California Expands Substance Abuse Treatment For Low-Income Residents

After years fighting a heroin addiction, Danny Montgomery, 33, is receiving inpatient treatment that is being paid for by Los Angeles County.

California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery.

The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what's known as a drug waiver, state officials will have new spending flexibility as they try to help people get sober and reduce social and financial costs of people with substance abuse disorders.

Under the waiver, the state plans to expand treatment services, including inpatient care, case management, recovery services and added medication. Beginning next year, drug treatment centers will be able to get reimbursed for providing this much wider range of options to people on Medi-Cal.

Only a small fraction of low-income Californians with substance abuse disorders receive treatment, largely because of restrictions on what Medicaid will pay for.

"This was a long time coming," said Keith Lewis, executive director of Horizon Services, which provides treatment in San Mateo, Santa Clara and Alameda counties. "It's a win/win for people with substance use issues and their families ... and for the people providing those services."

The changes, which will be phased in starting next year, stem in part from the Affordable Care Act, which required that substance abuse treatment be covered for people newly insured through Medicaid or insurance exchanges. The health law allowed states to expand Medicaid to cover millions more people.

Drug rehabilitation providers say the changes will give addicts a better chance at getting — and staying — clean. But they fear the state won't raise the traditionally low Medi-Cal reimbursement rates for treatment, making it harder to provide services and produce the outcomes California is hoping for.

Lewis, of Horizon Services, said that under the waiver he expects drug treatment services to be higher quality and the workforce better trained. But he said that "Medi-Cal rates, which have always been too low, have to go up."

California's Medi-Cal drug treatment program currently costs about $180 million annually, paid through a combination of state and federal funds. There aren't any estimates for costs under the new approach. But the idea is that the changes will help health care expenses overall by enabling more people to get sober and healthier so they stop rotating through treatment centers, jails and hospitals.

Nearly 14 percent of Medicaid recipients are believed to have a substance abuse disorder, according to the National Survey on Drug Use and Health.

The five-year pilot project in California was approved by the federal Centers for Medicare & Medicaid Services in August. Under the waiver, counties will approve treatment for Medi-Cal patients based on medical necessity and criteria established by the American Society of Addiction Medicine.

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The Tarzana Treatment Centers in Los Angeles County provide outpatient and inpatient care for substance use disorders.

Anna Gorman/KHN

Current federal rules limit drug treatment centers' ability to get reimbursed under Medicaid for residential care. Clinics with more than 16 beds essentially cannot get paid, except for treating pregnant and postpartum women. That restriction will be dropped for California under the waiver.

As a result, Medi-Cal beneficiaries will be able to access up to two 90-day residential stays each year, with the possibility of one 30-day extension if providers determine that it is medically necessary. Certain populations, including those in the criminal justice system, can get approval for longer stays.

The waiver is also designed to provide better coordination between physical, mental health and substance abuse services," according to John Connolly, deputy director of substance abuse prevention and control for the Los Angeles County Department of Public Health. That along with more access could result in fewer emergency room visits and hospitalizations, he said.

That's potentially good news for people like Caitlin Knoles, a resident of Orange County who says she gets turned down for treatment of her methamphetamine addiction every time she tells residential centers she's on Medi-Cal. She has ended up in the hospital more than once because of her addiction.

"It's hard," Knoles said. "I can't get help."

The only way she can reliably get clean now is in jail, she says.

"It'd be nice to have a job and have my family back and just be normal," said Knoles, 24, as she sat outside a liquor store in Laguna Hills.

For the first time, substance abuse disorders will be treated like a disease rather than a short-term illness, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services. "Even though we know it's a chronic condition, we have treated it acutely," she said.

Much depends, however, on reimbursement rates, which are still being negotiated. Clinic officials say they need higher rates to expand services and handle the anticipated influx of clients, many of whom will be seeking rehab for the first time.

"There is a cost to raising the bar on treatment," said Albert Senella, president of the California Association of Alcohol and Drug Program Executives. "If the rates aren't adequate ... we are not going to be able to effectively meet the [new requirements] and the needs of the population."

Senella, who is also CEO of Tarzana Treatment Centers in Tarzana, Calif., said many clinics across the state don't have money to prepare for the overhaul, which will require improving technology and adding and training staff. For now, no plans are in place to provide counties or clinics with startup funds.

