Implementation Strategies: An Oklahoma Case Study

Successfully implementing new policies to improve access to SSI/SSDI and Medicaid for individuals leaving jail or prison requires extensive planning. Listed below are four strategies for implementing policies to increase the number of people enrolled in SSI/SSDI and Medicaid upon release from jail or prison. Under each strategy, information from an Oklahoma interagency group illustrates how these strategies can be put into practice. By including this information, the Justice Center is not endorsing or promoting the work of this interagency group, but simply outlining an approach that other state officials may find useful as they review the policies outlined in this tool.

1. Seek out state leadership to bring together diverse stakeholders and collaborate to oversee the development of the initiative.

In 2000, the Governor of Oklahoma selected representatives of 11 state agencies to attend a national criminal justice and mental health conference. After the conference, these representatives were asked by the Governor to convene two conferences in the state to relay information from the national conference; ultimately these conferences laid the groundwork for the formation of several state workgroups focused on criminal justice and mental health issues, including one dedicated to the behavioral health needs of individuals in jails and prisons. Members of this workgroup included officials from the Department of Corrections (DOC); the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS); the Department of Human Services (DHS), which processes Medicaid applications; and the Oklahoma Health Care Authority (OHCA), which administers the Medicaid program. In particular, the workgroup wanted to improve processes by which eligible individuals with serious mental illnesses were connected to benefit programs upon release.

Following on activities begun by the workgroup, in 2004, the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, contracted with Mathematica Policy Research, Inc. to help the state of Oklahoma design, implement, and evaluate a program to ensure that adults with a serious mental illness have health insurance coverage on the day they were discharged from correctional facilities.^[1] After receiving this grant, the executive leadership of DOC, ODMHSAS, DHS and the OHCA met initially to determine how to collaboratively manage this project and also met periodically thereafter to oversee ongoing activities.

2. Utilize diverse funding sources to support the initiative

In addition to the SAMHSA grant, the Oklahoma legislature also supported several elements of the discharge planning project. In 2005, the Oklahoma Legislature funded three ODMHSAS integrated services discharge managers to work in the three DOC facilities that have mental health units. The legislature also dedicated funding to the development of four “Reentry Intensive Care Coordination Teams,” designed to help determine the eligibility of potential applicants and also follow up with benefit agencies and offices to determine the status of pending applications.

3. Cross-train

The ODMHSAS integrated services discharge managers received the same trainings as DOC employees in order to increase their familiarity with work in correctional settings. The discharge managers were also trained on how to use the data systems of ODMHSAS and DOC and have ongoing access to records from both systems. All integrated services discharge managers and Reentry Intensive Care Coordination Teams completed SOAR training (SSI/SSDI Outreach, Access and Recovery) and were instructed by staff of the Oklahoma Department of Human Services on how to fill out Medicaid applications. In addition, staff from the Department of Rehabilitative Services Disability Determination Division (DDD), which evaluates disability claims for SSI/SSDI, met with DOC staff to offer guidance on filling out forms related to disability claims.

4. Initiate regular check-ins with interagency members and evaluate long-term progress

DOC staff conduct weekly conference calls with ODMHSAS discharge managers and include members of the Reentry Intensive Care Coordination Teams (RICCT) in the conference calls every other week. The entire DOC/ODMHSAS mental health reentry team meets on a quarterly basis to discuss operational issues and also to analyze data. Finally, Mathematica Policy Research Inc. is conducting a long-term evaluation of the project and will track the effects of discharge planning on access to benefits and recidivism rates, among other items.

This content in this special topic is based upon personal communication with Bob Mann, Coordinator of Clinical Social Work Services Oklahoma Department of Corrections and Henry T. Ireys, Ph.D. on February 26, 2008 and discussion with Bob Mann on March 7, 2008.

^[1] MPR also helped the state of Oklahoma design, implement, and evaluate a program to ensure that adults with serious mental illness have health insurance coverage on the day they are discharged from Institutions for Mental Diseases (IMDs).