“Medicaid is there for those who need it, and thank goodness it is. But it could be a lot better,” she said. “It’s all the rigmarole you have to go through to get someone to the place they need to be.
“If they get lost somewhere in between the beginning and the end of the process, they’re not going to make it to that end, where they’re stable and functioning,” she said.
One of the groups most vulnerable to getting lost in the shuffle is sitting at the Howard County jail.
When people are incarcerated, they can keep their Medicaid and Social Security benefits for 30 days. If they remain jailed for more than a month — and even if they’re never convicted of a crime — federal law requires that they’re dropped from the program and have to reapply.
That can be a four- to eight-month process. In the interim, people released from jail who are suffering from a mental illness and trying to get back on to Medicaid aren’t getting any medication.
That’s bad news, said Kristie Shirey, the nurse at the Howard County jail. And it happens a lot — eight times a month, sometimes.
Shirey said it’s much too common for incarcerated people with mental illnesses to lose their benefits and medication after a stint at the jail. They spiral downward, become homeless and eventually land back in a cell, she said.
“They’re scrambling to find a place to live and it ends in disaster,” Shirey said.
And for someone suffering from bipolar disease or schizophrenia, the application process to get back into Medicaid can be daunting, if not impossible.
“If you’re mentally impaired, you don’t know how to do that,” Shirey said. “You don’t even know where to begin.”
It’s an ugly cycle, and it’s one the Howard County Sheriff’s Department has worked to break.
Jail Commander Capt. Harold Vincent said department officials work closely with the local Social Security Office and court system to expedite the reapplication process for mentally ill people released from jail after more than 30 days.
Through their collaboration with local agencies, Vincent said they can cut the time it takes for someone to requalify for Medicaid from four months to just two weeks in some cases.
The accelerated reapplication process means people with mental illnesses are getting their psychiatric meds quicker. That can mean the difference between a smooth transition back into society or mentally deteriorating and serving another stint at the jail.
Even with the expedited reapplication, it’s still not a good situation for people with serious mental health issues, Vincent said.
“It doesn’t take nearly as long to get them their benefits back, but in the meantime, they’ve still lost their access to services and their medical contacts,” he said.
SWITCHING MEDS? BAD IDEA
Then there’s the problem of receiving mental-health treatment when people are actually at the jail.
Vincent said jail nursing staff members try to communicate with inmates’ health-care providers to keep them on their current psychiatric medication. If they can’t provide an inmate with the exact prescription, staff find the next best thing to keep them stable.
But that’s not the case at a lot of jails, said Mental Health America of Indiana President McCaffrey.
Many jails switch inmates’ psychiatric medication to different, cheaper drugs to save money, he said. If they end up in the Indiana Department of Correction, prison staff there could change their prescriptions once again.
“There are 92 different jail systems [in Indiana], and 92 different ways on deciding on how to provide for mental health medications,” he said. “It’s a patchwork system with varying degrees of access and lack of access … But nobody would say switching medication that works makes good clinical sense.”
McCaffrey said in the long run, it is more fiscally responsible to spend money up front to provide the appropriate medication to inmates to keep them stable. If they remain untreated, former inmates could once again act out from their mental illness and end up back in jail.
And keeping someone incarcerated is a lot more expensive than providing the proper mental-health treatment the first time and keeping them out of a cell a second time, he said.
HIP 2.0
One of the biggest steps the state could take to get more people access to mental-health treatment is expanding the Healthy Indiana Plan, McCaffrey said.
Currently, more than 390,000 Indiana adults don’t have insurance because they make too much money to qualify for Medicaid, but they don’t make enough to qualify for insurance supplemented by the Affordable Care Act, commonly known as Obamacare.
That’s a big problem for people with mental illnesses.
“It’s awful. They have no place to go,” McCaffrey said. “They can’t get access to the drugs they need or the therapy they need. Only bad things can happen from that.”
Pence has been steadfast in his refusal to expand traditional Medicaid, as provided for in the Affordable Care Act, which would also offer coverage for Hoosiers left in limbo by their income.
Instead, Pence is choosing to pursue federal approval for state-level coverage called HIP 2.0., which was denied last week in his first meeting in Washington with Health and Human Services Secretary Sylvia Burwell.
But while the state and the feds debate which program to implement in Indiana, McCaffrey said the uninsured mentally ill continue to struggle with their disorder.
That leads to a host of other social problems, including domestic violence, kids dropping out of school and criminal offenses that erode the state’s social fabric and safety, he said.
“If people had received the treatment they needed, we’d like to think that incidents like that would never have occurred,” McCaffrey said.