Eli Veitzer, interim CEO of Prototypes, which provides treatment services in Los Angeles, Orange and Ventura counties, said the waiver provides an "incredible opportunity" to transform care.

But in addition to fears about rates, Veitzer said he is also worried that 90 days of residential treatment won't be enough for many people. Someone may be able to stem their addiction in three months but will still need more time in a treatment facility to prepare for life outside.

"If their ability to function independently in the community is not addressed, they are likely to relapse," he said.

Danny Montgomery, a 33-year-old patient at Tarzana Treatment Centers, said he needed more than a few months to get clean after nearly a decade on heroin. The addiction, which he estimated cost him up to $100 a day, caused him to lose his job and nearly lose his family.

"The whole thing is a process," said Montgomery, who lives in the San Fernando Valley. "You get the substance removed from your body, but you have to retrain your mind." Montgomery said he tried to get a bed in a residential treatment center but couldn't find one that would take Medi-Cal.

He tried to get clean on his own but it never lasted. Months after beginning his search, Montgomery was finally able to get a spot at Tarzana. He said Los Angeles County is paying for his stay, which began in May.

As worried as they are about reimbursements, clinic operators said a big advantage of the new approach is that it could help stabilize their funding. Providers now depend largely on counties to pay for residential treatment for low-income residents.

"You always suffered the vagaries of the budget cycle," said Vitka Eisen, CEO of HealthRIGHT 360, which provides drug treatment in the Bay Area.

The waiver also means increased oversight of treatment centers.

Last year, a state audit found widespread fraud and questionable billing among Medi-Cal drug treatment providers. The audit followed reports by the Center for Investigative Reporting that clinics were billing for fake clients.

The new system will include more levels of accountability, Perez says, including more stringent requirements for clinics and more local control over contracting.

Knoles, who is addicted to methamphetamine, said she hopes that more people like her will be able to get treatment.

"I've had a lot of friends die from addiction," she said. "Imagine if they'd gotten the help they wanted and needed. Things would have been different."

Anna Gorman is a reporter with Kaiser Health News, a nonprofit news organization covering health care policy and politics. 

Via: http://www.npr.org/sections/health-shots/2015/12/11/459226074/california-expands-substance-abuse-treatment-for-low-income-residents

Rally to Stop the Jail Expansion in Riverside County!

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Repackaging Mass Incarceration

by JAMES KILGORE

Since my CounterPunch article last November which  assessed the state of the movement against mass incarceration, the rumblings of change in the criminal justice have steadily grown louder. Attorney General Eric Holder has continued to stream his mild-mannered critique by raising the issue of felony disenfranchisement; the President has stepped forward with a proposal for clemency for people with drug offenses that could free hundreds. In the media, we’ve seen a scathing attack on America’s addiction to punishment in the New York Times and the American Academy of Sciences has released perhaps the most comprehensive critique of mass incarceration to date, the 464 page The Growth of Incarceration in the United States: Exploring Causes and Consequences. In late May, several dozen conservatives including Newt Gingrich, Grover Norquist, and former NRA President David Keene pulled together the first Right on Crime (ROC) Leadership Summit in Washington DC.

The ROC, an organization which boasts a coterie of members with impeccable right wing credentials, reiterated the need for conservatives to drive the process of prison reform. The Conference  “call to action” argued: “In our earnest desire to have safer neighborhoods, policy responses to crime have too often neglected core conservative values — government accountability, personal responsibility, family preservation, victim restoration, fiscal discipline, limited government and free enterprise.” Gingrich engaged in similar kinds of soul searching:  “Once you decide everybody in prison is also an American then you gotta really reach into your own heart and ask, is this the best we can do?”

All of this has precipitated another round of optimistic cries about the possibilities of a Left-Right Coalition on mass incarceration, including a high profile Time Magazine op-ed co-authored by Norquist and MoveOn.org co-founder Joan Blades.

While the spirit of reconciliation in criminal justice attracts most of the media attention, a number of pieces have also emerged rejecting any rush to positive judgment.  For example, fellows at the Brennan Center compiled a statistically based report which contends that careral change has not yet turned the corner while Black Agenda Report co-founderBruce Dixon asserted that Obama’s clemency measures would have no significant impact on mass incarceration.

