What do Court Leaders Need to Know About Medicaid Opportunities and Improving Outcomes?


National Initiative Updates

What do Court Leaders Need to Know About Medicaid Opportunities and Improving Outcomes?

Let us know your questions or concerns relating to Medicaid Funding and opportunities. The Advisory Committee will be developing resources for Court Leaders. Please contact Patti Tobias at ptobias@ncsc.org.

Education and Training for the National Court Community on Mental Illness and Co-Occurring Disorders is a PriorityRepresentatives from the Council of State Government (CSG)  Justice Center, the Judges and Psychiatrists leadership Initiative (JPLI), Policy Research Associates (PRA)/Gains Center, National Association of Presiding judges and Court Executive officers (NAPCO), National Association for Court Management (NACM), American Academy of Addiction Psychiatry (AAAP), National Center for State Courts (NCSC), Treatment Advocacy Center (TAC), American Psychiatric Association (APA), Trial Judges from Colorado and Illinois Education committees, National Association of State Judicial Educators (NASJE), and others joined together to develop recommendations for a national agenda of Mental health education and training curriculum, resources and programs.  Please forward any resources and thoughts to the National Initiative in care of Patti Tobias at ptobias@ncsc.org.

Let Us Hear from You About Your CaseFlow Management Practices!The National Initiative is seeking your help to identify innovative or promising practices regarding timely and effective resolution of civil and criminal cases that involve persons with mental illness. Some promising practices include one-day competency evaluations and centralized assignments of cases involving fitness, coordinated civil and criminal processing, expedited mental health dockets, court behavioral health specialists, use of social workers in public defender offices, telehealth connections to timely psychiatric consultations, expanded use and sharing of behavioral health screening and assessment tools, and the expanded use of caseflow management and other behavioral health data to manage dockets and timely access to treatment. If you have or know of a court using an innovative or promising mental health practice, please contact Michelle O’Brien at mobrien@ncsc.org.

Research and Resources

Convening, Collaborating, Connecting: Courts as Leaders in the Crisis of Addiction The Final Report of the National Judicial Opioid Task Force.

Michigan Joint Task Force on Jail and Pretrial Incarceration In a relatively short period of time, county jail populations nearly tripled in Michigan. Elevating jails as a shared bipartisan priority, state and local leaders created the Michigan Joint Task Force on Jail and Pretrial Incarceration, directing the body to analyze jail populations across the state and develop legislative recommendations for consideration in 2020.

Behavioral Health Diversion Interventions: Moving from Individual Programs to a Systems-Wide Strategy This publication is intended to provide local leaders with a systems-level conceptual framework for developing a continuum of behavioral health diversion interventions that span the community’s criminal justice system—starting from first contact with law enforcement through incarceration.

IMPROVING THE COURTS' RESPONSE TO PEOPLE WITH MENTAL ILLNESSES Our justice system often finds itself handling not just individual cases but also the complex outcomes of other areas of social policy. Whether in Judge Leifman's courtroom in Miami or in thousands of courtrooms around the country, legal professionals come face-to-face with individuals who likely would not be involved with the courts were it not for untreated or undertreated mental illnesses or substance use disorders (“behavioral health” needs). Although the legal options may be clear, they often seem inadequate. Authored by Judge Leifman and Hallie Fader-Towe (Westlaw link).

NACo‑NSA Joint Task Force PRE‑TRIAL DETAINEE HEALTH CARE AND RECIDIVISM The task force is made up of NACo and NSA members representing county leaders, law enforcement, judges, prosecutors, public defenders, behavioral health and veterans’ services, who will be dedicated to exploring and raising awareness about the impacts of the Medicaid Inmate Exclusion Policy (MIEP), a federal policy that strips federal health and veterans benefits from individuals upon admission to jail – not upon conviction, and its contribution to the national behavioral and mental health crisis as well as rates of recidivism in our local jails.

