Transcript 415pm_BUILDING-SERVICE-LINKAGES-FOR-JUSTICE

Health Reform: Understanding and Navigating the
Affordable Care Act and Its Implications for Justice-Involved
Individuals
The National Association of Medicaid Directors Panel
Fall Meeting
November 7, 2016
1. Morbidity of Incarcerated Individuals
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Health Status of Justice-Involved Individuals
• Individuals in jail are disproportionately young, male, persons
of color, and poor.
• They have high rates of health problems (chronic and
infectious disease, injuries), mental health disorders, and
substance use disorders (SUDs).
• 80% of individuals in jail with chronic medical conditions have
not received treatment in the community prior to arrest.
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Hypertension
60
50
40
% 30
General Population
Jail Inmates
Prison Inmates
20
10
0
18-33
34-49
Age
50-65
Source: A Binswanger, PM Krueger, JF Steiner, Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the
general population, J Epidemiol Community Health. 2009 Nov;63(11):912-9. doi: 10.1136/jech.2009.090662. Epub 2009 Jul 30.
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September 2013
Hepatitis
18
16
14
12
%
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General Population
Jail Inmates
Prison Inmates
8
6
4
2
0
18-33
34-49
Age
50-65
Source: A Binswanger, PM Krueger, JF Steiner, Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the
general population, J Epidemiol Community Health. 2009 Nov;63(11):912-9. doi: 10.1136/jech.2009.090662. Epub 2009 Jul 30.
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September 2013
Prevalence of Substance Dependance or Abuse
(Drug or Alcohol) by DSM - IV Criteria
80%
70%
60%
50%
40%
30%
20%
10%
0%
Non-institutionalized
Adults (18 and older)
Jail Inmates
Sources: Substance Abuse and Mental Health Services Administration. (2003). Results from the 2002 National Survey on Drug Use and Health: National
Findings (Office of Applied Studies, NHSDA Series H-22, DHHS Publication No. SMA 03–3836). Rockville, MD. Bureau of Justice Statistics,
Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002,
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September 2013
Prevalence of Serious Mental Illness
35.0%
30.0%
25.0%
Non-institutionalized
Adults (18 and older)
Jail Inmates
20.0%
15.0%
10.0%
5.0%
0.0%
Male
Female
Sources: Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Mental Health
Findings, NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Henry J. Steadman, Ph.D.; Fred C. Osher, M.D.; Pamela Clark Robbins, B.A.; Brian Case, B.A.; Steven Samuels, Ph.D., Prevalence of Serious Mental
Illness Among Jail Inmates, Psychiatric Services 2009; doi: 10.1176/appi.ps.60.6.761.
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September 2013
2. When are Justice-Involved Individuals
Covered by Medicaid?
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Clarifications Made by the April 28, 2016 CMS
Letter in Reference to Halfway Houses, Work
Release Programs, and Day Treatment Programs
• Defined an inmate as someone who has lost their legal
ability to exercise personal freedoms
• Clarified that individuals with freedom of movement,
residing in corrections-related, supervised community
residential facilities are covered by Medicaid. Sleeping in a
locked facility does not remove access to FFP for services
• “Being on count” of a correctional institution does not
disqualify an individual for FFP
Wachino, Vikki. RE: To Facilitate successful re-entry for individuals transitioning from incarceration to their communities. pg. 3-14. From
Medicaid.gov. https://www.medicaid.gov/federal-policy-guidance/downloads/sho16007.pdf (accessed October 17, 2016)
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Clarifications in Reference to Hospital Stays of
Greater than 24 Hours
• Correctional providers that have contracted to pay for
inpatient stays will not be reimbursed from Medicaid (TPL)
• FFP is only available for inpatient services furnished to
patients in a medical institution who stay 24 hours or more
in which there is an admission of the individual to the
facility as an inpatient (not observation beds)
• Inmate inpatient hospitalizations to community hospitals is
now modified to exclude admission based on justice
status. Beds used by justice involved individuals must
relate to their clinical condition (same concept in reference
to SNF)
Wachino, Vikki. RE: To Facilitate successful re-entry for individuals transitioning from incarceration to their communities. pg. 3-14. From
Medicaid.gov. https://www.medicaid.gov/federal-policy-guidance/downloads/sho16007.pdf (accessed October 17, 2016)
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In states that have expanded Medicaid under the
Affordable Care Act, nearly all individuals are
presumed to be eligible for Medicaid following
release from jail or prison.
Davis, Matthew and Winkleman, Tyler. Improving Outcomes for Justice-Involved Individuals with Lessons from Veterans Programs. October 6,
2016. Website, http://healthaffairs.org/blog/2016/10/06/improving-outcomes-for-justice-involved-individuals-with-lessons-from-veteransprograms/ (Accessed October 16, 2016)
October 16, 2016)
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The Future?
• 1115
– New York State
– NACo and the opiate epidemic
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Medicaid Enrollment for Justice-Involved
Individuals
• Released inmates have a markedly elevated risk of death,
driven by factors including overdose, cardiovascular
disease, liver disease, HIV-related conditions, and suicide.
• Former prisoners have mortality rates 12 times higher
then the general public in the first 2 weeks after release
• Enrollment reduces rates of recidivism for those with
serious mental illness
Davis, Matthew and Winkleman, Tyler. Improving Outcomes for Justice-Involved Individuals with Lessons from Veterans
Programs. October 6, 2016. Website, http://healthaffairs.org/blog/2016/10/06/improving-outcomes-for-justice-involvedindividuals-with-lessons-from-veterans-programs/ (Accessed October 16, 2016)
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Medicaid Enrollment for Justice-Involved
Individuals
• Providers, state Medicaid Agencies, and beneficiaries may
look at the issues surrounding enrollment differently
• Enrollment is different than planned selection
• Enrollment does not ensure exchange of claims data to
expedite care
Davis, Matthew and Winkleman, Tyler. Improving Outcomes for Justice-Involved Individuals with Lessons from Veterans
Programs. October 6, 2016. Website, http://healthaffairs.org/blog/2016/10/06/improving-outcomes-for-justice-involvedindividuals-with-lessons-from-veterans-programs/ (Accessed October 16, 2016)
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Questions?
www.cochs.org
510-595-7360
Steve Rosenberg [email protected]
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