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.

AZCPOA: Diaz v. Brewer: gender justice

From the Arizona Correctional Peace Officers Association. I seldom post the stuff they send out, but this was pretty intriguing. I don't care much for some of the people Binh defends, but more power to him on this if they can get health coverage for all couples - and all kinds of families. Brewercare is killing too many people in this state already...

---------------September 11, 2011---------------

Recently the 9th Circuit issued a ruling in Diaz v. Brewer recognizing that the Arizona Legislature discriminated against same sex partners of state employees in rescinding their health insurance coverage. You will recall that in April 2008, under then Governor Napolitano, ADOA rules were modified so that health insurance coverage could be offered to both same-sex and different-sex domestic partners. But, November 2008, voters approved Prop 102 which amended the Arizona Constitution to outlaw gay marriage, by defining "marriage" as the union of "one man" and "one woman" The following year, in 2009, the Arizona legislature enacted House Bill 2013 that limited health insurance coverage offered by the State to a "spouse under the laws of this State." This effectively eliminated health insurance coverage for all same-sex and different-sex domestic partners as of January 1, 2011. The Diaz v. Brewer suit was filed by a number of gay State employees to challenge House Bill 2013 as discriminatory. The plaintiffs filed for a preliminary injunction which was granted by the Federal District Court in Phoenix. The District Court noted that House Bill 2013 was not discriminatory on its face, because it affected both same-sex and different-sex couples. However the court found that HB 2013 had a discriminatory effect. This is because, under Arizona law, different-sex couples could retain their health coverage by marrying, but same-sex couples could not. The preliminary injunction stopped HB 2013 from going into effect for same-sex couples (and required the State to continue to provide health coverage for them) until a full trial could be held on the case. Before a full trial could be held, the State appealed to the Ninth Circuit. While the appeal was pending the preliminary injunction allowed same-sex domestic partners of State employees to retain their health coverage. Opposite-sex couples, however, lost heath coverage as of January 1, 2011. A three judge panel of the Ninth Circuit reviewed the Arizona District Court's ruling, found it to be correct, and upheld it. The State of Arizona had argued that the law was valid because it: (1) promoted marriage, and (2) was a cost savings measure. The court rejected the "promotion of marriage" argument because same-sex marriages are illegal under the Arizona Constitution. Next the court rejected the "cost savings" justification because the only "cost" evidence that the State submitted was the fact that 863 "same and opposite-sex domestic partners" being covered. This is a miniscule number compared to the 57,000 State employees who have health coverage for their spouses and families. Once the State of Arizona's justifications for the law were entirely discredited, the Ninth Circuit had to uphold the injunction. The court noted: "the district court correctly recognized that barring the state of Arizona from discriminating against same-sex couples in its distribution of employee health benefits does not constitute the recognition of a new constitutional right to such benefits. Rather, it is consistent with long standing equal protection jurisprudence holding that "some objectives, such as 'a bare . . . desire to harm a politically unpopular group,' are not legitimate state interests." The big question is what happens now? The State has a number of options: (1) the State can ask for an en banc rehearing in front of all of the Ninth Circuit judges and hope they overturn the decision, (2) the State can appeal to the US Supreme Court which will take some time, or (3) the State can let the decision stand and bring the case back to the Arizona Federal District Court for a full trial on the merits. We should know what direction the State will take in the next few weeks. In the meantime, same-sex domestic partners of State employees will continue to have health insurance. Opposite-sex domestic partners, who lost health coverage in 2011 are not impacted by this ruling. We are working on possible legislation to fix this issue for our opposite-sex domestic partner members. However, a lot hinges on the ultimate outcome of the case. If same-sex domestic partners wind up winning, we feel we have a strong argument to push for health insurance for opposite-sex domestic partners. We will keep you posted.

Martin Bihn AZCPOA Attorney

Releasing our Elders; Health Care Reform and Prisoners.

From the list-serve/newsletter of www.curenational.org (Citizens United for the Rehabilitation of Errants)

-------New Vera Report Shows Difference between Geriatric Release Policy and Practice-------

Harsh sentencing policies have made correctional facilities throughout the United States home to a growing number of older adults. Yet most states with provisions for releasing older prisoners rarely use them, despite the relatively low risk eligible inmates would pose to public safety and the opportunity for potential cost savings.

“It’s About Time: Aging Prisoners, Increasing Costs, and Geriatric Release” examines statutes related to geriatric release in 15 states and the District of Columbia, identifies factors that help explain the discrepancy, and offers recommendations for those who would address it.

“The upshot is that there’s a difference between what states would like to do—save money by releasing older prisoners—and what actually happens,” says the report’s author, Tina Chiu. “If states want the result of geriatric release policies to be consistent with that objective, they should review the release process to address potential and existing obstacles.”

The Vera Institute of Justice is an independent nonprofit organization that combines expertise in research, demonstration projects, and technical assistance to help leaders in government and civil society improve the systems people rely on for justice and safety.

------------------------------ Health Care Reform and Prisoners------------------------

Thirteen million people are incarcerated in jails annually.

Three and a half million of this 13 million are incarcerated more than once during the year.

 The Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act (together referred to as "the health reform law" expands health insurance coverage by expanding Medicaid, the federal-state health insurance program for low income people, to cover everyone under 133 percent of the federal poverty level (FPL). For uninsured individuals above 133 FPL the bill sets up state-based "health insurance exchanges" or regulated insurance marketplaces where individuals and small businesses can compare and purchase private health insurance policies. (They will function something like websites like Travelocity or Orbitz, but for health insurance.) Lower income individuals will be eligible for tax subsidies to buy insurance on the exchanges.

The health reform law does not change the current inmate exclusion for Medicaid and other federal health programs. Convicted inmates are also ineligible for insurance from the exchanges. However, pre-conviction inmates remain eligible and they also remain subject to the individual mandate to carry health insurance.

Regardless of the insurance arrangements covering prisoners, jails will still have a legal obligation based on the /Gamble /decision by the Supreme Court to provide medical care for all prisoners regardless of conviction status. How this obligation will be satisfied or impacted by the health reform legislation has not been addressed.

 There are two additional references to the criminal justice system in the health care bill. First, "conviction for a relevant crime of patient or resident abuse" disqualifies a person from being hired
as a health care worker, and second, the Federal Bureau of Prisons is specifically included in the Interagency Working Group on Health Care quality.

The Legal Action Center reports that the final health care bill incorporates many key elements on addiction and mental health services, as follows:

Includes substance use disorder and mental health (SUD/MH) services as required benefits in the basic benefit package for individual and small business health plans;

Requires that all plans in the health insurance exchange comply with the Wellstone/Domenici Parity Act in providing SUD/MH benefits in the same way as all other covered medical and surgical benefits;

Expands Medicaid eligibility for all Americans up to 133 percent of the federal poverty level and require newly eligible parents and childless adults receive coverage that includes SUD/MH services provided at parity;

Includes SUD and MH prevention strategies and efforts in the bill's chronic disease initiatives;

Includes the capacity of the mental and behavioral health workforce as high-priority topics in the bill's National Workforce Strategy section; and

Includes insurance reforms and consumer protections critical for individuals seeking or in recovery, including prohibiting insurers from denying coverage to people with pre-existing conditions, charging higher premiums based on health status, and placing annual or lifetime caps on insurance coverage.