DEADLINE EXTENDED: SAMHSA’S GAINS CENTER CRIMINAL JUSTICE COMMUNITIES OF PRACTICE Deadline is now February 12 SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation is convening three topical Communities of Practice to work intensively with select communities on the following topics:

  • Equity and Inclusion in Adult Drug Courts
  • Using the Sequential Intercept Model (SIM) to Guide Medication-assisted Treatment Implementation (new eligibility criteria!)
  • Improving Recovery Support Services for People with Substance Use Disorders Returning from Jail or Prison

CLOUD: Your source for curated, actionable, evidence-based resources on opioids and the opioid crisis in the United States. A centralized source to find actionable, evidence-based resources. CLOUD engages in a thorough inclusion review process to ensure the highest quality of materials are selected for the site. The library is a dynamic project, regularly adding resources to ensure users have the latest information available.

Certified Community Behavioral Health Clinic Expansion Grants The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS) is accepting applications for fiscal year (FY) 2020 Certified Community Behavioral Health Clinics (CCBHCs) Expansion Grants (Short Title: CCBHC Expansion Grants). The purpose of this program is to increase access to and improve the quality of community mental and substance use disorder treatment services through the expansion of CCBHCs.

Comprehensive Opioid Recovery Centers Grant The purpose of this SAMHSA grant program is the operation of comprehensive centers that provide a full spectrum of treatment and recovery support services to address the opioid epidemic.

RACE, ETHNICITY, AND BEHAVIORAL HEALTH: ARE DISPARITIES IN DIAGNOSIS AND TREATMENT CONTRIBUTING TO MASS INCARCERATION? A central feature of our criminal justice system is the dramatic overrepresentation of racial and ethnic minorities in jails and prisons in the U.S. The question we should be asking is whether racial disparities in behavioral health diagnosis and treatment are contributing to the disproportionately high number of people behind bars and under correctional supervision. Data and existing research point us to a likely “yes.”

COMMUNITY-BASED RESPONSE TO OPIOID EPIDEMIC IN RURAL AMERICA LAUNCHES WITH $14.8 MILLION FOR 21 SITES Twenty-one rural American communities that have borne the brunt of the opioid epidemic will receive $14.8 million in funding to develop tailored and innovative responses to gaps in prevention, treatment and/or recovery services for individuals involved in the criminal justice system.

Crisis Intervention Teams for Youth (CIT-Y) The standard CIT training offered to most police officers focuses primarily on response techniques for adults. While there are some general similarities between adults and youth, there are important and unique distinctions that require specialized knowledge and training. CIT-Y trains police officers on response techniques that are appropriate for youth with behavioral health needs.

In-betweeners: Looking at the people between behavioral health stability and crisis To make a real, lasting impact on the health and behavioral health outcomes and improve the return on investment of taxpayer dollars, we encourage counties to challenge their assumptions on super-utilizers and look deeper into those that fall in-between stability and chronic crisis.

Does Involuntary Treatment Scare People with Mental Illness Away from Treatment? There are several studies on this question, done scientifically and published in peer‐reviewed journals.

National Association of State Mental Health Program Directors Weekly Update

Reducing the Use of Jails In this National League of Cities brief, learn how six cities developed and began to implement pilot diversion programs to reduce the use of local jails.

Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit People who have been incarcerated are approximately 100 times more likely to die by overdose in the first two weeks after their release than the general public. This toolkit provides correctional administrators and health care providers recommendations and tools for implementing medication-assisted treatment (MAT) in correctional settings and strategies for overcoming challenges. Informed by real-world practice, the toolkit provides examples from the field that can be widely applied and adapted.

Rural Community Action Guide: Building Stronger Healthy, Drug-Free Rural Communities This guide continues the effort to support rural leaders by providing insight and recommended action steps from partners who are working on the frontlines of combating drug addiction in rural communities. The direction offered in this guide is then supplemented by examples of promising practices which can be found on the USDA webpage.

Illinois Criminal Justice Information Authority Data and Research Welcome to the Illinois Criminal Justice Information Authority (ICJIA) Research Hub. Here you can find various criminal justice datasets, research publications, and resources to develop web applications, dashboards, and more.

