1 Medicaid Maximization & Criminal Justice Involved Individuals Raman Singh, M.D. Medical / Mental Health Director Louisiana Department of Public Safety & Corrections
2 Medicaid was created on July 30, 1965, through Title XIX of the Social Security Act. Each state administers its own Medicaid program while the federal Centers for Medicare and Medicaid Services (CMS) monitors the state- run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.
3 Who is eligible for Medicaid? FPG(Federal Poverty Guidelines)and any of the following:Aged – 65 or olderBlindPregnantWoman needing treatment for breast cancerDisabled – meet Social Security Administration’s (SSA) disability criteria
4 Medicaid and Offender Population FFP not available for un allowable servicesUpon incarceration Medicaid is suspended.Termination or suspensionTermDefinitionInmateAn individual confined involuntary or serving time for a criminal offense in state or federal prisons, jails, detention facilities or other penal facilities.
5 Exceptions to the ruleHealth care for offenders is the responsibility of the institution housing the offenders .Any federal dollar ( FFP)can not be claimed for offender care except in the following circumstances:Infants living with the inmate in the public institutionParoled individualsInmates who become inpatients of a hospital, nursing facility or intermediate care facility ( subject to meeting other requirements of the State’s Medicaid program)50% of the administrative cost for the discharge planning for otherwise eligible offenders
6 Louisiana Offender Population Offender Type/LocationNumberDOC Offenders in State Facilities18,723DOC Offender in Local Facilities21,327Parish Offenders in Local Facilities2,737Pre-Trial Offenders in Parish Prison21,199Juveniles (OJJ)436Probation & Parole69,845Total134,267
7 Snapshot of Prisoner Population Highest incarceration rate in worldLouisiana has a very high rate of PLWHA, we sit in the cancer belt, and have one of the worst obesity problems leading to a higher number of heart disease and strokes.So offenders show similar trends.Staggering numbers of individuals are incarcerated who have; serious mental health conditions, multiple risk factors for heart conditions, cancers and infectious diseases who lacked access to health care before their incarceration.The number of elderly offenders is growing at an alarming rate, further burdening already strained state budgets. Offenders 50 or older comprises 25% of Louisiana DOC population.
8 Current Chronic Illnesses Diagnosed in Louisiana DOC run Prisons (average age: 43 years) Disease for Year 2012Number Diagnosed / Percentage of Population in DOC facilitiesHypertension5,409 30%Diabetes1,300 7%Cancer%Heart Disease305 2%Pulmonary Disease1,196 7%HIV +525 3%Serious Mental Illness3,332 18%Substance Abuse13,480 73%
10 Pre-Incarceration Lafayette – Mental Health Courts Act 389 Diversion Program
11 During IncarcerationIn patient stay coveredFiscal year 2012/ ,070 off-site admits, 3,042 on-site admissions
12 Medical Releases from DOC Currently ActiveCompassionate Releases42006200720082009201020112012TotalApproved / Released1510934Currently ActiveMedical Parole Releases222006200720082009201020112012TotalReleased during year145141034
13 Release Planning / Reentry DOC releases approximately 15,000 offenders per year.DOC is engaged with with community mental health providers and Medicaid providers for a seamless transition for offenders upon release.Common drug formulary for prisons, jails, mental health and Medicaid.Pre-release conferencing to assure services are readily available to the most seriously mentally ill.
14 Multi-Agency Collaborations OBH and DOC collaboration for expedited mental health services for releasing offender with severe mental illnessDHH and DOC worked together to expand and improve the Medicaid application process for releasing offendersDHH and DOC data exchange placing Medicaid services on hold for incarcerated offendersSSA and DOC collaborate to improve the application process for releasing offendersDCI Discharge Program for releasing offenders
15 Article: Medicaid for Prisoners on-millions-in-medicaid-for-prisonersSo far, only Arkansas, California, Colorado, Delaware, Louisiana, Michigan, Mississippi, Nebraska, North Carolina, Oklahoma, Pennsylvania, Washington and some scattered local governments are tapping Medicaid to pay for inpatient medical and nursing home care. A few more states are looking into it, including Georgia, Massachusetts, Minnesota, New Mexico, New York and Virginia.Only a dozen states have taken advantage of a long-standing option to stick the federal government with at least half the cost of hospitalizations and nursing home stays of state prison inmates.The other states have left tens of millions of federal dollars on the table, either because they didn’t know about a federal rule dating to 1997 or they were unable to write the laws and administrative processes to take advantage of it.
16 Impact of ACACMS is not changing the exceptions when FFP is allowed for actively incarcerated offenders.Discharge planning and continuity of careMental health parity