Health Management Associates (HMA) hosted a webinar to discuss opportunities to build programs for justice-involved individuals and Medicaid initiatives on Thursday. Several HMA experts identified ways to improve services for those who are leaving or entering incarceration.
On Jan. 26th, CMS approved California’s proposal to cover certain healthcare service costs for individuals who are incarcerated. Justice-involved individuals are disproportionately impacted by negative outcomes including injury, death, trauma, violence, and drug-overdose.
“The goal here is to help ensure continuity of health coverage after incarceration,” HMA Principal Julie White said. “We incarcerate a higher rate of individuals than any other developed country in the world.”
White said there are about two million individuals currently incarcerated in the US, and people of color and LGBT individuals are disproportionately represented in local jails, federal prisons, state jails, and youth correctional facilities.
The webinar focused on key considerations regarding the continuity of care for formerly and currently incarcerated individuals, with identifying their health/behavioral health needs early a main priority.
HMA’s John Volpe said factors that affect reentry for incarcerated individuals are easier to predict when people leave prisons, but individuals leaving jails don’t always depart on a set schedule.
“To the degree that you can front-load discharge planning, that can really help the individual should they find themselves [as] an unexpected discharge,” Volpe said.
Because of discharge scheduling, Volpe said frontloading services like health assessments and discharge plans early is beneficial.
“We really do recommend that work be done around planning for releases that are not anticipated,” Volpe said.
Volpe said a critical issue affecting individuals’ reentry and transition back into the community is the ability to obtain health insurance or Medi-Cal. If there is no robust screening or health insurance application assistance available, it would be beneficial to consider conducting insurance screenings during entry, he said.
Presenters discussed the effectiveness of Medicaid enrollment for individuals who are incarcerated at Chicago’s Cook County Jail. The jail expanded Medicaid to incarcerated individuals as an early demonstration project for Medicaid expansion. Linda Follenweider, managing director for HMA’s (which owns State of Reform) Justice Involved Services, said Cook County Jail contracted with a vendor that was tasked with Medicaid enrollment.
“Enrolling people in Medicaid at intake allowed us not to wait,” Follenweider said.
Individuals were first booked at Cook County Jail, then underwent an insurance screening. After that, they were screened for medical and mental issues. Healthcare services provided at the jail include primary and dental care, detox, pharmacy, and urgent care, among others. Discharge planning and community linkages for the transition of care were put in place prior to inmate discharge.
HMA Managing Principal Margaret Tatar talked about the work California is doing to expand Medicaid to incarcerated individuals, and what the early days of the initiative have looked like.
“California’s Justice-Involved waiver is part of a larger waiver package which is referred to as CalAIM,” Tatar said.
CalAIM (California Advancing and Innovating Medi-Cal) is focused on transforming Medi-Cal to promote health equity and address social determinants of health.
“It’s an ambitious waiver,” Tatar said.
Tatar said youth and adults in state prisons and county jails may be eligible for Medi-Cal after meeting certain health criteria, in relation to behavioral health issues and certain chronic conditions, but that youth in correctional facilities are eligible for reentry services regardless of whether they meet additional health criteria.
“The estimated overall eligible population who are receiving the reentry services is estimated to be 200,000 for the state of California,” Tatar said.
Department of Health Care Services estimates that over one million individuals transition out of or into carceral settings annually, Tatar said, and 80% of them are likely to be Medi-Cal eligible.
“The approach in California is, in 2023 through 2024, really aiming to forge new working relationships with the key stakeholders in this program,” Tatar said.
To help ensure access to care for individuals leaving carceral settings, Tatar said California will be increasing its base Medi-Cal rates for primary care, behavioral healthcare, and obstetrics providers to at least 80% of the Medicare Part B schedule.