Tonko bill would extend Medicaid coverage of inmates

The Enterprise — Sean Mulkerrin

Faces of recovery: Darryl White, center, an inmate at Albany County’s jail, is taking part in the Sheriff’s Heroin Addiction Recovery Program. He said participating in the program has made him more compassionate and considerate toward others, a better person.

ALBANY COUNTY — For Darryl White, it was crack, weed, and booze.

“When I first came in, I was absolutely spiritually bankrupt,” he said.

White is among the 45 percent of inmates at Albany County’s jail whose addiction is at the root of his incarceration for false impersonation and petty larceny.

Across the country, 65 percent of prisoners are addicted to drugs or alcohol — among the general population, it’s 9 percent. About 11 percent of prisoners with an addiction receive treatment, according to the National Center on Addiction and Substance Abuse.

White has been in jail since April 28, 2017, and, voluntarily, in the Sheriff’s Heroin Addiction Recovery Program, known as SHARP, since July 27, 2017.

He’s due to be released in July, he said.

That’s when freedom becomes the hard part.

In 2016, sixty-four-thousand people died from a drug overdose in the United States. And, according to the New York State Department of Public Health, there were 26 opioid-related deaths in Albany County that year.

“We have an epidemic that is worse than gunshots and car accidents combined and one that rivals, or surpasses, the HIV crisis of the early ’90s,” said Congressman Paul Tonko, a Democrat representing the Capital Region, the 20th District, at an event at Albany County’s jail on Thursday, Jan. 25.

According to Tonko, people released from prison are about eight times more likely to die of an overdose in the first two weeks after being released compared to other times. And, according to the New England Journal of Medicine, during the first two weeks after release, the risk of death among former inmates is 12 times more likely, when accounting for other factors like homicide and suicide.

Tonko’s bill, currently without any co-sponsors, would allow states to restore benefits for inmates who are eligible for Medicaid 30 days prior to release, which is now generally prohibited.

Tonko told The Enterprise this week that the chances of the bill passing and becoming law will only grow as the public and policy-makers become better informed of its concept and how it would work. “It [addiction] doesn’t know political boundary; it doesn’t know age, or gender, or creed, or cultural background,”  Tonko said. “If you think this one through, there should be universal support.”

According a study from the Vera Institute for Justice, New York State spends an average of $69,355 annually to house an inmate, the most expensive per-inmate cost in the country.

A June 2017 analysis by the Kaiser Family Foundation found that New York State spent $8,618 per full-benefit Medicaid enrollee (this included seniors, the disabled, adults, and children); for an adult only, New York State spent $4,709 per full-benefit Medicaid enrollee.

What Tonko’s bill would cost is not yet known; there is a request for the Congressional Budget Office to score the bill and come up with an estimate.

“If there is a cost to it — as there would be — it’s what cost are you avoiding, that needs to be looked at,” Tonko asserted,” because you either pay now or you pay many times over, later.”  

Tonko is using President Donald Trump’s State of the Union Address on Tuesday, Jan. 30, to highlight the opioid epidemic in the 20th District. Tonko will be using his guest ticket to bring Brendan Norton, of Saratoga Springs, to the event.

Norton became addicted to prescription painkillers when he was 23, after a  life-threatening leg injury.

After struggling with addiction for many years, Norton eventually kicked his habit and earned a master's degree in rehabilitation counseling from the University at Buffalo, and now works as a certified rehabilitation counselor.  

Tonko said Norton’s willingness to shed his anonymity to share the pride he has taken in his recovery will give people a better understanding of the urgency of the opioid epidemic, enlighten them about the different paths to recovery, and provide hope.

At the Jan. 25 event at Albany County’s jail, Tonko said that his bill would help newly-released inmates build on the sobriety that they’ve worked toward in the SHARP.

When inmates are processed to enter jail, they are asked if the sheriff's office can sign them up for the Affordable Care Act — this makes them eligible to receive Medicaid — which many do, said Albany County Sheriff Craig Apple.

“By allowing states to restart Medicaid benefits prior to release, states would be able to more readily provide effective treatment and care-coordination services pre-release, allowing for smoother transition to community care and reducing the risk of overdose deaths post-release,” according to a release from Tonko’s office.

The proposed legislation does not expand Medicaid eligibility.

“If the inmate doesn’t have Medicaid, it is the county taxpayers who are picking up the bill,” Apple said.

The move has saved Albany County about $1 million over the past two years, according to Apple. This is because when an inmate who has health coverage through the Affordable Care Act is sent to the hospital, it is the ACA that picks up the bill, not the county taxpayer.

“I know a lot of people have varied views about the Affordable Care Act, but as the sheriff of Albany County and this facility, trust me, I like the Affordable Care Act,” he said.

“There is no silver bullet here that takes care of it,” Tonko said of addiction. “It’s everything: From prevention, to treatment, to recovery.”

The problem, often times, when inmates with addiction are released from jail is that they return home to the only life they’ve ever known and can fall back into old, bad habits.

Tonko’s bill would build on SHARP’s treatment by helping the released inmate’s recovery by buffeing that return home.

“Hopefully, with this Medicaid re-entry bill, we will be able to get them from treatment and into treatment,” Apple said, meaning inmates would move from SHARP to an outside addiction recovery program.

Apple said participants in SHARP have a low recidivism rate — 15 percent; among inmates with an addiction who don’t seek treatment, it’s 75 percent. Jails face the problem of discharged inmates with addictions committing crimes to feed their habits and then returning to jail.

Started in 2015, SHARP is a dedicated treatment housing unit in Albany County’s jail, where inmates work with counselors as well as each other to kick their habits.

It begins with communication — inmates sharing their issues with one another and listening in turn.  

“It allows you to let you know what your defects are, what issues you might have, and how to work through those issues,” White said. “That’s what it’s all about today, it’s working through those issues and not trying to run from them or go around them. And with the help of my peers, you get used to taking positive criticism.”

White said that before SHARP he would not look at himself critically; it was easier to run, to use. The healing process, he said, made him a better person — more compassionate and considerate toward others “because you can see yourself in other people and help them get through what you have been through and vice versa,” he said.

White then described what he’s learned about giving.

“I was never a big Christmas-spirit type of guy,” he said.

Christmas was about taking — about receiving gifts.

“The gift of giving is the best thing,” he said. “It’s the joy of giving, you’re not looking for anything in return — it becomes a blessing.”
 

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