The Enrollment Opportunity for Criminal Justice Populations


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Slides from a webinar Enroll America co-hosted (April 9, 2014) with The California Endowment and Californians for Safety and Justice to discuss the work currently being done to ensure that criminal justice populations are connecting to the new coverage options available as a result of the Affordable Care Act. Watch the recording above — and check out the slides and related resources below — to learn about successful partnerships between criminal justice and health care systems in three states, best practices for setting up a health care enrollment program for people in the justice system, and resources for taking this work to the next level.

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The Enrollment Opportunity for Criminal Justice Populations

  1. 1. © 2014 Enroll America | The Enrollment Opportunity for Criminal Justice Populations April 9th, 2014
  2. 2. © 2014 Enroll America | EnrollAmerica.org2 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.
  3. 3. © 2014 Enroll America | ACA AND CRIMINAL JUSTICE POPULATIONS and VIEW FROM THE GROUND: LOS ANGELES Jenny Montoya Tansey Health Matters Program Director Californians for Safety and Justice
  4. 4. SAFEANDJUST.ORG Increasing Public Safety and Health and Reducing Costs through Health Coverage Enrollment The California Endowment/Enroll America Webinar April 9, 2014
  5. 5. 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
  6. 6. High recidivism, high costs: County justice system and health issues •  Justice populations = high rates of chronic disease, including mental illness and substance use disorders SAFEANDJUST.ORG | 6
  7. 7. High recidivism, high costs: County justice system and health issues •  Mentally ill = longer jail stays, higher custody costs SAFEANDJUST.ORG | 7
  8. 8. High recidivism, high costs: County justice system and health issues •  People with substance use disorders/mental illness = higher rates of recidivism SAFEANDJUST.ORG | 8
  9. 9. High recidivism, high costs: County justice system and health issues •  Few have health coverage/access to ongoing treatment SAFEANDJUST.ORG | 9
  10. 10. 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 SAFEANDJUST.ORG | 10
  11. 11. 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. SAFEANDJUST.ORG | 11 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.)
  12. 12. Covered California is our state’s health benefits marketplace and offers financial assistance to pay for private insurance. SAFEANDJUST.ORG | 12 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.
  13. 13. 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.
  14. 14. 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.
  15. 15. 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
  16. 16. 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
  17. 17. Questions? SAFEANDJUST.ORG | 17 For more information, please visit: Or contact me: Jenny Montoya Tansey Health Matters Project Director Californians for Safety and Justice
  18. 18. © 2014 Enroll America | VIEW FROM THE GROUND: COOK COUNTY Maureen McDonnell Director for Business and Health Care Strategy Development Treatment Alternatives for Safe Communities, Inc. (TASC)
  19. 19. 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
  20. 20. 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  
  21. 21.   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  
  22. 22. 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      
  23. 23. 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  aer  release     Results:  Over  14,000  Medicaid  applicaDons  have  been  iniDated   to  date  (April  2013  –  March  2014)  
  24. 24. 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  aer  tesDng     Under  Development:  Further  Approaches  to  Jail  and  Prison  Diversion  
  25. 25.   Maureen  McDonnell   Director,  Business  &  Health  Care  Strategy   Development   TASC,  Inc.     1500  N.  Halsted  Street   Chicago,  IL  60642   312.573.8222      
  26. 26. © 2014 Enroll America | VIEW FROM THE GROUND: DENVER Sheriff Gary Wilson, Denver Sheriff Department
  27. 27. Affordable  Care  Act  for  County   Jails   Presented  by:   Sheriff  Gary  Wilson   Denver  Sheriff  Department  
  28. 28. 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  
  29. 29. 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.  
  30. 30. 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.    
  31. 31. 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.  
  32. 32. Step  1   •  Determine  Offender  Need/Scope   – 71%  of  offenders  did  not  have  insurance   0   500   1000   1500   2000   2500   3000   3500   No  Insurance   Insurance   Drivers  Lic   Birth  cert  
  33. 33. 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?)  
  34. 34. 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?    
  35. 35. Step  4   •  Limited  Power  of  AIorney    
  36. 36. Step  5   •  Hire  Enrollment  Specialist  
  37. 37. Step  6   •  Educate  Offenders    
  38. 38. Step  7   •  Train  and  Educate  Staff    
  39. 39. Step  8   •  Track,  Measure,  Report  and  REFINE    
  40. 40. 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  
  41. 41. Contact  Informa+on   •  Sheriff  Gary  Wilson   •  Email:   •  Phone:    720-­‐337-­‐0194  
  42. 42. © 2014 Enroll America | RESOURCES Find more information at •  Today’s webinar recording •  Today’s slides •  List of related resources
  43. 43. © 2014 Enroll America | QUESTIONS? Submit questions via chat.