The Enrollment Opportunity for Criminal Justice Populations

© 2014 Enroll America | EnrollAmerica.org

The Enrollment Opportunity for Criminal Justice Populations

April 9th, 2014

© 2014 Enroll America | EnrollAmerica.org 2

AGENDA

I. Introduction Jenny Sullivan Enroll America

II. ACA and Criminal Justice Populations

Jenny Montoya Tansey Californians for Safety & Justice

III.  View from the Ground

•  Los Angeles, CA Jenny Montoya Tansey

•  Cook County, IL Maureen McDonnell TASC, Inc.

•  Denver, CO Sheriff Gary Wilson Denver Sheriff Department

IV. Resources Jenny Sullivan

V. Q&A Submit your questions via chat.


ACA AND CRIMINAL JUSTICE POPULATIONS and VIEW FROM THE GROUND: LOS ANGELES Jenny Montoya Tansey Health Matters Program Director Californians for Safety and Justice

SAFEANDJUST.ORG

Increasing Public Safety and Health and Reducing Costs through Health Coverage Enrollment

The California Endowment/Enroll America Webinar April 9, 2014

ACA and Criminal Justice Populations

Agenda 1. High Recidivism, High Costs: Justice Populations and

Health Coverage 2. The ACA Opportunity 3. Los Angeles Jail Enrollment Model 4. Los Angeles Probation Enrollment Model 5. Key Considerations and Next Steps

High recidivism, high costs: County justice system and health issues

•  Justice populations = high rates of chronic disease, including mental illness and substance use disorders

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•  Mentally ill = longer jail stays, higher custody costs

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•  People with substance use disorders/mental illness = higher rates of recidivism

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•  Few have health coverage/access to ongoing treatment

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The ACA Opportunity: Reduce recidivism and costs, improve health outcomes 1)   New eligibility = more people in the justice system can get

health coverage and treatment 2)   New federal funds = new federal money to subsidize health

care costs and to help pay for cost of administering enrollment

3)   Enhanced benefits for mental health and substance abuse

treatment = more treatment can be covered

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The ACA Opportunity: Medicaid

California opted to expand our state Medicaid Program (Medi-Cal) under the ACA. A new state law (AB 720) directs suspension, not termination, of Medi-Cal when people are incarcerated and also establishes a process for jail-based enrollment.


Criminal Justice

Population

Medi-Cal Newly-Eligible

Population

(Medicaid will not pay for health care while individuals are incarcerated, except for inpatient stays in a non-correctional hospital.)

Covered California is our state’s health benefits marketplace and offers financial assistance to pay for private insurance.


The ACA Opportunity: Health Benefits Exchange

Not eligible to enroll in an exchange health plan: Individuals serving a sentence in jail at time of application. Release from incarceration is a qualifying event that enables sign up outside of open enrollment.

Enrolling the LA Jail Population

Reentry to Community

For targeted high needs individuals: implementation of discharge plan, including information sharing with provider, coordination of services.

During jail stay On-site eligibility worker checks for existing Medi-Cal case. Custody assistant uses existing jail and social

services data and works with inmate to collect additional information needed to complete application. Medi-Cal application is submitted through county online system.

Inmate Reception Center (Booking) At medical screening, jail medical staff determine health insurance status and current provider, if any. Assess

health care needs, including mental health and SUD.

Enrolling LA Probationers

Probation officer screens probationer for insurance status, makes referral to on-

site enrollment assistance

Probationer meets with enrollment counselor, who

provides assistance to complete application

Counselor assists probationer to select a plan and provider,

make first appointments, if

desired.

Community health clinics and organizations will provide on-site enrollment assistance at LA probation department’s 19 area field offices.

Funding Justice Population Enrollment •  Medi-Cal Administrative Activities (MAA)

Program •  Covered California In-Person Assistance

Program •  Inmate Inpatient Hospitalization Reimbursement •  County General Funds •  AB 109 (California criminal justice funding to

counties) •  Philanthropic support

Key Considerations and Next Steps

•  Fostering a “culture of coverage” amongst justice populations

•  Maximizing the use of existing county and state data to complete applications

•  Ensuring that enrollment translates into access to care

•  Developing additional high-quality treatment capacity

•  Creating a long-term model for investing in enrollment efforts for justice populations

Questions?


For more information, please visit:

www.safeandjust.org Or contact me: Jenny Montoya Tansey Health Matters Project Director Californians for Safety and Justice [email protected]


VIEW FROM THE GROUND: COOK COUNTY

Maureen McDonnell Director for Business and Health Care Strategy Development Treatment Alternatives for Safe Communities, Inc. (TASC)

Leveraging National Health Reform to Build Public Safety and Public Health: ACA in Action in the Justice System

Center for Health and Justice at TASC

National public policy group focused on nexus of criminal justice and public health

Expertise grounded in science and practical, on-the ground experience of TASC, providing alternatives to incarceration

since 1976 – TASC reaches 27,000 clients per year

Collaborations with broad network of public policy leaders, researchers, criminal justice practitioners, and clinicians

Cook County Jus+ce & Health Ini+a+ve •  August 2012 – Planning process convened by the Honorable

