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THE CARE MANAGEMENT UNIT
THE CARE MANAGEMENT UNIT – THE FORTUNE SOCIETY’S OWN “HEALTHCARE CONCIERGE”
As the number of people in jails and prisons requiring treatment for lifelong illnesses increases, so does the need for reentry services that are sensitive to the needs of people with chronic health problems. In response to this gap in services, The Fortune Society created the Care Management Unit (CMU), which began its work in July 2016.
CMU was made possible by the Affordable Care Act, which gave state governments the authority to create “health homes” for people with Medicaid. Health homes (not to be confused with home health) are organizations that bring healthcare and social service providers together to improve patient care. New York State created its own health home program in 2011.
Medicaid health homes work with organizations called “care management agencies” (or CMAs) to provide direct services to individuals on Medicaid who have been identified as having two or more chronic conditions and are high utilizers of the emergency room(s) for their medical needs. For those returning “home” from periods of incarceration, navigating a healthcare system while also trying to adjust to new environments is much more challenging. As such, Fortune created the CMU – a health home concierge, if you will – providing a team to help people reentering the community navigate their medical and mental health needs until they can manage on their own.
The services provided by our Health Home/CMU staff include Medicaid activation/re-activation, Managed Care Organization selection and benefits navigation, referrals to
Our Benefits Access Program connected 301 people with Medicaid in 2019.
primary care and specialty providers, connection to medical transportation, and case conferencing with doctors, social workers, and other members of the patient’s care team. Home visits, which for many of our clients take place within the NYC shelters, are also an active part of our daily routine.
However, our work doesn’t stop there. Once the immediate medical and mental health needs are addressed, and a plan is put into place for ongoing healthcare stabilization, the focus then turns to the social determinants of health (SDOH) needs of those we serve. Non-medical issues like unstable housing, food deficiencies, improper clothing, and lack of social supports can have a significant impact on someone’s long-term health, so our staff works closely with partnering services, both within Fortune and externally, to connect them to the supportive services they need to live healthier lives. For the CMU team, shopping for groceries with clients, assembling shelter care kits, assisting with paperwork related to obtaining ID or changing one’s legal name or gender, and connecting people to 2010e application assistance for supportive housing, are all part of a day’s work.
THE CMU IS EXPANDING
Fortune’s Care Management Unit has expanded beyond the traditional Health Home model to serve a number of individuals who would either not qualify for health home services, or who are in need of much more intensive case management.
The CMU recently joined forces with the Health Justice Network (HJN), a program developed in partnership with the NYC Department of Health and Mental Hygiene, the Manhattan District Attorney’s Office, and fellow community-based organizations, to provide direct connections to medical and reentry services, through the help and guidance of Community Healthcare Workers. The program is open to adults who have been released from jail or prison to NYC within the past 12 months. Many of these individuals do not meet the chronic conditions criteria for health home care management but are in need of primary care. By developing a closed loop referral system, HJN is able to track the effectiveness of the services provided, as well as the progress of the individuals referred.
INNOVATIVE CONNECTIONS FOR THOSE WITH THE HIGHEST NEEDS
Additionally, this summer the CMU took a huge leap into the world of Recovery Coordination Agency (RCA) work. Through a partnership with Healthfirst, Fortune’s RCA team is implementing an innovative model for connecting Medicaid enrollees with significant mental
Nearly 100% of Fortune’s housing clients are connected to primary care.
illness, substance use disorders, or both, to intensive community-based supportive services. The funding for this program comes from a NYS grant created in response to the low utilization of services by people who are eligible for a Health and Recovery Plan (HARP). HARPs are a health insurance benefit offered by many Medicaid Managed Care providers to patients with significant histories of a need for behavioral health treatment (i.e. multiple admissions to inpatient substance abuse or mental health treatment). One of the advantages of HARP enrollment is the opportunity to receive Home and Community Based Services, which can include supportive employment, short-term crisis care, programs for patients and their families, and access to networks of certified peers with lived experience of substance use and mental health treatment.
Our predominantly field-based RCA team is focusing specifically on identifying and helping HARP-eligible individuals receive the supportive home and community-based services they’re entitled to. Our team is able to engage, assess, and receive approval from the insurance providers for these services and take the extra step of ensuring that they make it to their initial appointments. We believe that this model will connect more people to services that are crucial to improving their health and well-being.
