Stephanie Collins, Ph.D., LMHC Assistant Deputy Commissioner MA Department of Correction October 30, 2017
Examine the issues impacting ex-offender Examine the issues impacting ex-offender reentry into the community reentry into the community Identify reentry practices that work to Identify reentry practices that work to increase community access and continuity of increase community access and continuity of care care Identify resources to bridge the gap and Identify resources to bridge the gap and establish a network of establish a network of care for ex-offenders care for ex-offenders transition to community transition to community
MA DOC Institution Overview Medical Services Medicaid Reentry Program MA DOC Community Linkages
MA Department of Correction Census Sites Largest Sites Smallest Site Number of admissions annually Number of releases annually
Comprehensive Services Contract Contracted comprehensive medical, mental health and dental services ◦ “Medical services shall include medical, laboratory, pharmaceutical, hospitalization, and inpatient care which shall include primary, secondary, and tertiary levels, outpatient, medical clinic care, physician specialty care, telemedicine and all other health care services.” Fully at risk, capitated contract ◦ The Contractor shall be solely responsible for making all decisions with respect to the type, timing and level of services needed by inmates.
FY 2017 ( July 1, 2016 – June 30, 2017) ◦ 8,262 Medical Trips ◦ 1,219 Emergency Medical Trips ◦ 552,000 Onsite Clinical Visits 49,000 MD/ANP 503,000 RN/LPN 29,000 Dental 832 seen for reentry and discharge planning 1,788 seen for aftercare appointments 1,085 discharged with active MassHealth/39 without 279 referred for medication assisted treatment
Infectious disease medications top cost drivers were for HIV and Hepatitis C: Harvoni 1. Viekira XR 2. Atripla 3. Epclusa 4. The top cost drivers (for Non HIV or Hepatitis C medications) for medical costs were: Adalimumab 1. Etanercept 2. Truvada 3. The top drivers for order volume were: Ibuprofen 1. APAP 2. Clonidine 3. The top cost drivers for psychiatric medications include: Amitriptyline 1. Chlorpromazine 2. Perphenazine 3.
Vendor services as providers for clinical services in MA ◦ MPCH ◦ Spectrum MassHealth Fellowships and Grants Volunteer Services
Offender enrollment in correct program Separate systems ◦ Inpatient Only Medicaid ◦ Community Medicaid ◦ Neither process is automated, applications and changes are completed through a paper process
Must complete a Medicaid application in facility Completed by vendor medical staff Enrolled prior to first inpatient stay which exceeds 24 hours Medicaid does not assume eligibility Only covers costs for services during the stay
Must complete a Medicaid application in facility 30 days prior to return to community Completed with a Correctional Program Officer Not automatically enrolled. Application alerts MassHealth that “Inpatient Only” status is changing to Community status Not assumed eligibility Does not always start immediately upon release
Provide continuity of medical and mental health care for offenders returning to the community Make appointments Provide medications Provide the offender with list of resources Increase chances at recovery and successful reintegration Housing Vocational opportunities
MATRI ◦ Medication Assisted Treatment Reentry Initiative Housing Vocational Programs Employment Cultural Programs (Churches, Organizations) Parole SSI/SSDI
Court Systems ◦ No medical services ◦ No access to care ◦ No prior clinical information Parole/Probation ◦ Responsibility for successful reentry fall to Parolee Community Providers ◦ Lack of mental health resources ◦ Community Providers will not schedule appointments before Medicaid is activated DOC No electronic health record Cannot provide treatment/medications beyond
Thank You! Stephanie.collins@massmail.state.ma.us
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