SAMHSA Criminal Justice Resource Publications

NIMH offers authoritative information about mental disorders, a range of related topics, and the latest mental health research

In the News

State Health Officials Say Medicaid Expansion Helped Combat Opioid Epidemic Expansion of Medicaid has allowed states to more broadly fund prevention and treatment initiatives to battle the opioid epidemic, state health officials told a congressional committee.

Idaho Chief Justice calls for 'new course forward' on mental illness All three branches of Idaho’s state government need to join together to “chart a new course forward” on dealing with the mentally ill, state Supreme Court Chief Justice Roger Burdick told lawmakers.

Mental illness an 'enormous challenge' to Utah courts, Chief Justice says Jails and prisons have become the U.S.’s “de facto mental institutions,” Durrant said, containing more people experiencing mental illness than Utah’s state-funded mental hospital. “That’s an enormous challenge to the court system and for everyone in our communities.”

Hawaii Lawmakers Work To Keep The Mentally Ill Out Of Jail The Legislature is considering major policy changes aimed at redirecting people with serious mental illness who commit non-violent, low-level crimes out of jail and into mental health treatment.

Michigan Report calls for “significant investment” in mental health services to divert people from jail One of those recommendations includes diverting residents with behavioral health issues away from jails. According to findings in the task force report, nearly one in four people entering jails has a serious mental illness. That number is even higher in rural jails.

Miami Film Festival Debuts "The Definition of Insanity" Shocked by how people with mental illness were treated in his county’s jails, Miami-Dade Judge Steve Leifman has set out to work with a team of dedicated public servants -- as well as former adversaries in the criminal justice system -- to help people with mental illness navigate the sometimes cruel system, and live lives full of possibilities. The Definition of Insanity shows how one local judge’s novel approach to solving the mental health crisis could be the model to tackle the much larger epidemic throughout America. Narrated by Rob Reiner.

Alaska releases court-ordered plan to get waiting psychiatric patients out of jails, ERs Alaska officials released a report explaining how the state intends to keep psychiatric patients from being warehoused in emergency rooms and jail cells while they await scarce treatment beds.

State courts plan to use mental telehealth services in rural parts of South Dakota South Dakota courts want the Legislature’s approval to look at how mental telehealth services could work in some of South Dakota’s rural counties. State Supreme Court Chief Justice David Gilbertson has asked lawmakers for permission to spend up to $418,000 for the study. The money would come from outside state government.

Repairing Our Broken Mental Health Care System: Advice for Policymakers Patients with severe mental illness (SMI) routinely have no access to adequate medication, psychological counseling, social support, and/or housing. The horrible result is that 600,000 patients are either prisoners or homeless—or rotate between the two. The past 50 years of neglect and criminalization have made the US one of the worst places in the world to have a mental illness.

Michigan sheriff pleads for help for mentally ill patient in his jail, calls system “broken” A Michigan sheriff says his jail is not equipped to house an inmate who is displaying severe mental health issues, and that his pleas for help have not been answered by state and mental health officials.

Mental health leaders hope new, "Moneyball" approach will reduce recidivism at JoCo jail Beginning this year, the sheriff will contract the Johnson County Mental Health Center to work inside the adult detention center; transferring the $1.5 million it annually gave to an outside company to the county's own center. The mental health center will hire 12.5 new positions. It will offer counseling and case management to people in the jail and continue to work with those people once the jail releases them.

New Bail Statute and Remanding Defendants Awaiting Psychiatric Exam: Part 2 Part 1 of this article discussed whether a defendant who appears unfit can still be remanded or have bail set under the new New York statute; and if not, whether other options are available to facilitate a successful completion of a 730 examination, as will be discussed here in Part 2.

Multnomah County Awarded Additional $2 Million by MacArthur Foundation Safety and Justice Challenge to Advance Local Justice System Reform Multnomah County was one of five jurisdictions selected for additional funding based on the promise and progress of work to date. This new round of funding will provide the County’s Local Public Safety Coordinating Council and partners with continued support and expert technical assistance to strengthen and expand strategies that address the main drivers of local jail incarceration and racial and ethnic disparities, with the stated goal of safely reducing the County’s average daily jail population by 14.4 percent in 2 years while keeping the jail population at safe and well managed levels — at 85 percent of current budgeted capacity.

