SANTA CRUZ, Calif. — Dressed in jailhouse orange, with palms and ft shackled, Jimi Ray Haynes stood up in a Santa Cruz County courtroom and pleaded responsible to a felony weapons cost.
Haynes, then 32, had spent the earlier two weeks in jail detoxing from methamphetamine and heroin. The decide instructed Haynes he may serve a part of his yearlong jail sentence in a drug remedy program quite than locked in county jail.
Eileen Jao, an assistant district lawyer, shortly interjected: “It has to be residential, not outpatient,” she mentioned. “It’s residential or jail.”
Jao wished the phrases to be crystal-clear. Because of a brand new county coverage that took impact firstly of the 12 months, remedy for low-income residents like Haynes, with drug-related felony prices, have to be determined by clinicians and suppliers — not the court docket. Judges can order no matter they need by way of remedy, and prosecutors can block designated remedy they deem too dangerous, however primarily the sort and size of remedy deemed applicable is out of their palms.
When conflicts come up between what the court docket orders and the suppliers resolve, felons can languish in jail with no remedy in any respect.
Court-ordered rehab is more and more falling out of vogue in California as Santa Cruz and 18 other counties start to deal with habit like another well being situation — with the Medicaid program counting on evidence-based practices and educated personnel to make selections on care. That has upended the established order for judges, attorneys and defendants who usually had agreed to residential remedy in lieu of jail — or no less than to decreased sentences so inmates may get that remedy.
The California program seems to be distinctive in lots of respects, however different states — together with Utah, Indiana, Kentucky, West Virginia, Virginia, Maryland, New Jersey and Massachusetts — even have sought federal permission to experiment with improvements in Medicaid-funded drug remedy.
In California, “these changes are a tough pill to swallow for the criminal justice system,” mentioned Gavin O’Neill, drug court docket supervisor for the Alameda County Superior Court, which applied the coverage in July. “In the past, some judges and attorneys have been able to use residential treatment as a sanction and long-term monitoring mechanism, as well as a chance to address the underlying drug problem,” mentioned O’Neill. “That option has been shut down.”
Proponents say that evidence-based remedy will result in higher outcomes and that residential care needs to be reserved for these with essentially the most extreme addictions. Under Medi-Cal, it’s restricted to 90 days.
“From the provider’s perspective, the judge ordering services has always been a problem,” mentioned Katie Mayeda, a Santa Cruz County Superior Court clinician. “Judges have good intentions to put someone in treatment rather than in jail, but they don’t know the whole story. They don’t work in that realm — they’re not a clinical professional.”
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Advocates of the brand new strategy — a Medicaid-funded pilot program that finally is predicted to be applied in 40 California counties — say residential remedy is the costliest and invasive possibility, and in lots of circumstances, outpatient remedy works as nicely, if not higher.
If clinicians don’t approve residential remedy and prosecutors or judges gained’t permit a launch to outpatient remedy, the case can stall and felons develop into doomed to spend extra time in jail.
Nearly three months into his jail keep, Haynes nonetheless was ready for somebody from a drug remedy program even to judge him, not to mention decide his care plan. In the meantime, Haynes mentioned, he obtained no drug remedy.
Because of the coverage change, some prosecutors say they’re much less more likely to settle for something however jail time.
“We are more inclined to just say, ‘Hey, put him in the custody of the sheriff,’ and not worry trying to treat the substance abuse problem,” mentioned Santa Cruz County assistant district lawyer Archie Webber. “If you want to do a program, you can do it on your own time.”
Webber’s rationale: He doesn’t belief the care suppliers, drug remedy organizations that contract with the county, to behave within the curiosity of the state.
“We don’t want someone else to come in after us — a care provider, who hasn’t been in the process — and make those decisions for us,” Webber mentioned.
The new coverage, working now in a 3rd of the state’s 58 counties, stems from the enlargement of Medicaid underneath the Affordable Care Act. That elevated entry to well being care, together with drug remedy, to the greater than 13 million low-income adults in California who qualify for Medicaid.
In the previous, counties had to make use of normal funds or “block grants” to pay for court-ordered drug remedy for many who couldn’t afford it. Now, counties will pay for a spread of drug remedy companies — outpatient, medication-assisted, detox and residential — by means of Medicaid, or Medi-Cal, as it’s recognized in California. But the brand new coverage requires everybody looking for residential remedy to have a scientific evaluation to find out whether or not that setting fits their analysis.
The counties which have begun offering drug remedy companies underneath the so-called Drug Medi-Cal Organized Delivery System characterize practically 75 p.c of the state’s greater than 13 million Medi-Cal enrollees, in response to the California Health Care Foundation. (California Healthline is an editorially impartial publication of the California Health Care Foundation.) The guidelines on scientific selections apply to everybody, not simply inmates.
Proponents hope all 58 California counties will come on board finally, though the pilot Medi-Cal program is accredited solely by means of 2020, after which the federal authorities must reapprove the experiment.
Los Angeles County applied the brand new Medi-Cal program simply over a 12 months in the past and signifies it’s working comparatively easily.
“L.A. County got in front of it early on,” mentioned Albert Senella, president and CEO of Tarzana Treatment Centers. “Treatment is now driven by medical necessity.”
But educating the courts on the brand new procedures is usually a time-consuming course of, and consultants say it might take months or longer in some counties earlier than the brand new guidelines sink in.
In addition, counties and drug remedy suppliers say they’ve been weighed down by an administrative and staffing burden not like something they’ve seen earlier than.
“It has been a tremendous amount of work,” mentioned Senella. “A huge sea change in the way things are done.”
Some offenders say delays in receiving care are powerful.
Haynes mentioned he simply wished remedy, ideally in a residential setting.
“I’ve tried the whole white-knuckling sobriety thing,” mentioned Haynes, who has a 10-year historical past with methamphetamine and heroin habit. “The only measure of success I’ve had being clean and sober was in a residential drug treatment program.”
He would really like to have the ability to go to along with his spouse and three kids in a setting extra nice than jail. Haynes wasn’t a lot older than his school-age youngsters at the moment are when he visited his personal father, then behind bars. He shook his head as if to erase the picture.
“I don’t want my kids to see me in jail,” he mentioned.
Haynes was launched from jail this summer season. Court information say his probation was revoked on July 17 after he was discharged from a drug remedy program for defiance and non-compliance.
He was re-arrested and, as of late final month, jailed in Fresno County.