Breaking the cycle 

Could access to Medicaid keep inmates from returning to jail? The county is placing its bet

Experts often lament that jails and prisons have become the new psychiatric hospitals.

Wendy Habert, director of detention compliance for the El Paso County Sheriff's Office, says there's some truth to that. When new inmates come to the county's Criminal Justice Center, she explains, they undergo physical and mental health screenings.

If a mental health issue is suspected, they are referred to the jail's mental health staff.

Though the jail doesn't keep statistics on how many inmates are diagnosed with mental health issues, it's safe to say the program is frequently used, and many inmates are first diagnosed and treated for a problem at the jail. Like any illness, treatment usually leads to improvement. But that progress can evaporate the minute inmates walk out the jail doors, losing access to counseling and medication — as well as food, shelter, and other resources.

"The sky is falling for them, so they may re-offend, whether minor or major," Habert says, adding, "Every jail across the country has what we call the 'frequent fliers.'"

Sheriff Bill Elder thinks it's a problem the jail is capable of solving.

"We think there's a very, very significant mental health issue in the jail," Elder says. "We're working on alternatives to address that."

Specifically, the jail is working on a renewable, two-and-a-half-year partnership with the Department of Human Services, starting as soon as August. DHS plans to provide three employees to the jail to assist exiting inmates with enrollment in government programs for which they qualify, from food stamps to GED classes, job placement services and Medicaid.

Rebecca Michael, DHS manager of economic assistance, says the program wouldn't have been as successful before the state expanded Medicaid in 2014. Now, Medicaid is available to any documented citizen or legal permanent residents of five years or more who earn $1,305 a month or less. And with Medicaid comes access to mental health care.

The idea isn't exactly new. Back in 2002, then-Rep. Andrew Romanoff was among the Colorado lawmakers who sponsored House Bill 1295.

The bill passed into law, requiring prisons to help exiting prisoners sign up for certain government-provided health care, if they had been on a program before entering prison. Romanoff's aim was to help those with mental illness — who sometimes qualified for help — to continue treatment.

Romanoff, who now leads the nonprofit Mental Health America of Colorado, says the bill just made sense.

"The point is to actually save money, because it's cheaper to get someone back on a course of treatment than back in a prison," he says, adding, "They were literally a captive audience, so you shouldn't have trouble getting them to fill out the paperwork."

Marc Williams, spokesperson for the Colorado Department of Health Care Policy and Financing, says the law is still enforced.

"Because of the way the state prison system works, [the Department of Corrections] knows when an inmate is coming up for parole and begins the Medicaid application process 90-180 days before parole to ensure that everything is in place the moment the inmate steps outside the DOC facility," Williams writes in an email to the Independent.

He adds that his office has been reaching out to "county jails, sheriff's offices and county human service offices" to provide training and advice on how to partner if they offer the same services. His department considers it a "best practice" to connect exiting inmates with workers who can enroll them in Medicaid in jail.

It's not clear how many such programs exist. Habert says she believes the CJC plan is the first in Colorado to offer inmates an opportunity to enroll in all DHS services, and only the second to connect them with Medicaid in a county jail. (Habert thinks Jefferson County was the first.)

Mark Techmeyer, spokesperson for the Jefferson County Sheriff's Office, says his county jail, in a partnership with the state, has offered Medicaid enrollment to inmates for four years now. He says the jail hasn't tracked whether the program is keeping people from returning to the jail, but the staff there believes it has.

"We believe that the program is very successful," he says. "We believe also that it is reducing the recidivism rate."

In an email to the Independent, Dr. Fred Michel, chief medical officer at AspenPointe, a local behavioral health center, says major life transitions — from jail to the civilian world, for example — are tough for anyone. A person with mental illness may struggle more than most, compounded if there's a sudden discontinuation of medication, which "can sometimes lead to adverse reactions simply from the rapid drop in medication blood levels.

"Additionally, discontinuation of the medication will often result in recurrence of primary psychiatric symptoms such as anxiety or depression," Michel adds. "In severe situations, this can also result in return of psychotic symptoms or suicidal ideation that may have been under good control when on a regular medication regimen."

For a successful transition, he says, regular use of medication and therapy must continue after release. Access to medical resources, job training, housing, transportation and family support are also crucial.

Habert says she's optimistic El Paso County's new program can do that. She hopes it will, in turn, reduce crime, save the county money and help inmates go on to lead successful lives that will benefit those around them, including dependent children.

"It's like the starfish mentality," Habert explains. "If we can help one person, we're helping so many people that are connected to that person."

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