Paul P. Biebel, Jr., Presiding Judge of the Criminal Division •  The JusDce and Health IniDaDve (JHI) Steering CommiIee

includes leadership from –  All Cook County jusDce agencies –  County Health and Hospitals System –  Community substance abuse and mental health providers –  Community foundaDons

•  Builds on Cook County’s early expansion of Medicaid (2012) •  JHI was developed and led by TASC with Chicago Community

Trust funding; other foundaDons joined

Jus+ce & Health Ini+a+ve Goals •  Determine how to facilitate applicaDons for all eligible persons

entering the jusDce system

•  Develop infrastructure and processes that support universal linkage to medical, mental health, and substance abuse treatment

•  Support expansion of care in the community that meets the needs of people under supervision

•  Expand diversion from jail and prison to care in the community under appropriate supervision

Jail Intake Applica+on Process: Partnership between Cook County Health & Hospitals System, Cook County Sheriff’s Office and TASC

Opera+onal Goals: Maximize Applica+ons & Use of Care •  Complete full applicaDon during intake

–  Fingerprint-‐based idenDfying informaDon used to verify inmate idenDty –  ApplicaDons are completed online using state and county Medicaid

applicaDon websites and jail management system records •  Process must fit in fast-‐paced secure environment

–  200-‐300 new detainees/day –  Cannot impede security or medical flow –  Each applicaDon takes approximately ten minutes

•  Encourage applicants to use care a\er release

Results: Over 14,000 Medicaid applicaDons have been iniDated to date (April 2013 – March 2014)

Jail to Community Con+nuity of Care •  Planning Process: How to establish processes that link people with serious

mental illness, severe substance use disorders and chronic medical condiDons to needed care in the community, given jail release Dmeframes?

•  DemonstraDon Project: Link 30 people with serious mental illness released each day to care in the community

•  Partnership between Sheriff’s Office, Cermak Mental Health Services and TASC

“Health Care Reform Ready” Court

•  Court that uses all available funding streams and all community resources to link probaDoners to services

•  Prison diversion court •  Model for all felony courtrooms a\er tesDng Under Development: Further Approaches to Jail and Prison Diversion

Maureen McDonnell Director, Business & Health Care Strategy Development TASC, Inc. 1500 N. Halsted Street Chicago, IL 60642 312.573.8222 [email protected] www.tasc.org


VIEW FROM THE GROUND: DENVER

Sheriff Gary Wilson, Denver Sheriff Department

Affordable Care Act for County Jails

Presented by: Sheriff Gary Wilson

Denver Sheriff Department

Affordable Care Act

•  The Affordable Care Act (ACA) is expected to help lower county jail healthcare costs, reduce recidivism, and create healthier individuals, families and communiDes partly because of provisions for expanded Medicaid eligibility and other healthcare affordability measures available to previously uninsured populaDons, including the offender populaDon in county jails

Community Oriented CorrecDonal Health Services

•  COCHS esDmates that about 2/3 of the jusDce-‐involved populaDon will be eligible for Medicaid under expansion; many of these individuals will have access to affordable healthcare for the first Dme.

Expected Benefits to Agencies and their CommuniDes

•  A strengthening of the relaDonships with individual ciDzens and communiDes also vested in public health, adequate medical care, healthy living, and reduced recidivism.

•  A reducDon in the absolute number of incarcerated individuals

•  A healthier offender populaDon because of the availability of care while in the community; significant cost savings associated with offenders needing less care and medicine upon arrival and while incarcerated.

•  Significant cost savings associated with healthcare and medicaDons that can be billed to insurance.

Prac+cal Strategies

•  Healthcare enrollment protocols, •  EducaDon of the inmate populaDon, •  Enrollment assistance and facilitaDon of the applicaDon process upon inmate release.

•  Enrollment assistance and facilita+on of the applica+on process at Medical Facili+es.

Step 1

•  Determine Offender Need/Scope – 71% of offenders did not have insurance

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No Insurance Insurance Drivers Lic Birth cert

Step 2 •  Assemble your team

–  Human Services Medical provider(s) –  State Medicaid Administrator –  State Exchange Plan Administrator –  Division leaders –  Legal Department –  Inmate Programs –  Finance (EsDmaDng projected savings short term/long term, expenditures, budget issues)

–  Technology Unit (How will we capture needed data and report results?)

–  Human Resources (Are addiDonal personnel needed to support implementaDon?)

Step 3

•  Develop a SCREENING PROCESS and related forms. – Do you have health insurance? – Are you a US CiDzen? – Are you a resident of Denver County?

Step 4

•  Limited Power of AIorney

Step 5

•  Hire Enrollment Specialist

Step 6

•  Educate Offenders

Step 7

•  Train and Educate Staff

Step 8

•  Track, Measure, Report and REFINE

DSD Outcomes

•  County Jail – 17 Inmates enrolled upon release (Medical and Food Assistance)

– Two Pending •  Downtown Jail

– 12 Approved – One Pending

•  Denver Health Medical Center

Contact Informa+on

•  Sheriff Gary Wilson •  Email: [email protected] •  Phone: 720-‐337-‐0194


RESOURCES

Find more information at enrollamerica.org/resources/webinars •  Today’s webinar recording •  Today’s slides •  List of related resources


QUESTIONS?

Submit questions via chat.