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Office of Mental Health

Questions

Who is eligible for this program?

Individuals who qualify for this program are those released from jails/prisons and discharged from hospitals who require medications to treat mental illness. Each county determines who within these settings would qualify for the program. To be eligible for the program qualified individuals must file a Medicaid application prior to or within seven days of discharge or release.

How will the enrollment process work for an individual leaving jail?

For an individual leaving jail, they would likely have a transition manager (or another designated jail employee) to make sure they complete a Medicaid application within seven days of release. The individual, either on their own or accompanied by a transition manager (or another designated jail employee) can then go to their local Department of Mental Hygiene to receive a Medication Grant Card. A Medication Grant enrollment form and a form indicating that the person qualifies for the Medication Grant Program must also be provided to the county.

In larger metropolitan jails, an individual working with a transition manager (or designated jail employee) can fax their Medication Grant enrollment form to the local Department of Mental Hygiene before release. Once an individual receives a Medication Grant card, they can present that card at any one of over 3800 pharmacies across New York State.

How will the enrollment process work for an individual leaving the hospital?

The individual would work with the hospital discharge planner (or designated hospital employee) to complete a Medicaid application and Medication Grant enrollment form. Upon release from the hospital, the individual either on their own or accompanied by a hospital discharge planner (or designated hospital employee) can present this form to the Local Department of Mental Hygiene to receive their Medication Grant card.

How does the enrollment process work for an individual leaving state prison?

Prison pre-release coordinators will send the Medicaid application to the county Department of Mental Hygiene in which the individual will be residing. The prerelease coordinators will enroll the individual in the Medication Grant Program and issue their card on release.

What happens after the decision is made about Medicaid eligibility?

Once Medicaid eligibility is determined, the individual would be disenrolled from the Medication Grant program. Individuals who qualify for Medicaid would then use their Medicaid card for their pharmaceutical needs. For those people who are denied Medicaid coverage, counties will be encouraged to aid in assuring a smooth transition to other funding streams to support the medication needs of these individuals.

What is the role of the County Department of Mental Hygiene?

The Medication Grant Program is a locally operated program. The role of the County Department of Mental Hygiene is to administer the Medication Grant program. This includes publicizing the program with the institutions and providers in the community, working with local departments of social services to facilitate the transition of these individuals into the community and to encourage linkages in the community for targeted individuals so that their medications needs are met.

To help alleviate the administrative burden to the county, the state OMH has contracted with a Pharmacy Benefits Manager (PBM). The PBM will provide a number of services to the county including the rostering of all program enrollees, provide enrollee access to their pharmacy network of over 3800 pharmacies statewide, reimburse pharmacies for services and maintain a provider help line.

How will these locally operated programs work?

Each participating county Department of Mental Hygiene will receive Medicaid applications and enrollment forms from qualified individuals leaving jail, prison and hospital settings. The counties would fax the enrollment form to the Pharmacy Benefit Manager (PBM) who would roster the individual. The PBM would then fax the roster notification to the county who would provide the individual with a medication grant card. The local Department of Mental Hygiene would then forward the Medicaid/Cash Assistance/Food Stamp Application to the local Department of Social Services.

After receiving the medication grant card, how will the individual know which pharmacies will participate in the program?

Upon receiving the medication grant card from the local Department of Mental Hygiene, an individual would receive a list of participating pharmacies in their area.

What is the cost of the program?

Once an individual has their medication grant card, there will be no cost for medications related directly to their mental illness. There are also no co-payments for the medications.

When does the program begin?

The program has been running as of September 5, 2000. We will update this section of the OMH web page as additional material become available.

What Counties are participating in this program?

This is not a mandatory program and counties can choose not to participate. To find out which counties are participating, you can contact Andrew Kazukenus at (518) 474-5968.

Where can I get more information?

Additional information is available through your local department of mental hygiene Leaving OMH site

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