medi-cal enrollment for county jail and probation populations · and the probation department. mou...
TRANSCRIPT
SAFEANDJUST.ORG
Medi-Cal Enrollment for County Jail
and Probation Populations
September 10, 2014
Statewide Webinar
Agenda
• Welcome – Elizabeth Howard Espinosa, CSAC
• Opening Remarks – Jenny Montoya Tansey, Safe and Just
• County Case Studies:
• Yolo County – Nate Palmer, Probation; Amanda Amos, Public
Defender’s Office; Nolan Sullivan, Social Services; Maggi
Schubert, Day Reporting Center
• San Luis Obispo County – Tim Siler, Social Services;
Commander Brian Hascall, Sheriff’s Dept.
• State Remarks: John Zapata, Jeff Baca, Department of Health
Care Services
• Q&A
SAFEANDJUST.ORG | 2
Historic Opportunities to Reduce
Recidivism and Costs
Public Safety
Realignment Transfer of
responsibility for most
non-violent individuals
to local jurisdictions
SAFEANDJUST.ORG | 3
Affordable Care Act
Implementation Expanded eligibility
Enhanced mental health
and substance abuse
benefits
New federal funds
About the Survey
• Californians for Safety and Justice
conducted an online survey of all 58
counties June-July 2014 about enrollment
of jail, probation and other criminal justice
populations
• 46 counties have responded so far
• Those counties represent 98% of
California’s population
SAFEANDJUST.ORG | 4
Key Findings
SAFEANDJUST.ORG | 5
• All 46 counties that have responded are
providing or planning to provide enrollment
assistance to their local criminal justice
population
• Counties are using a range of enrollment
strategies
• Some counties are beginning to connect people
in the justice system to covered community
treatment
Peer-to-Peer Learning
SAFEANDJUST.ORG | 6
• This is new.
• Learning from other county’s experiences
can help to:
– Make process more efficient
– Reach more people
– Achieve end goals: cost savings, improved
health outcomes, and reductions in recidivism
San Luis Obispo County Jail Processes and Outcomes
How the Effort Started
Department of Social Services, Sheriff Department, and the Probation Department.
MOU February 1, 2014
Inmates who are currently incarcerated would be the priority for Medi-Cal enrollment.
Probation Dept would be the second effort to get post release inmates enrolled, if the inmates were not enrolled while in jail.
DSS Employment Resource Specialist would take applications to enroll inmates
Roles of Each Agency
Sheriff Department
Make available electronic data on the inmates release dates and medical fragility
Ask each incoming inmate if they have medical insurance
Provide for the safety of DSS staff
Roles of Each Agency Cont’d
Department of Social Services
Meet with inmates in groups or individual application sessions
Provide educational material and brochures to inmates and the jail on how to enroll in Medi-Cal and CoveredCA.
Target Inmate Population
Inmates who will be released within 90 days
Inmates who have a medical fragility
Inmates who do not have medical insurance
Inmates who are hospitalized while in custody
Pre-Application Screening
Sheriff Department
Pre-booking paperwork: ask inmates if they have insurance
Department of Social Services
Each potential inmate in custody in the target population is screened in MEDS for coverage
Processing Applications
Display Institutional Care Summary
Booked date and expected release date
Batch Exception
Prevents EDBC from running and changing overridden aid code
N7 Override
Supervisor places correct eligibility for person in custody
MEDS Coordinator
Ensures N7 aid code goes to MEDS for correct months
Processing Released Applications
Release Dates ERS works with Correctional Technician
Release dates are on the data imported from the jail
Display Institutional Care Summary End date the month the month before the release date, if
possible
Run EDBC Reevaluate month before release date and each consecutive
month to get future month passing full scope Medi-Cal
MEDS coordinator Change N7 to full scope Medi-Cal for correct months
IT Computer Application
Sheriff Dept
Electronic data on booking, release, and medical fragility provided to DSS
Department of Social Services
Jail data imported into application
Reports on inmates seen, applications taken, etc.
