Restoring Benefits: State And Local Initiatives

Several states and communities have undertaken initiatives to facilitate access to federal benefits upon release. Jails and prisons can help inmates restore their benefits or apply for benefits to which they may be entitled but which for one reason or another they did not have upon incarceration. For example, correctional facilities can:

• screen inmates for potential eligibility for SSI, SSDI, Medicaid, TANF, veterans benefits or food stamps;
• have information and necessary forms available;
• learn the basic program rules to assist inmates;
• provide assistance to inmates in completing applications;
• work with local community mental health providers who know benefit issues; and
• work with the federal, state and local government agencies responsible for administering benefit programs.
• Examples of initiatives to assist inmates with benefit issues are provided below.

Texas: Access to Social Security Benefits

The Texas Council on Offenders with Mental Impairments and the Texas Department of Criminal Justice entered into an interagency Memorandum of Understanding with the regional office of the Social Security Administration for a pilot pre-release project. This agreement allows Texas Council staff to submit federal benefit applications for SSI, SSDI and/or food stamps 90 days prior to an inmates' release from custody.

Immediate access to SSI or SSDI benefits was recognized as potentially making the difference between successful and unsuccessful release to the community. Moreover, counties benefit by not having to cover the full cost of released offenders' medical or psychiatric care because they can bill Medicaid for such services as medication, psychiatric rehabilitation, hospitalization or physician care.

The improved process for benefit access is part of a broader initiative for release planning and follow-up community care. The Texas Council has contracted with local mental health or human services agencies for staff to visit inmates six months prior to release, to engage in pre-release planning, help inmates access benefits and either provide follow-up care (when the inmate is released into the same community as the corrections facility) or arrange follow-up care in the inmate's home community (for those sent to corrections facilities in other parts of the state).

Ninety days prior to release, all the paperwork for Social Security benefits is submitted to the local SSA office. The applications are processed, then sent on to a designated individual at the state Disability Determination Services (DDS) who makes the initial decision on eligibility. A high proportion of these claims are approved at this level (95% of medical claims and 60% of psychiatric disability claims). Inmates whose claims are turned down are assisted in filing an appeal.

For the system to work smoothly, it was found necessary to train the local SSA staff, who at first resisted the new process and did not understand SSA's rules. These difficulties were overcome with training by the SSA regional office, so that local office staff understood the goals of the program and the rules with respect to inmates. The human services benefit specialists have also undergone intensive 40-hour training by SSA on the rules regarding disability benefits and how to file a claim appropriately, with all necessary supporting documents.

Equally important was training of the human services staff who go into the prisons and jails. Leaders of this program report that human services staff need to deal with important issues and adjustments in order to function effectively in the correctional environments. Cross-training of human services and corrections staff has been helpful. Finally, it has been helpful for physicians at corrections facilities, who provide much of the supporting medical information, to be educated about the SSA process and particularly about what SSA considers to be a "disability," so that they can provide the appropriate medical information and thus speed consideration of the claim.⁽¹³⁾ The contracted mental health and human service agency staff continue to meet with Social Security staff on a regular basis to smooth out any ongoing issues.

Inmates who go through this process typically receive their disability checks very quickly upon release. The state provides a small stipend to released inmates, which is helpful until the check comes through. The release plan also addresses the need for housing; as a result, SSA can be given an address to which checks are to be mailed.

In Texas, award or reinstatement of SSI benefits automatically triggers Medicaid coverage. The applications to SSA for disability benefits also include an application for food stamps (see federal rules section above).

The pilot program handled applications from 1,114 inmates through 2000, of which 567 were completed and filed with SSA; 484 inmates had received a determination as of December 2000. Applications were not completed and filed by inmates released prior to completion, those who were ineligible due to alien status, those who died and 505 who declined to participate.

Additional information on this pilot is available through its web site:http://www.tdcj.state.tx.us/tcomi/tcomi-home.htm.

Albany, New York: Medicaid Coverage

Albany County Correctional Facility, with a daily census in 2000 of 719, is the state's fifth largest jail. The needs of people with mental illnesses were not being met in the county and the jail saw the result: a revolving door into the criminal justice system as inmates were discharged with no resources only to decompensate and return time after time to jail. Moreover, jail officials were told by a state agency that "the problem is yours" and not a state responsibility.