However, another process, likely at least as important in the long run as number crunching, coalitions or clemency also has been gaining steam. The official voices of incarceration- politicians, corrections officials, private prison operators, prison guards unions and county sheriffs, are exploring changing discourse and cosmetic reform in order to avoid systemic restructuring. In the business world, they call this re-packaging.

Re-Packaging Mass Incarceration: Carceral Humanism

Currently this re-packaging assumes several forms.  One of the most important is carceral humanism or what some people refer to as incarceration lite.  Carceral humanism recasts the jailers as caring social service providers. The cutting edge of carceral humanism is the field of mental health. According to a recent report by the Treatment Advocacy Center, in 2012 the US had over 350,000 people with serious mental health issues in prisons and jails as compared to just 35,000 in the remaining state mental health facilities.  Prisons and jails have become the new asylums and the jailers are waking up to the fact that mental health facilities also represent a new cash cow. Likely the most important examples of carceral humanism are happening in California. There Governor Jerry Brown has played a shell game called realignment in which he’s transferred thousands of people from state facilities to county jails in order to comply with a Federal court order to reduce the state prison population. To help counties adapt to all these new prisoners, the Governor put up $500 million to the state’s sheriffs to build extensions onto their jails. In response, the Sheriffs had to come to Sacramento to pitch for a slice of that money. They didn’t come talking about public safety. Their mantra focused on caring-providing opportunities and improved circumstances for those in custody. The Department of Corrections and Rehabilitation’s summary from Lake County, one of the 15 winners out of 36 submissions, is illustrative:

“$20 million for a new Type II, 40-bed women’s jail with a new stand alone 39-bed Medical/Mental Health Services building with program space, a new administration building, and renovations so that existing space can accommodate programs.”

The new jails are about institutionalizing the funding of mental health and other services behind the walls, further diverting money from the already bare bones social services in communities.  The Lake County proposal also featured another prominent strain of carceral humanism- a woman’s jail or in the present corrections jargon, a “gender-responsive” facility. Since mainstream research now argues that women experience incarceration differently than men, law enforcement is waving the gender banner to access more funding for construction.  Los Angeles lies at the cutting edge in this regard. In March the LA Board of Supervisors authorized $5.5 million for consultants to draw up a plan for what some law enforcement people are calling a “women’s village.” Deputy Sheriff Terri McDonald of Los Angeles suggested that the new facility could be a place where “women and children could serve their time together.”

Carceral humanism has also surfaced in the repackaging of immigration detention centers.  The latest immigration prisons carry the label “civil detention” centers. The GEO Group, the nation’s second largest private prison operator, opened their latest such facility in Karnes Texas. TheLA Times called it a “pleasant surprise for illegal immigrants.” Immigration and Customs Enforcement (ICE) officials boast that people detained in Karnes won’t be housed in cells but in “suites” holding eight people.  Those detained will be supervised not by guards or correctional officers but by “resident advisers.”

Repackaging 2: Non-Alternative Alternatives to Incarceration

A second form of repackaging mass incarceration falls under the heading of non-alternative alternatives to incarceration. These non-alternatives purport to change things but in essence simply perpetuate the culture of punishment.  The most common forms of these are Drug Courts, Mental Health Courts and Day Reporting Centers. While many of these may be well-intentioned and in some cases have positive effects, they typically involve heavy monitoring of a person’s behavior including frequent drug testing, limitations on movement and association, a whole range of involuntary but supposedly therapeutic  programs of dubious value and very little margin of error to avoid reincarceration.  Perhaps the most extreme example of a non-alternative alternative to incarceration, and one which is likely to gain increasing traction, is electronic monitoring.

While advocates claim electronic monitoring facilitates employment, building family ties and participation in community activities, my interviews with a number of people on a monitor have revealed a different experience.  Jean – Pierre Shackelford, who spent two years on an ankle bracelet in Columbus, Ohio said that he felt like his probation officer had him in a “choke hold” while he was on an ankle bracelet. He labelled monitoring “another form of control and slavery, 21^st century electronic style.” Shaun Harris, on a monitor for a year in Michigan called it a form of privatized incarceration, “it’s like you just turned my family’s house into another cell” was his comment. Shackelford and Harris, like many others I spoke with, both reported difficulty getting movement for family activities and a lack of clarity about what was and wasn’t permitted.  Shackelford finally took to going to church because that seemed to be the only activity his probation officer would approve.  Both Shackelford and Harris, like most people interviewed, complained that they could be put on 24 hour “lockdown” (meaning they couldn’t leave the house at all) for any reason for an indefinite period and there would be no way to appeal such a decision.  Even a late return home from work due to a delay in public transportation could result in a re-arrest. To make matters worse, most electronic monitors come with a daily user fee which ranges anywhere from five to twenty dollars a day.

