Download The Affordable Care Act and the Criminal Justice System

The Affordable Care Act and the
Criminal Justice System:
Huge Opportunities and Needed Next Steps
Gabrielle de la Guéronnière,
Legal Action Center
2014 RSAT Grantee Meeting
July 18, 2014
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What We’ll Discuss Today
 What are the ACA’s (Affordable Care Act)
major opportunities to expand coverage for
services and to improve access to care for
justice-involved individuals?
 Updates on activity
 What should we expect next?
 What should our next steps be?
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About LAC and the Coalition for Whole
Health
 Legal Action Center
 National law and policy organization that works to fight
discrimination against people related to substance use disorders,
HIV/AIDS, and/or criminal records
 Grant through BJA to support a number of grantees on health
reform and the criminal justice system
 Coalition for Whole Health
 A coalition of over 100 national, state, and local organizations in
the mental health and substance use disorder fields and allied
organizations working to ensure health reform is successfully
implemented for individuals with mental health and substance
use disorder needs
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Health Characteristics of JusticeInvolved Individuals
 High rates of physical health problems, mental illness and
substance use disorders (SUDs) in the criminal justice system
 State and local court systems and correctional agencies have spent
huge amounts of money on care
 Most people reentering from incarceration have no or little health
insurance coverage in the community
 Even for individuals with health insurance, coverage for mental
health and substance use disorder benefits has been inconsistent
and often lacking
 Most justice-involved people have had poor access to health care
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Health and Recidivism
 Relationship between criminal justice system
involvement, high rates of recidivism and untreated
mental health and SUD
 Drug overdose is the highest cause of death for
individuals reentering the community
 Twelve-times higher risk of death in the first two
weeks after release
 However, with access to care, health outcomes improve,
and recidivism rates and costs to the correctional and
health systems decline
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Importance of the ACA to the Criminal Justice System:
Coverage Expansions and Infusion of Federal Dollars
 The ACA presents a huge opportunity to improve public health,
increase public safety, and save states huge amounts of money
 The ACA dramatically expands health insurance coverage to
millions of people
 In the 27 states expanding their Medicaid population, federal
Medicaid will for the first time pay for non-disabled adults with no
dependent children up to 138% FPL
 Huge federal investment: federal dollars will cover 100% of the
costs for first 3 years, decreasing to 90 percent indefinitely
 Federal dollars likely create greater incentives in states and
counties for systems reforms and collaborations
 Opportunities for reimbursement for enrollment activities
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Leveraging Additional Federal Funding
to Improve Continuity of Care
 Most states terminate Medicaid when someone becomes
incarcerated
 The “inmate exclusion” prohibits federal Medicaid payments
for care provided to any individual involuntarily confined in
state or federal prisons, jails, detention facilities, or other
penal facilities
 As a result, states may not use federal Medicaid funds to pay for
care provided to incarcerated individuals in most circumstances
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Medicaid, Incarcerated Beneficiaries,
and the Inpatient Exclusion
 Medicaid can pay for services when the incarcerated
individual is a “patient in a medical institution”
 When they’ve been admitted as an inpatient in a community-
based hospital, nursing facility, juvenile psychiatric facility, or
intermediate care facility for at least 24 hours
 All medically necessary Medicaid covered services provided to
that individual while admitted can be billed to Medicaid
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State Cost-Savings through Medicaid
Suspension
 A number of states have recognized the huge potential for
cost savings when they suspend Medicaid
 North Carolina saved $10 million in the first year (2011)
 California saved about $31 million in FY 2013
 New York estimated in 2012 that it could save $20 million
annually if the state billed Medicaid for eligible inpatient care
 The enhanced federal Medicaid share in expansion states
presents an even greater opportunity
 Reforming state policies to suspend instead of terminating
Medicaid will significantly help with continuity of care into
the community
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Using Medicaid to Pay for Inpatient
Care
 Medicaid can be suspended during incarceration
 Although federal rules prohibit payment for services for incarcerated
individuals , this has no effect on eligibility or enrollment
 The federal government (CMS) has encouraged states to suspend
not terminate Medicaid
 There is no federal prohibition against screening for eligibility
during incarceration
 HHS has also clarified “corrections department employees…are not
precluded from serving as an authorized representative of
incarcerated individuals for purposes of submitting a (Medicaid)
application on such an individual’s behalf.”
 Enrollment can and should happen at all stages of justice system
involvement
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Importance of the ACA to the Criminal Justice System:
Improved Coverage for and Access to Addiction and
Mental Health Services
 The ACA will dramatically improve coverage for and access to
substance use disorder (SUD) and mental health (MH) services
 Under the ACA, SUD and MH services are essential health
benefits which must be covered at parity (Mental Health Parity
and Addiction Equity Act) with other covered medical benefits
 Requirements apply to most Medicaid and private insurance
coverage; access improvements will apply to millions of
people
 Parity requirements relate to scope of MH and SUD services
and medications covered, financial requirements, and
quantitative and non-quantitative treatment limitations
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Related updates and potential
developments
 Developments related to the federal parity law
 Final rule became effective for certain plans on July 1st
 State enforcement activity
 Expecting additional guidance from CMS later this year
 Discussions about supporting the full continuum of SUD care
 Specific focus on coverage for residential SUD treatment and
the IMD exclusion
 Coalition for Whole Health survey to gauge transparency of
MH and SUD benefits and other coverage information
 Network adequacy focus
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Importance of the ACA to the Criminal Justice System:
Improved Access to Care for People with Chronic Health
Conditions
 The ACA has a strong focus on creating incentives to help people
with multiple chronic health conditions
 Section 2703 of the ACA created the new health home Medicaid
option for beneficiaries with multiple chronic conditions.
 Health homes are meant to build on other care coordination models
to create linkages to community and social supports, enhance
coordination of physical health, mental health and substance use care,
and to improve health outcomes for high-cost patients.
 Enhanced federal funding
 Huge opportunity to both improve health and reduce entry and
reentry into the criminal justice system by getting people enrolled
and linking them to care as early as possible
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Related updates and potential
developments
 Launch of CMS Innovation Accelerator Program
 Technical assistance to the states with a focus on substance use
disorders
 Focus on medication-assisted treatment
 Joint CMS Informational Bulletin released this week
 Significant focus in Washington in response to the opioid crisis
around the country
 Federal appropriations timing and outlook
 Work by Senators Whitehouse and Portman
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Our Next Steps
 Understanding the landscape of decision-makers and how to
determine coverage options
 Did your state expand Medicaid? Which services, including MH
and SUD services and medications, will be covered? Is your
state a Health Home state? Who is running your state’s
Marketplace? Which Marketplace plans provide the strongest
coverage options for people with complex health needs?
 Critical need for health and criminal justice stakeholders to
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work closely together
 Work between the State Medicaid agency, the State health
insurance exchange board and community care providers
with corrections and other justice system decision-makers
and stakeholders
LAC’s Field-Initiated Project with the
Bureau of Justice Assistance
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Helping the Criminal Justice Field to
Maximize the Opportunities of the ACA
 Determining the technical assistance needs and supporting a
number of BJA’s grantees
 Upcoming newsletter series
 Creating additional educational materials and practical tools to
support enrollment and linkage to care and broadly
disseminating them
 Providing assistance through TA calls, webinars, trainings, and
workshops
 Compiling and disseminating concrete examples of successful
practices and policies as well as barriers to implementation and
ways of overcoming these barriers.
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Questions and Discussion
Gabrielle de la Guéronnière
[email protected]
202-544-5478
www.lac.org
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