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					   Helping Michigan Parolees With Medical
           Needs – MPRI Re-entry



         A Successful Community Health Pathway
Vondie Woodbury – Director, Coordinated Community Benefit
             Affairs – Trinity Health Corporation
   Director, Community Benefit – Mercy Health Partners
  Executive Director, Muskegon Community Health Project
   Breaking the Cycle of Crime

95% of all inmates will leave prison
650,000 released nationally every year
MI - 50,000 inmates living in 42 facilities
MI spends $2 billion annually – one of 4 states
that spend more on corrections than on higher
education
12,000 are paroled annually
Half will commit new crimes or violate parole
rules
In MI 6,000 return to prison annually at a cost of
more than $180 million
    Breaking the Cycle of Crime
In Michigan prior to MPRI:

   Inmates left prison with a $75 bus ticket
   2-week voucher for a cheap hotel
   Many lack social security card, birth certificate
    or a state ID
   No help with substance abuse or mental health
    issues
   Parole officers working with 60-80 offenders
    did not have time to help.
   48% of parolees returned to prison
          What is MPRI?

           The Mission of MPRI
  …is to significantly reduce crime and
 enhance public safety by implementing a
seamless system of services for offenders
   from the time of their entry to prison
    through their transition, community
     reintegration and aftercare in their
                communities.
          Michigan Department of Corrections
          MPRI History

Started in 2005 with 8 pilot counties
Additional counties (including Muskegon)
added in 2007
Went statewide 2008
Initial funding $12 million
Fy10 $50 million
      Michigan Re-entry

18 County re-entry collaborations
$30 M appropriation from State for FY-09
Increases to over $50 million in FY-10
Contracts are managed locally – county
level
Basic Structure and
 Process of MPRI
          Typical MPRI Process

1.   A Local Coalition is Established (single or
     multi-county)
2.   Coalition develops semi-annual Action Plan
3.   Action Plan approved by MDOC – funded
4.   Individual subcontractors responsible for core
     activities: housing, transportation, job
     placement/training, mental health and
     substance abuse
5.   MPRI Coordinator is HUB for Multi-functional
     Collaborative operation
Muskegon’s MPRI Collaborative
 Goodwill Industries
 West Michigan Therapy
 Michigan Rehabilitation Services
 Department of Human Services
 Muskegon Community Health Project
 Department of Corrections & Parole
 Orchard View Community Ed
 Community Mental Health
 Victim’s Services
 Shoreline Prison Facility
 Local Police Agencies
 Faith Based Organizations
              Parolee Interface
1.   6 months prior to release “in-reach” team meets
     with parolee in prison; process is explained.
2.   Immediately prior to release – exit interview;
     appointments scheduled;
3.   Upon release each contractor coordinates their
     piece of the puzzle;
4.   Payment is based upon successful completion
     of each part of process (e.g. job placement; a
     place to live;)
Using Local Health Navigation –
    Muskegon’s Approach
       Background MDOC
Michigan Prison System Health Care

   $330 million a year for inmate health care
    (based on a projected number of 48,000
    inmates)
   Annual health cost per prisoner of $6,600
   4,000 prisoners estimated to have chronic
    diseases
   524 estimated to be medically fragile
    Why Medical Navigation?

90% of parolees return to community as
uninsured without medical home;
No medical records returned with parolee;
Pharmaceutical support for chronic
disease terminated after 30-days
Parolees were unaware of medical safety
net support structure
Significant level of imbedded chronic
disease
Job retention could be affected
   Muskegon’s Basic MPRI Health
            Initiative
Incorporated Health Care navigation as part of
Muskegon’s MPRI collaborative process in 07
  Only site in state piloting approach


1,037 parolees have received assistance since
2007

Designated community health navigator is part of
community in-reach and support team for parole;
Health Project is HUB for Health Care Initiative

Program expanded 09 to include 11 additional
counties
Muskegon’s Basic Re-entry
  Health Initiative Goals
Secure Medical Record
Conduct Health Assessment
Screen for enrollment into Medicaid, FSP,
etc.
Identify and schedule first appointment for
medical home
Provide for pharmaceutical assistance
Provide chronic disease self management
Action Pathway for Medical Assistance
        – How Does it Work??

 STEP ONE: Individual is identified as eligible
 for parole and the MPRI program
              ACTION PATHWAY
  STEP TWO: Team schedules/conducts MPRI
  In-reach at the Prison facility

As a Team they meet with and interview each parolee to
  determine individual need
    Review parolee plan – going home?
    Are there special considerations – CSC?

    Process and individuals are introduced
          ACTION PATHWAY

STEP TWO (medical only):
Health Navigator Meets Privately with the
Parolee

   Makes arrangements to get medical records at
    release;
   Conducts health assessment for chronic
    conditions and medication need
   Initiates enrollment screening – Medicaid, SSI,
    FSP, Lion’s Vision, etc.
             ACTION PATHWAY

STEP TWO – Health Navigator Schedules
Medical Appointment

   Contacts FQHC’s, Migrant Clinics, Free Clincs,
    Private Physicians;
   Prioritizes parolees with medical conditions
   Identifies need for medication assistance
Within two weeks of release….
          ACTION PATHWAY

STEP THREE – Team Schedules and
Implements Exit Interview before Release

   Affirm date of medical appointment
   Will transportation be an issue?
   How will medication be handled?
          ACTION PATHWAY
STEP FOUR –Medical Navigator meets
with parolee – post release.