While the punitive nature of ankle bracelet regimes is a cause for concern, the potential to implement exclusion zones with GPS-based monitors contains more serious long-term implications.  Exclusion zones are places where monitors are programmed not to let people go.  At the moment authorities mainly use exclusion zones to keep individuals with a sex offense history away from schools and parks. But such zones have the potential to become new ways to reconstruct the space of our cities, to keep the good people in and the bad people out.  This technology, which can be set up via smart phones, holds the possibility to turn houses, buildings, even neighborhoods into self-financing sites of incarceration.  In the meantime, firms like the GEO Group, which owns BI Incorporated, the nation’s largest provider of electronic monitoring technology and backup services, are experimenting with new target groups for ankle bracelets. In parts of California and Texas they’ve used electronic monitors on kids with school truancy records. Under a $370 million contract, BI already has thousands of people awaiting immigration adjudication on monitors. Packaged as an alternative these bracelets actually represent a new horizon for incarceration, finding ways to do it cheaper with technology through the private sector and then getting the user to pay, likely a  model that would line up squarely with Right on Crime’s notions of reform..

Re-Packaging: Why Now?

Most commentators attribute the spirit of change in criminal justice to a belated recognition of the fundamental irrationality of spending so much money locking up so many people for so long.  As Grover Norquist put it, “Conservatives may have wanted more incarceration than was necessary in the past, so what we’re trying to do is find out about what works.”

Such analyses make perfect sense but they also ignore a big picture political question. Mass incarceration is becoming a flash point of rebellion and resistance, with African American communities the most visible hot spot. Mass incarceration and the racialized vagaries of criminal justice have been going on for decades but recently we’ve seen new levels of anger and frustration in reaction to the deaths of Trayvon Martin and Oscar Grant, as well as to the sentencing of Marissa Alexander.  Even mainstream Black commentators like Melissa Harris-Perry appear incensed.  At the grassroots level we’ve witnessed campaigns against stop and frisk, solitary confinement, mandatory minimums, crack cocaine laws and a host of new jails and prisons.  On the ideological plane, the notion of the New Jim Crow, categorizing  mass incarceration as a new form of slavery and segregation is catching on.  People are latching onto the idea of mass incarceration as a systemic problem that can only be solved with a vast redirecting of resources into the communities that have been devastated by imprisonment.  In other words, mass incarceration requires a total paradigm shift. The situation has the potential to explode.  Politicians and business people don’t like explosions.  When explosions appear a genuine possibility it is time to talk reform, time to re-package.

To make matters worse for purveyors of the carceral status quo, the immigrants’ rights movement has also been erupting over the last decade. From the immigrant worker strikes and demonstrations of 2006 to the endless string of demonstrations by the Dreamers and the Dream Defenders in the face of continued mass deportations, a steady stream of unrest has materialized.  With the changing national demographics, key players in criminal justice need to be seen to be doing something if they want to maintain their power.

Lastly, there is the movement inside the prisons themselves.  The hunger strikes at Pelican Bay in California and in Washington’s Northwest Detention Center coupled with the outpouring of solidarity these actions prompted,  pose a serious threat to the already heavily smeared image of US prisons. In addition, even once notorious political prisoners are gaining increasing legitimacy. Captives from across several generations are attracting large coteries of supporters.  This includes high profile individuals who have served decades behind bars, individuals  like Mumia Abu-Jamal, Albert Woodfox, Oscar Lopez Rivera, Russell Maroon Shoatz and Leonard Peltier, along with more contemporary prisoners like Lynne Stewart (recently released), Marie Mason and Chelsea Manning. Inside and beyond the walls, there is rebellion in the air.

