by David Fialkoff

Thousands of ill or disabled inmates are incarcerated in Federal, State, and local correctional facilities across the United States. The challenge of helping them obtain medical treatment and services after they are released is not a new one, but a recently released report looks at three programs that are assisting inmates in applying for such benefits.

Helping Inmates Obtain Federal Disability Benefits: Serious Medical and Mental Illness, Incarceration, and Federal Disability Entitlement Programs—cosponsored by the National Institute of Justice (NIJ) and the Centers for Disease Control and Prevention—reveals that many experts believe that continuing treatment after inmates are released results in a more successful return to society and could prevent the spread of tuberculosis, hepatitis C, HIV/AIDS, and drug-resistant strains of viruses, thus minimizing the cost to community and corrections health care systems. It also could reduce crime—and hence recidivism—by releasees who continue to receive the medical and mental health treatment they need.

Federal disability benefits—Medicaid, Social Security Disability Insurance (SSDI), Supplemental Security Insurance (SSI), and veterans’ compensation funds—offer one solution. Unfortunately, as many officials know, the process of applying for Federal benefits is often complex, and incarceration makes it difficult for inmates to collect their medical information. Three programs investigated in the NIJ study demonstrate, however, that assisting severely ill inmates with applying for these benefits before they leave prison may dramatically increase their chances of receiving benefits postrelease and ease their transition back into the community.

Three Benefits Assistance Programs

The study looked at benefits assistance programs in three jurisdictions:

• Philadelphia. The Coordinating Office for Drug and Alcohol Programs, part of the Philadelphia Behavioral Health System, offers services in behavioral health, case management, and job training to inmates through the Forensic Intensive Recovery Program.
• New York. Through a memorandum of understanding with the New York State Division of Parole, the Social Security Administration helps inmates apply, prior to their release, for SSI and SSDI benefits.
• Texas. The Texas Correctional Office on Offenders with Medical or Mental Impairments assists inmates who are elderly, terminally ill, mentally ill or disabled, or physically or developmentally disabled. Along with other State and local entities, the Office funds transitional, case management, and medical support for these individuals.

Recommendations for Implementing Programs

Recognizing the challenges of discharge planning for severely ill inmates, the researchers offered six recommendations for agencies that want to implement similar programs:

1. Partnerships keep the process alive. Whether a benefits applications process operates through a formal interagency agreement (as in Texas and New York) or an informal accord (as in Philadelphia), inmates receive better assistance when many agencies, organizations, and individuals work together to ensure that applications do not fall through the cracks and that benefits are distributed.
2. Dedicated staff is important. Specialized staff members who help offenders access benefits can streamline the process, provide complete applications for more individuals, and establish stronger working relationships with disability decisionmakers. In Texas, for example, the primary burden of gathering medical and mental health documentation shifted from corrections medical staff to benefits eligibility specialists, resulting in medical staff becoming more willing to assist in preparing applications.
3. Filling the gaps until benefits commence is essential. The benefits for many severely ill inmates do not begin immediately upon release. The Texas and Philadelphia programs pay for services during the period between an inmate’s release and the start of disability or health benefits.
4. Tracking outcomes is beneficial. Collecting outcome data on the benefits process allows staff to evaluate the progress of the program and garner additional financial support to offset costs. For example, the Texas program assesses which eligibility specialists were successful in obtaining benefits for inmates, and then uses these assessments in staff training. In contrast, New York does not maintain data on Social Security applications, so staff members in that program often assumed their efforts were largely unsuccessful, making it difficult for them to feel motivated when filing applications.
5. Centralizing operations reduces delays and improves communication. All three sites discovered the benefits of centralizing the medical and cash assistance claims processes. Philadelphia’s use of partnerships in the medical assistance applications process reduced the number of people involved in decisionmaking and significantly reduced the time until enrollment began.
6. Assisting mentally ill offenders poses special challenges. Some individuals interviewed for the study suggested that disability-determination staff appeared to be more cautious when approving benefits for mentally ill inmates. A number of complex situations may account for this: Offenders also may suffer from substance abuse, which can make it difficult to determine the primary illness; offenders may feign mental illness to obtain more favorable treatment; and truly mentally ill offenders may appear more stable within the structured environment of prison.

Benefits Are Only One Aspect of Planning

Helping inmates apply for medical and cash assistance is an important way to support the return of severely ill inmates to the community, according to the report. The researchers recommended, however, that such assistance should be part of a more extensive discharge plan that includes case management and housing services.

NCJ 218266

For More Information

• Conly, C.H., Helping Inmates Obtain Federal Disability Benefits: Serious Medical and Mental Illness, Incarceration and Federal Disability Entitlement Programs, final report submitted to the National Institute of Justice, Washington, DC: Abt Associates Inc., November 2005 (NCJ 211989), available at www.ncjrs.gov/pdffiles1/nij/grants/211989.pdf.