In the past, counties had to use general funds or “block grants” to pay for court-ordered drug treatment for those who couldn’t afford it. That increased access to health care, including drug treatment, to the more than 13 million low-income adults in California who qualify for Medicaid. The new policy, operating now in a third of the state’s 58 counties, stems from the expansion of Medicaid under the Affordable Care Act. “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 said. Webber’s rationale: He doesn’t trust the care providers, drug treatment organizations that contract with the county, to act in the interest of the state. “If you want to do a program, you can do it on your own 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,” said Santa Cruz County assistant district attorney Archie Webber. The sign for the Santa Cruz County main jail as seen from Water Street. ![]() They don’t work in that realm - they’re not a clinical professional.” “Judges have good intentions to put someone in treatment rather than in jail, but they don’t know the whole story. ![]() “From the provider’s perspective, the judge ordering services has always been a problem,” said Katie Mayeda, a Santa Cruz County Superior Court clinician. Under Medi-Cal, it is limited to 90 days. Proponents say that evidence-based treatment will lead to better outcomes and that residential care should be reserved for those with the most severe addictions. “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,” said O’Neill. In California, “these changes are a tough pill to swallow for the criminal justice system,” said Gavin O’Neill, drug court manager for the Alameda County Superior Court, which implemented the policy in July. The California program appears to be unique in many respects, but other states - including Utah, Indiana, Kentucky, West Virginia, Virginia, Maryland, New Jersey and Massachusetts - also have sought federal permission to experiment with innovations in Medicaid-funded drug treatment. That has upended the status quo for judges, attorneys and defendants who often had agreed to residential treatment in lieu of jail - or at least to reduced sentences so inmates could get that treatment. When conflicts arise between what the court orders and the providers decide, felons can languish in jail with no treatment at all.Ĭourt-ordered rehab is increasingly falling out of fashion in California as Santa Cruz and 18 other counties begin to treat addiction like any other health condition - with the Medicaid program relying on evidence-based practices and trained personnel to make decisions on care. The official record online showing that Jimi Ray Haynes can only do a residential program. ![]() Judges can order whatever they want in terms of treatment, and prosecutors can block designated treatment they deem too risky, but essentially the type and length of treatment deemed appropriate is out of their hands. Because of a new county policy that took effect at the beginning of the year, treatment for low-income residents like Haynes, with drug-related criminal charges, must be decided by clinicians and providers - not the court. Jao wanted the terms to be crystal-clear. The judge told Haynes he could serve part of his yearlong jail sentence in a drug treatment program rather than locked in county jail.Įileen Jao, an assistant district attorney, quickly interjected: “It has to be residential, not outpatient,” she said. Haynes, then 32, had spent the previous two weeks in jail detoxing from methamphetamine and heroin. Dressed in jailhouse orange, with hands and feet shackled, Jimi Ray Haynes stood up in a Santa Cruz County courtroom and pleaded guilty to a felony weapons charge. This story can be republished for free ( details).
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