Rachel Streiff

And there is a major, major failure on the part of our state to fund essentially supported housing and appropriate facilities for individuals.

So we've got a big financial problem that's led to a public safety crisis in our state.

We actually have a very good, well-established AOT program.

In Arizona, we call it court-ordered treatment or COT.

You'll find that different states might have other names for it.

So we have COT program in Arizona, both inpatient and outpatient.

At least the criteria is reasonable.

We have solid due process.

There's a couple gaps with it, but overall it's set up to be

reasonable and effective and also respect the patients and their families the problem is that it's poorly funded and there's gaps i mean there's pockets of good providers within our cot system but there are some real challenges in delivering the necessary care and the level of care that's needed to treat those folks

What's interesting is the money is there, but it needs to be redistributed.

I'll give you an example.

Because of the IMD exclusion, our hospital system is set up to deliver

care in only a two-week increment, and that's most states, okay?

So individuals can be hospitalized longer than two weeks, but the states then have to pick up the tab.

And so the way Arizona is designed is we have plenty of beds, plenty of hospital beds that

Plenty of Medicaid dollars being funneled into our state.

It's just happening in two-week increments in the most expensive way possible.

So there is a revolving door of individuals that are discharging from one facility after two weeks and going right into another within a matter of days.

Unlike programs that offer long-term care, for example, for developmental or intellectual disabilities, physical disabilities, or age-related disabilities in our long-term care programs, those conditions have opportunities for assisted living programs and long-term care because they are not part of this IMD exclusion.