Establishing System-Wide Access to Community Treatment: Effective Justice Systems Change Initiatives

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1 Establishing System-Wide Access to Community Treatment: Effective Justice Systems Change Initiatives Center for Health and Justice at TASC

2 Disclosure I have no actual or potential conflict of interest in relation to this program/presentation.

3 National public policy group focused on nexus of criminal justice and public health Expertise grounded in science and practical, on-the ground experience of TASC, providing alternatives to incarceration since 1976 Collaborations with broad network of public policy leaders, researchers, criminal justice practitioners, and clinicians

4 Justice Leaders Systems Change Initiative Partnership of the National Judicial College and the Center for Health and Justice at TASC

5 What is JLSCI? Systems change initiative at the intersection of justice, treatment, and community Results in improved management of justiceinvolved persons with substance use disorders Teams of local justice and treatment leaders 2011, 2012, White House National Drug Control Strategy

6 JLSCI Goals Provide training for local teams of judges, probation leaders, and community partners Create tangible, practical improvements for criminal justice systems Implement evidence-based, systemic solutions to deal with substance use that underlies criminal justice involvement Ultimately, improve outcomes for addicted offenders

7 General Population vs. CJS General Population In Treatment In Treatment Criminal Justice Addiction Harmful Use Addiction Little or No Use Harmful Use Little or No Use

8 JLSCI History National Symposia Savannah, Georgia; November 2009 Reno, Nevada; Sep 2011, Nov 2012 State Symposia Texas; Oct 2011 Georgia; Oct 2011 Ohio; Aug 2012 Nevada; Oct 2013 Ohio; Nov 2013 Distance Learning, Technical Assistance Funded by BJA, CSAT, NIDA and ONDCP

9 EXAMPLE: APPLYING JLSCI PRINCIPLES WITH AFFORDABLE CARE ACT IMPLEMENTATION

10 Unique Opportunity 40+ years of experience working with clients with substance use disorders Research, demonstration and pilot projects Some projects funded by BJA Next step: take the evidence based practices discovered over four decades and take it to scale

11 CJS Population Will Be A Large Part of the Newly Eligible in Justice Involvement 300,000 (approx.) Justice involvement includes: Jail bookings On Felony Probation Released From Prison New Medicaid Enrollees in Illinois beginning in 2014 No Justice Involvement 350,000 (approx.) Illinois is expecting 500, ,000 new Medicaid enrollees beginning in 2014 Note: Chart reflects the median range of 650,000 total new enrollees Sources: Illinois Criminal Justice Information Authority (2008); Illinois Supreme Court (2009); Illinois Department of Corrections (2009)

12 The Promise of Health Care Reform Implementing the Affordable Care Won t solve all challenges, but... Unique opportunity for significant change on a broad scale Near universal coverage for low income adults Address gaps in services Eliminate long waiting lists Developing unified systems with single point of access to care improve outcomes, increase competitive position Ending piecemeal approach to public funding

13 Preparations in Illinois Spring 2011-the Illinois Criminal Justice Information Authority (ICJIA) begins strategic planning process ICJIA forms a working group with other state agencies to explore opportunities for CJ populations 2011-the working group becomes a part of Governor Quinn s Healthcare Reform Implementation Council 2011 to 2012-focus on eligibility and enrollment issues, including suspension of benefits July 22, 2013-Governor Pat Quinn signs legislation to expand Medicaid in IL Allows about a half-million previously uninsured residents to become eligible for healthcare coverage

14 Collaboration and Planning: BJA Funding 2013-Illinois receives BJA funding for enrollment of justice populations Jails, prisons, probation, and parole departments invited to participate in conference calls to discuss the ACA and application process Educational materials and process maps developed to assist in making decisions about participation Includes 1115 Waiver for early expansion in Cook County called CountyCare Illinois operates its own, state-based marketplace at

15 Collaboration and Planning: ICJIA Funding ICJIA funds regional trainings reaching 76 of 102 counties Summer ICJIA, the Administrative Office of the Illinois Courts (AOIC), and TASC, Inc. host a series of Collaborative Conversations Leads to strong interest from probation and sheriff s departments in varied jurisdictions Results in increased collaboration to employ application assisters in communities that range from rural to urban

16 Collaboration and Planning: Illinois Department of Corrections 2011-IDOC begins planning for broad systems of enrollment upon entry and discharge Emphasis on maximum automation, integration of health records, and medical care at intake and prior to release Produced and submitted a process map to describe procedure for required activities Includes assessments for inmate eligibility along the IDOC continuum, starting with intake Inmates will also be evaluated if they go to the hospital, upon discharge, and at the outset of parole

17 Collaboration and Planning: Cook County August 2012-under the leadership of the Honorable Paul P. Biebel, Cook County justice systems begin ACA implementation process The Justice and Health Initiative (JHI) Steering Committee includes professionals from various Cook County agencies and organizations

18 JHI Goals Determine how to facilitate applications for all eligible persons entering the justice system Develop infrastructure and processes that support universal linkage to medical, mental health, and substance abuse treatment Support expansion of care in the community that meets the needs of people under supervision Expand diversion from jail and prison to care in the community under appropriate supervision

19 JHI Projects Facilitating Applications for Coverage In detention: Cook County Jail In community: Probation, TASC Health Care Reform-Ready Court" Focusing on prison diversion Jail-to-Community Continuity of Care Priority on people with severe substance use disorders, serious mental illness and priority medical conditions

20 Expansion to Winnebago County 2013-Chief Judge Joseph McGraw, 17 th Circuit (Rockford, IL) convenes planning process for ACA implementation Steering committee and several working groups determine how best to align enrollment and linkage to care with justice system processes Working group of medical, mental health, and substance use disorder treatment agencies discuss how community services can be expanded to respond to increased referrals This process is also led by TASC

21 Capacity Expansion Courts articulating their priorities: High quality treatment delivered by providers experienced with the justice-involved population Public substance abuse treatment providers adapting to Medicaid reimbursement stream Public mental health providers better prepared for Medicaid, challenged to expand Adapting to Medicaid Managed Care Educating funders and regulators (Medicaid authorities, health plans)

22 Future Planning Focusing on care capacity in the community for the growing number of newly eligible persons in the justice population Devoting efforts to building continuity of medical care between jails, prisons, and community Most organizations agree that the ACA has unique and exciting implications for the justice population, and they are willing to engage in the changing landscape of healthcare

23 Questions? Comments? Implementing the Affordable Care

24 Contact Information Maureen McDonnell Director for Business and Health Care Strategy Development

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