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Obamacare helps keep parolees in treatment

New health care funds give county a crime-fighting tool


Three out of four Oregonians on probation or parole after criminal convictions are addicted to alcohol or drugs. About one in three prison inmates were under the influence of drugs when they committed their offenses, according to a federal report.

Addiction fuels crime, according to criminal justice experts. And according to a National Council on Alcoholism and Drug Dependence report, nine of 10 inmates return to drugs and alcohol after their release from prison.

Which is why Ginger Martin, deputy director of the Multnomah County Department of Community Justice, is excited about how the Affordable Care Act is changing the face of addiction treatment for parolees and probationers under her charge.

“There are certainly fewer barriers to getting treatment now than there were,” says Martin.

Prior to Jan. 1, Multnomah County paid about 75 percent of the cost of addiction treatment for the county’s probationers and parolees, many of whom were required to seek treatment as a condition of their release. But with the Affordable Care Act’s expansion of Medicaid, most of the men and women released from jail and prison now qualify for Medicaid. For the first time in decades, they have federally funded health insurance which covers addiction treatment.

That may or may not mean a greater percentage of probationers are receiving treatment. But it appears that the treatment they receive will be more comprehensive, and, according to Martin, intensive.

Better treatment

In 2014, Multnomah County is spending $5.1 million on residential treatment for probationers. The 2015 budget calls for $2.7 million. The difference is being picked up by Medicaid insurance through the Oregon Health Plan. About $2.4 million — the savings — is being transferred to services that Martin is convinced can lower the number of probationers who return to alcohol and drugs.

For years, addiction experts have said that addiction counseling is far from the most critical piece of the sobriety puzzle. Even those parolees and probationers who receive treatment are likely to relapse unless they have access to long-term outpatient counseling and housing in clean and sober communities such as Oxford Houses.

That’s why the $2.4 million Multnomah County is able to re-direct toward these vital services should have long-lasting impact, according to Martin.

“I think our system is going to be much improved because of the changes we’re able to make right now,” she says.

The new Medicaid coverage for probationers and parolees is having an impact at a number of social service agencies. Ed Blackburn, executive director of homeless services provider Central City Concern, says 60 percent of the insured clients at his nonprofit’s outpatient alcohol and drug treatment program on Southeast 122nd Avenue are community justice clients. In previous years probationers made up about 15 percent of the insured clients, according to Blackburn.

With bills being paid at the state level, Martin and others in the Multnomah County treatment system aren’t sure if more probationers are receiving outpatient addiction counseling, though Blackburn’s data indicates they might be. Offenders on probation generally get referred to treatment through their parole and probation officers. Maybe, Martin says, parole officers, knowing their clients are insured, are sending more to treatment. Maybe, she adds, with the availability of additional services such as housing, more probationers are themselves becoming more serious about treatment.

Prior to this year, Cascadia Behavioral Healthcare, which provides mental health and addiction services to county probationers, received $266 a month per client, according to David Kohler, clinical director at Cascadia. That would cover what Kohler calls “a pretty basic level” of outpatient treatment.

Now, Martin says, some of those probationers will be getting more than the basic level of services. Kohler says the newly available funds for housing some of those clients could mean the difference between success and failure.

“It’s hard to get clean and sober when you’re homeless,” he says.

Big changes

Dr. Alisha Moreland-Capuia, chief medical director of Volunteers of America, says it is critical to address the housing, jobs and education needs of probationers if treatment is going to be successful, especially with new initiatives aimed at releasing more non-violent offenders from jail and prison.

“Housing is health care,” Moreland-Capuia says.

The VOA runs a 52-bed men’s residential treatment facility that is home to mostly “high-risk to re-offend” probationers and parolees from Multnomah County, and a 35-bed women’s residential facility. Until this year, less than 20 percent of residents had health insurance coverage, according to Moreland-Capuia, which left the county paying for the others. This year Medicaid is paying for almost all the residents.

The new funding will make dramatic changes in the way Multnomah County deals with its offenders on release, according to Martin. Long term, local crime rates could be affected.

“I keep telling people this year is like walking down the stairs in the dark. You don’t know where the next step is.”