Concerned about how to address the needs of this expanding population, four county representatives (from the jail, the office of public defender and the mental health authority) led efforts to form a local committee to address service issues for persons with co-occurring mental health and substance abuse disorders. Named the Options Committee, the group has grown to 20 members, most of them department heads,⁽¹⁴⁾ and continues to meet monthly. Its mission includes managing the integration of existing health, mental health, substance abuse and social service systems to match client needs with available services. It strives to improve client outcomes related to self-sufficiency and to reduce recidivism.

As a result of the Options Committee's work, various programs and services have been implemented, including improvements in mental health services in the jail and opportunities for pre-trial diversion. The committee has had a powerful effect on many issues, including the improvement of discharge planning for inmates with mental illnesses.

Initially, the Options Committee found that community-based providers did not want to come into the facility to screen inmates because no insurance would pay for the service. The Options Committee challenged the County Office of Social Services (the Medicaid agency) to remedy this. As a result:

• Guidelines were established for all inmates with a known date of discharge.
• County social services staff come into the jail 45 days before an inmate's release.
• The inmate is assisted in completing an application for Medicaid benefits, which is filed 45 days prior to the anticipated date of release.
• The application is registered and logged and held so it can be activated once the inmate is released.
• Upon release, the inmate must go to the Social Services office with certain information, including proof of identify, release papers, verification of financial eligibility (assets and income) and verification of residence in Albany County.
• The Social Services office not only processes the Medicaid application but also assists the released individual with other needs, such as job search, general assistance payments, food stamps and access to other programs.
• The individual's application is generally finalized upon a second visit to this office, within two or three days.
• The jail provides sufficient medication to cover inmates' needs until their Medicaid and other benefits can be obtained.

As a result of the Options Committee's efforts, community mental health providers are now willing to work with people being released from the jail.

Rensselaer County, New York: Medicaid

In Rensselaer County, a New York Forensic Task Force has been established with representatives from the jail, courts, district attorney, defense, parole, probation and police, and from mental health, substance abuse, health, education, housing and shelters, along with consumers and the county executive office. This task force recognized the need to reduce the delay in accessing benefits upon release. Task force members therefore met and negotiated an agreement with the head of the county's Medicaid agency. As a result, many applicants now receive Medicaid benefits within 24 hours of release. Under this agreement:

• Department of Social Services (DSS) staff provide public assistance applications and training to jail staff so they can help inmates complete their applications and collect the necessary supporting documentation, such as birth certificate, pay stubs and identification.
• Applications are completed prior to release and filed with the social services agency, where they are reviewed and, if approved, returned to the inmate, who can then take the approved application to social services upon release, speeding up the process.
• If the need for action is urgent, jail staff or a case manager can get an appointment and bring the former inmate to the social services office for immediate temporary assistance beginning on the day of release. In this case, DSS accepts a jail booking sheet and jail photo identification. Within 10 days, the former inmate must provide the proper documentation in order to apply for ongoing Medicaid benefits.

This effort has been facilitated by co-locating a probation officer in jail and providing transportation to community-based providers after release.

New York State: Access to Medications

New York State has a Medication Grant Program administered by the Office of Mental Health that will pay for psychiatric medications for people leaving jail or prison, provided the individual applies for Medicaid prior to or within seven days of release. Grants are made to counties to enable them to pay for medications. The Office of Mental Health also pays for transition managers, or pre-release coordinators, in certain local jails, who help develop an inmate's application. The local mental health agency then works with Medicaid to finalize the application. Upon release, the individual is given a temporary Medicaid card to cover medication costs while the full Medicaid application is being processed.

Lane County, Oregon: Access to Medicaid Upon Incarceration and Release⁽¹⁵⁾

Oregon Medicaid operates under a federal (Section 1115) waiver and the state Medicaid agency has an incarceration disenrollment policy, stating that individuals will not be disenrolled from Medicaid until the 15th day of their incarceration. Thus, inmates released within 14 days retain their eligibility and can access Medicaid-covered services immediately. Medical costs incurred during the first 14 days of incarceration are paid by the Medicaid managed care plan, which in Oregon is the county mental health authority. No specific federal financial participation is claimed for any inmate's mental health care.

In addition, through an agreement between a county and the local Medicaid office, the application/re-application process can begin while the individual is still in custody. This applies both for those who did not have benefits upon arrest and inmates whose Medicaid was terminated because they were incarcerated longer than 14 days. Jail staff help inmates fill out Medicaid applications and fax them to the Medicaid office prior to release. Medicaid puts the applications on a fast track for processing and most are processed in a day or two. Temporary Medicaid cards are then faxed back to the jail, ensuring that inmates have immediate access to Medicaid services upon release.

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