Cleveland judge says yes.

by Sarah Jane Tribble for Cleveland.com

May 20, 2011

CLEVELAND, Ohio -- Cuyahoga County Common Pleas Judge David Matia estimates that area residents could save millions in local taxes

if the offenders he sees in drug court had health insurance.

And if Ohio were to expand Medicaid, as being debated by state legislators, many of the defendants in his court would qualify for the state and federal health insurance program for the poor.

Matia believes the cost-savings would be twofold: The court could redirect the money it currently spends on drug treatment to support services; and, he says, there would be fewer crimes, which cost individuals and the community, because many who need ongoing medication and therapy after being released from the justice system would have coverage.

"People who are drug dependent pay for their habits with petty crimes. The mentally ill, who are more likely to commit crimes of violence when they are un-medicated, are less likely to harm you, your neighbor, your child or your friend," he said.

Matia is not alone in his beliefs. In Cuyahoga County, local advocates who work in mental health and addiction services as well as hospitals and business owners support his contention.

William Denihan, chief executive officer of the The Alcohol, Drug Addiction & Mental Health Services, or ADAMHS, board of Cuyahoga County said he would welcome redirecting the county tax dollars now used to pay for drug treatment. Other areas he said could use additional funding include housing, prevention services, employment training, some detoxification services, and peer support programs,

Last year, Cuyahoga County taxpayers spent an estimated $5.8 million on 2,100 people who, under expansion, could qualify for Medicaid and needed services because of drug addiction or mental illness, Denihan said.

Nationally, experts have studied how health coverage for those struggling with addiction and mental illness could impact the crime rate and, cost taxpayers who foot the bill for courts and jails less.

Researchers at the George Washington University reported in a November 2012 paper that those people released from jail with Medicaid coverage had reduced recidivism rates and the time between offenses was longer than those without health care.

The researchers note that a study of jail inmates with serious mental illness in King County, Washington, and Pinellas County, Florida, with Medicaid coverage had, on average, 16 percent fewer subsequent detentions. In Washington, those released with Medicaid were 60 percent more likely to get mental health services than those who no longer had Medicaid. In Florida, inmates released with Medicaid were 30 percent more likely to access services.

"Although not without its challenges, extending coverage to this highly vulnerable population would result in significant cost savings for states and counties," the researchers wrote.

The federal Affordable Care Act allows states to chose if they want to extend Medicaid to adults under the age of 65, who are without any children, and earn up to 138 percent of the federal poverty level. That's $15,856 for a single adult, $21,404 for a couple and $32,499 for a family of four.

The federal government would pay 100 percent of the health care costs of newly qualified individuals for three years. After that, the federal government would cover 95 percent and phase down to 90 percent. For states that choose to expand, the program will take effect January 1.

Previous stories

• Ohio Senate President Keith Faber signals hope for Medicaid 'reform' but not Kasich-style expansion
• Medicaid expansion top of mind for Cleveland Clinic and other local hospitals, advocates
• Ohio Medicaid expansion stalled, new options on the table
• Ohio's Medicaid expansion alternative could use private insurance
• Opting out of Medicaid expansion may mean penalties for business, other surprises
• Thousands rally at Ohio Statehouse to support Medicaid expansion

Ohio is one of more than two-dozen states that are opposed to or undecided about whether to expand Medicaid. Both Ohio's House and Senate have failed to fully support Gov. John Kasich's budget, which includes Medicaid expansion. And, in recent weeks, the two have created separate working committees to explore the pros and cons of expansion. Ohio's lawmakers must vote before July 1, the beginning of the next fiscal year, on a state budget.

Greg Lawson, statehouse liaison and policy analyst for the conservative policy group Buckeye Institute, said stories of human suffering like those found in the criminal justice system are compelling but he doesn't believe offering more health insurance is the solution.

Instead, he said, there needs to be "overarching systematic reform that will offer assistance to these people. . . there are more ways to deal with this issue than to simply say we have to expand this one program."

As the clock ticks on a decision, local lobbying for expansion has stepped up: On Monday, community activists held a rally at the Neighborhood Family Practice Center, a federally qualified community health center on Cleveland's West Side. In addition, Greater Cleveland Congregations announced that dozens of volunteers from area religious organizations and neighborhood groups will go door to door in the legislative swing districts of Rocky River, Berea and Solon this week to urge people to contact their legislators.

Last week, Cleveland City Councilman Joe Cimperman, who said the city has passed several resolutions in support of expansion, held a special committee meeting. The small City Hall committee room was standing room only with about 40 advocates and others who might benefit from the expansion there to speak and show support.

Donna Strugar-Fritsch, a principal with the national health policy consulting firm Health Management Associates, said it's difficult to predict exactly how much money would be saved if criminals had the type of regular health care coverage provided by Medicaid.

Strugar-Fritsh said prison and jail populations nationwide are a "sick crowd" with higher rates of hypertension, asthma and arthritis than the general population. And after being released, offenders don't have access to ongoing care for mental and physical health problems.

"Anything that we can do that can keep people from re-entering the criminal justice system -- which Medicaid could do if it's done right -- then it can only help everybody," she said.

One day recently in drug court, a man in his late 20s stood in front of Matia and explained that he had been too sick to meet with sponsors and follow the court's detoxification program: "I've been having a lot of pain and just haven't been doing that well."

Matia looked at him and asked "Do you have insurance?"

The man looked straight at the judge and said, "No."

After the court session ended, veteran case manager Donna Woods said that if he'd had insurance, he would have had a relationship with caregivers and could have turned to professionals for help.

The suffering caused by being sick, she said, isn't "Republican or Democratic, it's human."

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