Madison County to launch Assisted Outpatient Treatment program for mental illness Madison County is launching a program for people with untreated, severe mental illness. The Madison County probate court will start an Assisted Outpatient Treatment program or AOT on February 3. AOT is a court-ordered program that will focus on outpatient care for people with severe mental illness who are capable of surviving safely in the community with treatment but have shown problems continuing with voluntary treatment.

High court ruling must avoid encouraging involuntary commitment Giving mental health patients access to outpatient care and reserving involuntary commitments for situations that warrant them is crucial to patient safety because studies show that involuntarily commitments result in patients refusing help for fear their civil rights will be taken away.

Utah House advances Medicaid expansion for soon-to-be released inmates It would instruct the state to seek a waiver from the federal government to allow inmates to become eligible for Medicaid coverage 30 days before their release date — aiming especially to allow them to continue mental health treatment they may be receiving in prison.

Oklahoma Mental Health Officials Seeing Success with Prison Diversion Program By the end of June, jails in all 77 Oklahoma counties should be assessing every person arrested for a nonviolent crime for their mental health, potential substance abuse and their risk of reoffending. Oklahoma Interim Mental Health Commissioner Carrie Slatton-Hodges said 73 do so now. "Counties that have not been using this are sending two times the number of people on to prison than counties that use the offender screening system. To date, approximately 30,000 screens have been completed … and an estimated 82% of those screened individuals are eligible for diversion programs, including treatment and other services."

Trump Administration Clears The Way For Medicaid Block Grants The Trump administration wants to dramatically alter the way the federal government gives money to states for Medicaid. For states that adopt the new approach, it could profoundly reshape how Medicaid operates.

Trump Administration Announces Shift to Medicaid Block Grants Democrats, health industry groups and others quickly denounced the plan for transforming Medicaid from an open-ended entitlement program, which it has been since its inception, into one with a spending limit. They said funding Medicaid through block grants would deny health coverage to many people who need it. The plan almost certainly will face a court challenge.

National Council for Behavioral Health Statement on Medicaid Block Grant Proposal Despite promises of greater flexibility for states under this new system, the ultimate goal of these funding structures is to massively cut federal spending for Medicaid, potentially leaving millions without needed care. The National Council remains strongly opposed to funding mechanisms such as these that would shift costs onto states and beneficiaries, restrict access to care and increase the number of uninsured and underinsured individuals.

Attorney General Barr Announces the Establishment of the Presidential Commission on Law Enforcement and the Administration of Justice The Executive Order instructs the Commission to conduct its study by focusing on the law enforcement officers who are tasked with reducing crime on a daily basis. It also directs the Commission to research “important current issues facing law enforcement and the criminal justice system,” and recommends a variety of subjects for study, such as, but not limited to the challenges to law enforcement associated with mental illness, homelessness, substance abuse, and other social factors that influence crime and strain criminal justice resources.

'We've failed' Alabama lawmakers to look at mental health funding, treatment More money for mental health care and legislation to increase access to care, especially for people in crisis, are expected in the upcoming session of the Alabama Legislature. The potential bills will likely result in the first major discussions in Montgomery about mental health care since 2012 and 2015, when decisions were made to close three state mental health hospitals.

A tale about mental health, not bail Harris’ case perfectly illustrates why the criminal justice system is no place for people with serious mental illness. They belong in the mental health system where they can get treatment, not in jails or prisons where they are likely to suffer and get worse. Yet cycling in and out of jails has become the government’s tragic default response to mental health needs, particularly for poorer people who cannot access adequate care.

Mentally ill pose challenge for dangerously ineffectual system Dangerous. Ineffectual. Wasteful. Reformers want to change how the criminal justice system deals with the mentally ill — including cases like the homeless man holed up with explosives strapped to his chest barricaded in a Payson home. Now here’s the big surprise: The reformers were Navajo County Sheriff David Clouse and Navajo County Attorney Brad Carlyon.