Connecting Offenders to Primary Health Care in Iowa

By Addy, Jim; Rosmann, Jon-Michael | American Jails, March/April 2015 | Go to article overview

Connecting Offenders to Primary Health Care in Iowa


Addy, Jim, Rosmann, Jon-Michael, American Jails


In Iowa, inmates with chronic behavioral health disorders who cycle through county jails do not receive any medications at the time of their release. Discontinuing psychiatric medications at the time of release often leads to the underlying illness or illnesses no longer being under control- an outcome that could lead to the individual reoffending.

To fill this immediate need upon reentry, the Polk County Jail Behavioral Health Medication Assistance Program was developed by the Iowa Prescription Drug Corporation (IPDC), a nonprofit, safety net pharmaceutical provider. The program connects offenders to primary health care services and provides up to 90 days of behavioral health prescription drug coverage. The additional 90 days of access to free behavioral health medications fills a critical gap until the individual can obtain long-term behavioral health solutions that are available through local behavioral health safety net providers.

At the time of their release, offenders who seek assistance are referred to Primary Health Care, Inc., a federally qualified health center (FQHC) in Des Moines. At the initial visit, the offender receives both a financial and medical evaluation. Patients with household incomes 200 percent of the Federal Poverty Level or below are eligible to receive up to 90 days of behavioral health medications at no cost. Individuals meeting the eligibility requirements are enrolled in the Iowa Health and Wellness Plan (Iowa's Medicaid and Medicaid Expansion Plan).

Regardless of insurance status, insured and uninsured patients alike generally experience a 60- to 90-day waiting period or greater prior to seeing a licensed behavioral health provider due to a shortage of behavioral health professionals in the State. FQHC staff work closely with staff at the local community behavioral health center to ensure the patient's transition to longer-term behavioral health services proceeds as smoothly as possible.

IPDC reimburses FQHC for up to 90 days of behavioral health medications prescribed and dispensed to any safety net patient released from the Polk County Jail. The behavioral health medications are prescribed in quantities of 30 days or less, and dispensed from the 340B pharmacy affiliated with FQHC. Only prescriptions for non-controlled medications are eligible for reimbursement. The 340B Drug Discount Program is managed by the Health Resources and Services Administration Office of Pharmacy Affairs to provide low cost medications to safety net patients. Section 340B limits the cost of covered outpatient drugs to certain Federal grantees, federallyqualified health center look-alikes, and qualified disproportionate share hospitals. The purpose of the 340B Program is to enable these covered entities to stretch scarce Federal resources, reaching more eligible patients and providing more comprehensive services. Utilization of the 340B Program to serve safety net patients released from the Polk County Jail enables limited program funding to provide the greatest benefit possible.

The program became operational March 4, 2013, and filled its first prescription on March 7, 2013. From then through December 31, 2013, 621 separate drug prescriptions were filled for 151 offenders at a cost of $7,896. The minimum number of prescriptions an individual received was one and the maximum number was 18 over the course of 90 program days. The result is an average of slightly more than four (4.1) prescriptions per individual for the program. These prescriptions consisted of 87 different behavioral health medications.

The Data

Many attempts have been made to quantify the extent to which inmates in both jails and prisons have a mental health problem. The results vary based upon the group conducting the research and the means by which mental health is defined.

The Bureau of Justice Statistics (BJS) at midyear 2005 estimated more than half of all prison and jail inmates had a mental health problem: 56 percent of State prisons (705,600 inmates); 45 percent of Federal prisons (78,800 inmates); and 64 percent of local jails (479,900 inmates). …

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