This reality raises another question: whether a Left-Right Coalition can deliver even enough change to calm the waters. Mass incarceration has become such a fundamental part of how the US addresses issues of race, crime, poverty, gender and inequality, it appears unlikely to collapse from gradual reforms whether inspired by carceral humanism, punitive alternatives to incarceration or more genuine critique. As with civil rights, pressure from below will be required, from a social movement that has the creativity to envision an alternative, the skills and legitimacy to mobilize the people who are most directly affected, and the political power to make their voices be heard and get others to join them. Perhaps this social movement is, to borrow a phrase from the Spanish poet Antonio Machado, making the path by walking at this very moment.

James Kilgore is a Research Scholar at the Center for African Studies at the University of Illinois (Urbana-Champaign).  He is a frequent commentator on mass incarceration, a social justice activist, and the author of three novels, all of which were written during his six and a half years of incarceration.  He is currently working on a primer on mass incarceration to be published by The New Press in 2015. He can be reached at waazn1@gmail.com   His writings are available at his website, www.freedomneverrests.com

via: http://www.counterpunch.org/2014/06/06/repackaging-mass-incarceration/

LA Jail System Not Expanding After All As Taft Deal Dies

Prison reform advocates were appalled when Los Angeles County’s top elected officials last month agreed to lease an empty jail about two hours from Downtown LA.

“It’s so disappointing,” Lynne Lyman, the California director for the Drug Policy Alliance, a national advocacy group, said at the time.

Los Angeles County, which includes the city of LA, already had more people behind bars than any other U.S. county or city -- more than Miami and New York City combined. By adding the remote Taft city jail to its network of crowded facilities, the county would be able to lock up about 500 more people, raising its total inmate population as high as 22,000.

But on Tuesday, the county scrapped the plan after a key supporter changed her mind. Now, the county will have to come up with another way to relieve overcrowding in its jails.

County Supervisor Gloria Molina, who joined two of her colleagues in a 3-2 vote for the deal last month, told the Los Angeles Times she reversed her position after learning about an ongoing legal battle over the Taft jail. Until 2011, California used the Taft facility to house state inmates. Last year, Taft sued the state, after the state canceled the contract.

Molina told the LA Times she didn’t want the county to get dragged into the dispute. Molina’s office did not immediately respond to requests for comment from The Huffington Post on Wednesday. Molina generally favors jail expansion, and the county is likely to come up with another plan for enlarging its jail system soon.

In the meantime, prison reform advocates said they hope to convince Molina and the other county supervisors to support what they call “alternatives to incarceration.” That includes substance-abuse treatment, transitional housing, and other programs aimed at making sure people don’t go back to jail after they’re freed.

“Most of the people going into the jail system were already disconnected from basic services, such as housing, health services, and employment,” said Lyman. “Services provided after release can help them establish a basic foundation that moves them toward long term stabilization and ensure they do not return to jail.”

LA’s struggle with jail overcrowding goes back to 2011, when Gov. Jerry Brown (D) signed a law that shifted responsibility for many low-level, nonviolent offenders from the state to the counties in an attempt to ease overcrowding in state prisons.

To fund the program, Brown dedicated a portion of state sales tax revenues and vehicle licensing fees to the counties. In the program’s first three years, Los Angeles has received more than $700 million.

Lyman and her colleagues said they had hoped the county would spend that money on substance-abuse treatment programs, prisoner-reentry programs, and other alternatives to incarceration.

So far, however, only about 5 percent of LA’s funds have gone to reentry programs, although an additional 15 percent has gone to the Department of Mental Health and the Department of Public Health for treatment services.

“We are not investing in what we know works,” said Lyman.

In some parts of California, including San Francisco and Santa Clara, counties have invested in a different approach. Two years ago, for example, Santa Clara opened a reentry center that provides services to people coming out of prison or jail.

Ten months after the program began, only 20 percent of released inmates in the county were getting rearrested, compared with about 65 percent before the center opened.

By investing in similar programs, prison reformers said, LA could reduce its jail population by thousands of inmates.

“I walk the jails every month,” said Herman Avilez, the head of California Drug Counseling, a group that provides substance-abuse counseling and other services to low-income people in Pasadena. “Those places are packed with people that shouldn’t be in there.”

via http://www.huffingtonpost.com/2013/10/30/la-jails-taft_n_4179372.html