   Complete and sign all enrollment applications
    if necessary (CHW use)
   Review assessment document – complete if
    necessary
   Review pharmaceutical assistance program
    (Pharmacy CHW use)
   Re-confirm medical appointment plus any
    additional medical services warranted
    (Specialty care, Chronic Disease Self
    Management, Clinical-AIDs, etc.)
       ACTION PATHWAY

STEP FIVE –Medical Navigator confirms
that medical appointment kept.


 Yes?
 No? – What barriers indicated?

 If No – follow-up with parolee on
  rescheduling
      ACTION PATHWAY

STEP SIX – Resolution Step

   Parolee has medical access.
     Disease State of Participants
     Health Navigation Participant
            Demographics


1037 Helped through Health Project since
MPRI inception
70% of MPRI clients have a medical issue
at release
47% need pharmacy assistance
    Disease State of Participants
    (BEGINNING WITH HIGHEST FREQUENCY)
Asthma/Respiratory Disease
Hypertension/High Cholesterol
Mental Illness: Depression, Anxiety,
Psychosis
Pain: Chronic, Arthritis, Knee, Back, Ankle
Other: Hepatitus C, HIV
Diabetes
Gastrointestinal: Crohn’s Disease, Ulcerative
Colitis, Acid Reflux
Disease States Managed by
         Medication
   (pharmacy assistance program)
Mental Illness – 52%
Asthma – 33%
Diabetes – 35%
Heart Disease – 26%
   The Value of Health
Services for Basic Re-entry
Uninsured individuals who are high risk or who have
chronic conditions have medical care to improve or sustain
health

The ability to keep a job can be related to unmanaged
health problems

The community benefits when parolees succeed in
transitioning from prison to home

Reduction in recidivism results in lower state costs (28%
statewide/11-12% annually in Muskegon)
         MPRI Challenge
State has recently announced accelerated release
process
Intention is to save $180 million of $2 billion state
corrections budget
15-member parole board handles 375 cases a
month
Volume and economy places pressure on
placement capacity – health, jobs, housing, etc.
Opposition to accelerated release process by
Prosecuting Attorneys (public safety concerns)
may impact process
Assisting the Medically
   Fragile Parolee
Why Prisons Need a Medically Fragile
             Program
   Most medically fragile prisoners would have been
paroled if there was an appropriate community placement

  Medically Fragile prisoners cost an average of
  $72,500 annually for health care
  524 medically fragile prisoners cost $29M/yr.
  Community placement cost - $20,000 each
  The cost savings is $52,500 per prisoner
  Total savings could be $21M annually
    Muskegon’s Medically Fragile
      Re-entry Health Initiative
Assists medically fragile individuals who
pose little or no risk to communities
   Individuals who are close to or past their
    earliest parole dates, or have sentences
    commuted by the Governor
Provides community placement in
appropriate care setting
Provides Medicaid eligibility and other
entitlements
Provides transitional funding to health
care providers until Medicaid begins
Compassion and fiscal responsibility
       can work together




Kenneth Anderson, 80, of Iron County was one of the earlier community
         placements, moving from prison to a nursing home.
 The Unique Needs Required for
Community Placement of Medically
       Fragile Prisoners
 Population has medically-centered needs:
    SSI eligible to trigger Medicaid coverage
    Appropriate medical services must be near by
    Housing with medical support: Nursing
     Homes; Hospice; etc.
    Higher end meds
    CHORE services
    Family support
    Parole supervision
The Medically Fragile Program
          Services
Conducting Prison In-reach interview
Collecting the Medical Record
Providing the Benefit Eligibility Screening
Assisting with entitlement applications
Contracting for the appropriate Medical Home
Providing Corrections with the post-release
community placement plan
Coordinating with the Parole Office agents
Compliance monitoring for 6 months
Muskegon’s Medically Fragile
      Health Profile
 End stage kidney and liver diseases
 Multiple Sclerosis
 Chronic Obstructive Pulmonary Disease
 Cancers
 Severe hypertension
 Mental illness / Dementia
 Congestive heart failure
 Coronary artery disease
 Severe Arthritis
 Huntington’s Chorea
 Parkinson’s Disease
   The Value of Health Services
  for Medically Fragile Re-entry

Cost to Prison is unsustainable
Health care setting is inappropriate
Provides dignity at the end-of-life
  Additional Information

Vondie’s phone number and email –
231-672-3201 at the Health Project
woodburv@mchp.org
Mail letters to:
Muskegon Community Health Project
565 W. Western Avenue
Muskegon, MI 49440

				
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