Medicare, Medicaid, Long Term Care & Discharge from Jail

     One of the things that is most surprising is that many people who are incarcerated are also on SSI, Medicaid &/or Medicare when not incarcerated.

        Their needs have pretty much by definition not been adequately addressed.

         The paramount goal of DISCHARGE PLANNING from the JAIL has to be to adequately address these needs.

           The HANGOVER we are getting ready to wake up from is that many of these folks need LONG TERM CARE -- and it may not just be for mental health, it can include brain injury, developmental disability, and/or substance issues, etc.

             While there are LONG TERM CARE insurance policies out there, most people don't have them. 

             What is LONG TERM CARE?  Be prepared to have your brain fried.

              It used to be that long term care was limited to NURSING HOMES -- that's changed a lot but it is NOT internally consistent, especially here in Colorado.

               So long term care includes:
  • Nursing Homes
  • Assisted Living
  • Home & Community Based Services [CO's Community Mental Health Supports Waiver does NOT comply with the 2008 Mental Health Parity & Addiction Equity Act -- and is targeted to people with mental disorders who need assistance with "activities of daily living."  What??? -- yeah.]

            Assertive Community Treatment (ACT)
  • some private health insurance companies classify ACT as a long term care service -- and since they don't cover long term care -- they claim they don't have to cover ACT.
  • CO Medicaid covers ACT as an "ALTERNATIVE SERVICE" under its Behavioral Health Benefit -- BUT it is severely rationed and is not available where "reasonably medically necessary."  [BTW -- Minnesota provides ACT under Medicaid as a standard service -- so it can be done and Colorado and other states need to do it.]
  • A California Court has ruled that private health insurance companies must provide ACT.

          So it is generally not a good step down to go from Jail to nothing when there are serious cognitive concerns.  Further, trying to arrange to go straight from Jail to Housing is almost impossible if NOT already available to the person.  If the person has spent significant time incarcerated, that housing is likely gone.

          For a lot of people it makes more sense to go to the Assisted Living Residence or the Nursing Home and then from there make housing and intensive treatment arrangements if that is what is desired.

            What is so scary about our current system is that so many people do meet the level of care for long term care under a NEED FOR SUPERVISION under CO Medicaid's long term care assessment tool.  

              WAKE UP!  We can't have Systems this poorly DESIGNED -- and wonder why we have thousands of people with cognitive disabilities in Jails and Prisons.
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Photo Credit: Futurity.org -- "Could This Eye Device Detect Schizophrenia"

​Medicare Part A covers Hospitalization -- Medicare does NOT cover Long Term Care -- although it does have coverage for Skilled Nursing Facilities (SNFs) --  most people with Cognitive Disability don't need a ​SNF.

Further nursing homes are a common step down for Colorado's Mental Health Institutes.

Medicare Mental health care (outpatient)
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Medicare Part B (Medical Insurance) helps pay for these covered outpatient mental health services:
  • One depression screening per year. The screening must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals.
  • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services.
  • Family counseling, if the main purpose is to help with your treatment.
  • Testing to find out if you’re getting the services you need and if your current treatment is helping you.
  • Psychiatric evaluation.
  • Medication management.
  • Certain prescription drugs that aren’t usually “self administered” (drugs you would normally take on your own), like some injections.
  • Diagnostic tests.
  • Partial hospitalization.
  • A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your possible risk factors for depression.
  • A yearly “Wellness” visit. Talk to your doctor or other health care provider about changes in your mental health. They can evaluate your changes year to year.
Part B also covers outpatient mental health services for treatment of inappropriate alcohol and drug use.
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Photo Credit: oceact.org