California’s justice-involved population will have access to pre-release health and social services—following the Centers for Medicare & Medicaid Services’ (CMS) approval of the state’s 1115 demonstration waiver renewal request last year—in October. And Carelon Behavioral Health developed a clinical model to assist counties, health plans, and correctional facilities with pre-release services to support the initiative.
Brandy Gadino, behavioral health market director at Carelon, told State of Reform the clinical model was built around Carelon’s core services, many of which relate to care management and coordination.
“Part of our model is looking at collaboration, and potentially even contracting certain services—for example, physical health—that’s not something we necessarily deliver, although we do, in some markets, have teams that have nurse practitioners and physician assistants. But as far as the waiver goes, we’d be doing some assessments and consultations, and if there’s any physical health concerns or needs for medication, we’d be working with another organization to help deliver those services,” Gadino said.
California became the first state approved by CMS to offer a specialized set of Medicaid services to adults and youth in California prisons, jails, and youth correctional facilities up to 90 days prior to release. Those formerly or currently incarcerated have higher risks of injury, violence, death, overdoses and suicide, according to the Department of Health Care Services (DHCS).
Under the 1115 waiver, DHCS is coordinating with state agencies, counties, and community-based organizations to create a coordinated community reentry process that will connect people to mental and physical health services. Pre-release services include physical and behavioral health diagnoses and treatment, including medication administration; laboratory and radiology services; reentry care management; medication assisted therapy and counseling; and other services provided by community health workers with lived experience.
Carelon’s pre-release behavioral health services will include group or individual therapy, medication management, substance use disorder treatment, peer support, and medication-assisted treatment.
“Part of our model is looking at collaboration, and potentially even contracting certain services,” Gadino said.
Gadino is excited about the staffing model—specifically the addition of outreach care specialists, who will focus on contacting patients and connecting them to enhanced care management providers people will see after leaving the carceral setting. Gadino said it’s vital that the outreach care specialists have relevant lived experiences.
“We think that’s really an important piece when it comes to this population, and making sure they follow through on their discharge plan,” Gadino said.
Carelon is also considering adding a project coordinator to the staffing model, who would assist correctional facilities with additional services, like support in delivering first aid for mental health, staff training on how to better understand behavioral health conditions and signs of a crisis, and administrative functions like billing Medi-Cal.
With the initiative having a requirement for conducting screenings 90 days prior to release, combined with continued healthcare staffing shortages, Gadino thinks telehealth will come in handy. While Carelon has a large team of licensed clinicians that could deliver services, it’s not always possible to deliver care in-person.
“In this model, those folks could deliver those screening services. It’d be more likely via telehealth model, so not necessarily in-person, but I think that really helps for some of the more rural areas in California.”
— Gadino
Strategic partnerships with enhanced care management providers and other organizations doing community-based healthcare work will also be vital, Gadino said.
“I think this is an opportunity for us all to kind of coordinate and do best by the member, pool our resources, and really make sure the member gets those screenings in the time frame required,” Gadino said.
This won’t be Carelon’s first time working with the justice-involved population. Carelon created the Justice Connect program in 2014 in Colorado, which uses datasets to identify which incarcerated people have the highest healthcare costs and risks for behavioral health challenges in order to assist with post-release care.
People who previously received behavioral healthcare services under Medicaid are identified during the booking process. Jails and mental health centers receive their prescription histories in order to reduce lapses in medication. Carelon data shows that Justice Connect saw a 30 percent increase in enrollment from 2017 to 2019, and the program had a 22 percent reduction in the number of inmates who were booked with behavioral health diagnoses.
Two of the greatest challenges with the initiative in California is forming a bridge between healthcare and carceral settings, and establishing the ability to exchange data, Gadino said.
“The correctional facility systems have their own system where they house data and information. Managed care plans have their own. Providers that are seeing members in counties [have their own system], so being able to have a platform or system that [helps them] talk to one another and share information—especially when it starts to be sensitive information, like substance use disorder, where there’s a lot of regulations, requirements, and confidentiality of that information—I think it’s critical in making sure each of these systems are talking to one another and coordinating with one another.”
— Gadino
Gadino said Carelon is still in the early phases of the model’s implementation, and is working with Ventura County officials to determine how it can support its jails.
Those interested in learning more about healthcare in California can register to attend the 2024 Southern California State of Reform Health Policy Conference, which will be held at the Westin Pasadena on Sept. 11.