TRUST AND LAUGHTER: KEY JUNCTURES FOR CHANGE
At a recent gathering among staff at The Fortune Society, our Executive Vice President Stanley Richards challenged a group of us, asking “What makes Fortune special?” It’s a fair question posed for people who dedicate their lives to creating an accepting environment for people coming out of prison. I half-listened to the responses, trying to explore my own experiences. When Stanley pointed at me, I responded simply by saying “laughter.” Later, a colleague approached me and said, “That was a curious answer to a complicated question. Fill me in.” Here’s my explanation. People who have been though the prison system, in addition to experiencing the absurd concept of punishment, mostly share two emotions before and during incarceration — abandonment and betrayal. As a result, individuals with justice involvement experience an overwhelming lack of trust. Without trust, however, you can’t move a train or open a heart. I reached this assessment without “empirical evidence” provided by foundation-funded research surveys. And without reading proactive social BY DAVID ROTHENBERG Founder The Fortune Society
science tomes. (Well, I did a great deal of reading, but understanding the partnership between laughter and trust was achieved by on-the-scene experiences).
In 1967, when Fortune was founded, I was “the square”—the civilian amidst men and women whose lives were dramatically different than mine. They were my teachers. I listened, watched, and learned.
When Fortune grew and moved out of our one-room space into a loft with several room dividers and a community meeting room, someone gave us a ping pong table which provided diversion for the folks hanging around. start to trust. He began to confront the demons and remove the barriers that caused his pain and his acting out.
Toby’s life is just one story – or as one person in academia once charged me, “that’s an anecdote; we have statistics.”
I’ve read the statistics, but I’ve lived the anecdotes.
At Fortune, trust is a primary issue. It is a starting juncture for change. Health and medical care is an intricate part of re-entry—but it can be difficult for formerly incarcerated people to trust medical professionals, considering their past experiences. Staff persons
I met a 17-year-old who was referred to Fortune by his probation officer. Toby was a big young man and very angry. Very. He only spoke to answer a specific question with as few words as possible. I challenged Toby to a game of ping pong. He played—angrily—but he played. He would look through me as if I didn’t exist. I always chattered and made small jokes.
After a bit I became aware of his embarrassed smiles. In time, I earned a few muffled laughs. It took weeks but the laughs prompted some small talk. Toby began to open up. He took classes to earn a G.E.D., hanging out with other motivated young men. He started having a life.
A year later, at one of Fortune’s Progress Award ceremonies, Toby received a plaque entitling him “the outstanding teenager.”
Toby never looked back. He has had a good career, two daughters, and, he says, a good life.
It was playing ping pong, remembering how to laugh, that allowed him to
who are sensitive to this assume an important role in helping people with justice involvement access services by identifying andrespondingto real barriers caused by lack of trust.
To create a healing atmosphere, Fortune and similar programs must be cognizant of people’s backgrounds, and the betrayal and abandonment that creates a lack of trust.
If you listen carefully, you learn that a lack of trust mostly starts early in life—with abandonment and/or betrayal. When such a child becomes a teen, few societal guidelines are respected. They have stopped believing or caring for self.
In prison, as men and women mature, they often age out of rebellious feelings that led them into cages. In the past, they managed the pain by escaping to drugs or booze.
But even as people mature, trust is difficult to identify because too often in the past, trust was followed by abandonment or betrayal.
When men and women come out of prison – and enter a building where there is laughter – it is a new experience. The atmosphere at Fortune allows people to reclaim their lives, and suggests that they are more than the accumulated negative experiences of their pasts. There are a thousand ingredients that make this transformation possible. That path is cluttered with their unchallenged demons.
I have come to believe that laughter makes it easier to confront the past and prepare for a meaningful future.
P.S. 40 years after Toby left Fortune, he paid us a visit. I invited him to sit in on a group of teenagers in our Alternatives to Incarceration program. Afterwards, he said it had been like being in a time capsule.
“David,” he said, “those young men could have been the guys with me back in the ‘70s. Same anger, same emotions. Only thing different is their music.”
Then he asked, “Was I that angry?” I looked at him. “Of course you were,” I said. “I used to call you the angriest kid in New York City.” And then he laughed. He did comment that there was also laughter in the room.
That matters. Trust me.
