Leon Evans presents, Gains Conference March 18 2010

1. “ Federal Benefits: Current Debate” Health Care Reform, Mental Health Issues Barriers Impacting Ability to Access Treatment 2010 CMHS National GAINS Center Conference March 17-19, 2010 Coronado Springs Resort in Orlando, FL Leon Evans President, National Association of County Behavioral Health Directors; President and Chief Executive Officer The Center for Health Care Services Bexar County Mental Health Authority San Antonio, Texas [email_address]

3. Poor System Design There’s no integrated Plan The Individual Vocational Services Employment Law Enforcement Treatment Housing Poor Communication The Problem Jails Emergency Rooms Medical Homeless Services

4. Collaboration: It’s an unnatural act between… … two or more unconsenting adults .

5. Meeting the Challenge What we know is what works in one community may not work in another community but you can take bits and pieces of what works in one into another, to rural or metropolitan areas we need to find a way to share that information and identify best practices What Works

6. NACo Policy Reforming America’s health care system must include reforms to its jail system. Counties are responsible for providing health care for incarcerated individuals as required by the U.S. Supreme Court in Estelle v. Gamble, 429 U.S. 97 (1976). This unfunded mandate constitutes a major portion of local jail operating costs and a huge burden on local property tax payers. The federal government should lift the unfunded mandate by restoring its obligation for health care coverage for eligible inmates, pre-conviction. Furthermore, a true national partnership is needed to divert the non-violent mentally ill from jail and into appropriate evidence-based treatment in community settings, if possible. Finally, resources should be made available to counties to implement timely, comprehensive reentry programs so that former inmates have access to all the health and social services, including behavioral health and substance abuse treatment, to avoid recidivism and become fully integrated into the community.

7. NACo - Loss of Federal Entitlement Benefits Draft Resolution WHEREAS, U.S. Code of Federal Regulations, Title 42, Part 435.1009 states that federal financial participation (FFP) is not available in expenditures for services provided to Individuals who are inmates of public institutions, and WHEREAS, States being unable to assume the federal share of providing medical services to FFP eligible persons being held in county jails and detention facilities, tend to terminate or sometimes suspend eligibility, and WHEREAS, this immediate cessation of benefits occurs prior to the issuance of formal charges or conviction, and WHEREAS, counties must provide medical services to all persons incarcerated in local j ails and detention facilities, and WHEREAS, as the result of this regulation to immediately cease FFP for medical benefits, all costs of medical care must be borne solely by counties; NOW THEREFORE BE IT RESOLVED that the ____ Board of ____ requests and strongly urges Congress to amend necessary federal regulation to allow federal financial participation for medical benefits to incarcerated individuals until convicted and sentenced to secure detention. The California State Association of Counties (CSAC) has endorsed the resolution.

10. There are many more effective solutions in our States, in our Counties, and all across the Country ! YOU are at the core of the Solution !

11. Leon Evans, President and Chief Executive Officer, The Center for Health Care Services San Antonio, Texas For additional information contact: Leon Evans, Ph. 210 731-1300 Email: [email_address] Blog: http://diversioninitiatives.net Thank you ! www.chcsbc.org