Transcript Louisiana Department of Public Safety & Corrections

Medicaid
Maximization &
Criminal Justice
Involved Individuals
RAMAN SINGH, M.D.
MEDICAL / MENTAL HEALTH DIRECTOR
LOUISIANA DEPARTMENT OF PUBLIC SAFETY &
CORRECTIONS
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Medicaid was created on July 30, 1965, through
Title XIX of the Social Security Act.
Each state administers its own Medicaid
program while the federal Centers for Medicare
and Medicaid Services (CMS) monitors the staterun programs and establishes requirements for
service delivery, quality, funding, and eligibility
standards.
Who is eligible for Medicaid?
FPG(Federal Poverty
Guidelines)and any of the
following:
 Aged – 65 or older
 Blind
 Pregnant
 Woman needing treatment for
breast cancer
 Disabled – meet Social Security
Administration’s (SSA) disability
criteria
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Medicaid and Offender Population
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FFP not available for un allowable services
Upon incarceration Medicaid is suspended.
Termination or suspension
Term
Inmate
Definition
An individual confined involuntary or
serving time for a criminal offense in state
or federal prisons, jails, detention facilities
or other penal facilities.
Exceptions to the rule
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Health care for offenders is the responsibility of the institution housing the
offenders .
Any federal dollar ( FFP)can not be claimed for offender care except in the
following circumstances:
 Infants living with the inmate in the public institution
 Paroled individuals
 Inmates who become inpatients of a hospital, nursing facility or
intermediate care facility ( subject to meeting other requirements of the
State’s Medicaid program)
 50% of the administrative cost for the discharge planning for otherwise
eligible offenders
Louisiana Offender Population
Offender Type/Location
Number
DOC Offenders in State Facilities
18,723
DOC Offender in Local Facilities
21,327
Parish Offenders in Local Facilities
2,737
Pre-Trial Offenders in Parish Prison
21,199
Juveniles (OJJ)
Probation & Parole
Total
436
69,845
134,267
Snapshot of Prisoner Population
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Highest incarceration rate in world
Louisiana has a very high rate of PLWHA, we sit in the
cancer belt, and have one of the worst obesity problems
leading to a higher number of heart disease and strokes.
So offenders show similar trends.
Staggering numbers of individuals are incarcerated who
have; serious mental health conditions, multiple risk
factors for heart conditions, cancers and infectious
diseases who lacked access to health care before their
incarceration.
The number of elderly offenders is growing at an
alarming rate, further burdening already strained state
budgets. Offenders 50 or older comprises 25% of
Louisiana DOC population.
Current Chronic Illnesses Diagnosed in
Louisiana DOC run Prisons (average age: 43 years)
Disease for Year 2012
Number Diagnosed / Percentage of
Population in DOC facilities
Hypertension
5,409
30%
Diabetes
1,300
7%
Cancer
211
1.2%
Heart Disease
305
2%
Pulmonary Disease
1,196
7%
HIV +
525
3%
Serious Mental Illness
3,332
18%
Substance Abuse
13,480
73%
Advantages of Medicaid : Access and
cost
Pre-Incarceration
Lafayette – Mental Health Courts
 Act 389
 Diversion Program
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During
Incarceration
In
patient stay covered
Fiscal year 2012/2013
1,070 off-site admits,
3,042 on-site admissions
Medical Releases from DOC
Currently Active
Compassionate Releases
Approved / Released
Currently Active
Medical Parole Releases
Released during year
4
2006
2007
2008
2009
2010
2011
2012
Total
0
1
4
5
10
9
5
34
2006
2007
2008
2009
2010
2011
2012
Total
1
0
0
4
5
14
10
34
22
Release Planning / Reentry
DOC releases approximately 15,000 offenders
per year.
 DOC is engaged with with community mental
health providers and Medicaid providers for a
seamless transition for offenders upon release.
 Common drug formulary for prisons, jails,
mental health and Medicaid.
 Pre-release conferencing to assure services are
readily available to the most seriously mentally
ill.
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Multi-Agency Collaborations
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OBH and DOC collaboration for expedited mental
health services for releasing offender with severe
mental illness
DHH and DOC worked together to expand and
improve the Medicaid application process for
releasing offenders
DHH and DOC data exchange placing Medicaid
services on hold for incarcerated offenders
SSA and DOC collaborate to improve the
application process for releasing offenders
DCI Discharge Program for releasing offenders
Article: Medicaid for Prisoners
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http://www.pewstates.org/projects/stateline/headlines/states-missing-outon-millions-in-medicaid-for-prisoners-85899485969
So far, only Arkansas, California, Colorado, Delaware, Louisiana, Michigan,
Mississippi, Nebraska, North Carolina, Oklahoma, Pennsylvania,
Washington and some scattered local governments are tapping Medicaid
to pay for inpatient medical and nursing home care. A few more states are
looking into it, including Georgia, Massachusetts, Minnesota, New Mexico,
New York and Virginia.
Only a dozen states have taken advantage of a long-standing option to
stick the federal government with at least half the cost of hospitalizations
and nursing home stays of state prison inmates.
The other states have left tens of millions of federal dollars on the table,
either because they didn’t know about a federal rule dating to 1997 or
they were unable to write the laws and administrative processes to take
advantage of it.
Impact of ACA
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CMS is not changing the exceptions when FFP is
allowed for actively incarcerated offenders.
Discharge planning and continuity of care
Mental health parity
And Going Forward……