but she and lawmakers had sought to cut AHCCCS for nearly a year. The budget passed by the Legislature and signed by Brewer in March 2010 cut about 310,000 people from AHCCCS, but the cuts were restored when Congress approved additional temporary funding for state Medicaid programs.

“Our Medicaid folks are aware that this provision was going to expire. But obviously we applied for the waiver request thinking that would be necessary,” Brewer spokesman Matthew Benson said.

Sebelius wrote the letter in response to a letter Brewer sent her on Feb. 3. In that letter, Brewer complained that Sebelius’ recent suggestions for how states could cut Medicaid costs provided few opportunities for Arizona, which she said had already used every method Sebelius suggested.

Under guidelines set by HHS and the Centers for Medicare and Medicaid Services, Arizona still must establish a phase-out plan in which it provides for people who would face immediate harm from the loss of their coverage. The state must also determine whether the people being cut from AHCCCS are still otherwise eligible for Medicaid coverage.

Arizona will be permitted to cut only 250,000 of the 280,000 people Brewer sought to remove from the AHCCCS. The state will still be required to cover 30,000 parents of children who are on AHCCCS.

Benson did not say whether Brewer would still seek to drop the 30,000 parents from AHCCCS coverage.

“We’re going to continue studying this letter and what it means for the state,” Benson said. “There are a lot of things yet to be determined.”

And when the full Affordable Care Act goes into effect in 2014, Arizona will be required to provide coverage once again to the 250,000 AHCCCS patients who are likely to be cut. The health care act requires all state Medicaid programs to cover anyone who earns up to 133 percent of the federal poverty level.

The state may have a green light from HHS, but it likely will have a court battle on its hands over whether the proposed cuts violate Proposition 204. The ballot measure required the state to cover all people who earn up to 100 percent of the federal poverty level using money from a settlement with tobacco companies and other “available funds.”
Brewer and Republican lawmakers argue that no funds are available due to the budget deficit, which is estimated to be $1.2 billion in the fiscal year 2012, and that the state is therefore permitted under Proposition 204 to drop patients from AHCCCS.
“That has been our position,” Benson said.

Sebelius also offered HHS’s assistance in establishing a provider tax on hospitals to help fund Arizona’s Medicaid program. The Arizona Hospital and Healthcare Association was long resistant to the idea, but recently came out in support of a tax to prevent deep cuts to AHCCCS.

“We are also available to work with you on the possibility of adopting a provider fee, as we have done with several other states,” Sebelius wrote. “I realize that the (hospital) association’s proposal is in an early stage, but I want to assure you that the full resources of our department are available to you as you and the association work to structure this fee in a fiscally responsible and permissible manner.”

--------------FEDERAL LEGISLATION ALERTS-------------

Subject: Act Now - Massive Cuts Loom for Federal Mental Health and Housing Programs
To: givmearevolution@hotmail.com
From: e-news@nami.org
Date: Wed, 16 Feb 2011 11:57:16 -0500

NAMI.org

Massive Cuts Loom for Federal Mental Health and Housing Programs
Action Needed!

Contact your U.S. House member today and voice your opposition to proposed FY 2011 cuts to mental health services, research, special education and supportive housing for children and adults living with mental illness.

HR 1 Continuing Resolution Federal Budget Cuts for FY 2011
Mental Health Services

* The House bill slashes $200 million from the Substance Abuse and Mental Health Services Administration (SAMHSA), a 5.5 percent cut below the agency's FY 2008 funding level.

Research

* Cuts $86 million (7 percent) from research on mental illness at the National Institute of Mental Health (NIMH), reducing funding to $1.404 billion.

Special Education

* A $557 million reduction to special education funding.

Housing

* Reduces HUD Section 811 program by 70 percent--from $300 million in FY 2010 to $90.36 million.

All House offices can be reached by calling 202-224-3121 (not a toll free call), or send a message to your U.S. House member.

* View details of the U.S. House FY 2011 "Continuing Resolution"
* View the President's FY 2012 Budget

At a time when states are already imposing deep cuts to mental health services (over $2.2 billion over the past two years), proposed cuts in the federal FY 2011 continuing resolution further erode needed services and supports for individuals who live with serious mental illness.


NAMI E-News Alerts are electronic newsletters provided free of charge as a public service. With more than 1,100 state and local affiliates, NAMI is the nation's largest grassroots organization dedicated to improving the lives of people with severe mental illnesses.