Utilized to create lists of inmates to see for application
Suspend inmate’s Medi-Cal who are already insured and in custody
Launch Dates
Started March 2014
ERS went three days
April 2014
ERS went 15 days
May 2014
ERS started going almost daily
Setting the Foundation
Starting out
Seeing everyone
Creating Lists of Inmates to See
Began with release dates
04/11/2014: began seeing inmates released within 30 days
05/09/2014: began seeing inmates released within 60 days
05/21/2014: began seeing inmates released within 90 days
Medically fragile
06/05/2014: began creating lists
Hospitalized Inmates
Once per month
Data on Progress to Date
Inmates seen for Enrollment up to 04/14/2014
335: 165 applications taken, 170 inmates declined applications
Inmates seen for Enrollment up to 05/13/2014
650: 347 applications taken, 303 inmates declined apps
Inmates seen for Enrollment up to 07/16/2014
934: 494 applications taken, 440 inmates declined apps
Inmates seen for Enrollment up to 08/31/2014
1110: 584 applications taken, 526 inmates declined apps
556 applications processed
Data Cont’d
Inmates who Declined Applications (526)
Already insured
Undocumented inmates
Inmates planning on living out of state
Over the income limit for free Magi Medi-Cal
Did not want to get out of bed
Lessons Learned
See inmates in the afternoon and not morning
Inmates are reluctant to wake up early
Ask the inmates if they have health insurance and if they would like to apply for health insurance
Avoid only asking inmates if they would like to apply for Obamacare
Give inmates educational brochures
Drug and alcohol services
Medi-Cal coverage—including dental
Inmates show each other the information
Lessons Learned Cont’d
If possible, take applications inside of dorm setting housing units
Builds enthusiasm for the program
Inmates can ask their questions
The Less of a Footprint with the Officers, the Better
Be aware of the environment
Learn when to see inmates and when not to
When are the officers most busy?
When are meals given?
When are lockdown times?
Is there an emergency?
Lessons Learned Cont’d
Have a defined daily routine
ERS knows which housing units to go see inmates
Have the least amount of movement possible
Minimize impact on officer
ERS goes to the jail daily
Inmates are booked and released everyday. This ensures the maximum amount of inmates are seen for health applications.
You can always change N7, restricted benefits, to full scope coverage
Put an inmates coverage to N7. It can always be changed to full scope Medi-Cal.
23
DHCS is dedicated to working with our county partners to ensure the success of the various
inmate Medi-Cal programs.
24
What programs are available to inmates?
The Medi-Cal Inmate Eligibility Program (MCIEP)
The Pre-Release Medi-Cal Application Process
25
Medi-Cal Inmate Eligibility Program (MCIEP)
Provides Medi-Cal covered in-patient hospital services to eligible state and county inmates who receive in-patient medical services off the grounds of the correctional facility.
For juvenile inmates, the MCIEP program covers inpatient hospital services and inpatient mental health services.
Adult inmates are not eligible for inpatient mental health services.
26
Medi-Cal Inmate Eligibility Program (MCIEP)
Provides Medi-Cal covered in-patient hospital services to eligible state and county inmates who receive in-patient medical services off the grounds of the correctional facility.
For juvenile inmates, the MCIEP program covers inpatient hospital services and inpatient mental health services.
Adult inmates are not eligible for inpatient mental health services.
27
The Pre-Release Medi-Cal Application Process
Provides Medi-Cal application assistance to inmates nearing release and allows processing of those applications prior to the inmate’s release to insure Medi-Cal coverage upon release whenever possible.
28
29
DHCS Divisions Serving Inmates
Medi-Cal Eligibility Division (MCED)
Medi-Cal Benefits Division (BD)
Safety Net Financing Division (SNFD)
Medi-Cal Managed Care Division (MMCD)
30
Roles within DHCS
Medi-Cal Eligibility Division (MCED)
MCED is responsible for the coordination, clarification, and implementation of Medi-Cal regulations, policy, and procedures.
Benefits Division (BD) BD is responsible for setting covered services for the
Medi-Cal program.
Safety Net Financing Division (SNFD) SNFD is responsible for financial claiming.
31
Roles within DHCS
Medi-Cal Managed Care Division (MMCD)
MMCD is responsible for enrolling individuals into established networks of organized systems of care.
An inmate receiving Medi-Cal coverage of inpatient services is not enrolled into managed care.
An inmate applying for eligibility upon release will be enrolled into managed care (if applicable) for that coverage.
32
Resources
All County Welfare Directors Letter (ACWDL) 13-18: Medi-Cal and Related Programs for State and County Inmates
ACWDL 14-24: State Inmate Pre-Release Medi-Cal Application Process
ACWDL 14-26: Implementation of Assembly Bill (AB) 720 - Suspension of Medi-Cal Benefits for all Inmates and other Requirements
ACWDLs are available on-line at: http://www.dhcs.ca.gov/services/medi-
cal/eligibility/Pages/ACWDLbyyear.aspx
Q & A’s
33