Medicaid Maximization & Criminal Justice Involved Individuals Raman Singh, M.D. Medical / Mental Health Director Louisiana Department of Public Safety & Corrections

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.

Who is eligible for Medicaid? FPG(Federal Poverty Guidelines)and any of the following: Aged – 65 or older Blind Pregnant Woman needing treatment for breast cancer Disabled – meet Social Security Administration’s (SSA) disability criteria

Medicaid and Offender Population FFP not available for un allowable services Upon incarceration Medicaid is suspended. Termination or suspension Term Definition Inmate An individual confined involuntary or serving time for a criminal offense in state or federal prisons, jails, detention facilities or other penal facilities.

Exceptions to the rule Health 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 institution Paroled individuals Inmates 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

Louisiana Offender Population Offender Type/Location Number DOC Offenders in State Facilities 18,723 DOC Offender in Local Facilities 21,327 Parish Offenders in Local Facilities 2,737 Pre-Trial Offenders in Parish Prison 21,199 Juveniles (OJJ) 436 Probation & Parole 69,845 Total 134,267

Snapshot of Prisoner Population Highest incarceration rate in world Louisiana 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.

Current Chronic Illnesses Diagnosed in Louisiana DOC run Prisons (average age: 43 years) Disease for Year 2012 Number Diagnosed / Percentage of Population in DOC facilities Hypertension 5,409 30% Diabetes 1,300 7% Cancer 211 1.2% Heart Disease 305 2% Pulmonary Disease 1,196 7% HIV + 525 3% Serious Mental Illness 3,332 18% Substance Abuse 13,480 73%

Advantages of Medicaid : Access and cost

Pre-Incarceration Lafayette – Mental Health Courts Act 389 Diversion Program

During Incarceration In patient stay covered Fiscal year 2012/2013 1,070 off-site admits, 3,042 on-site admissions

Medical Releases from DOC Currently Active Compassionate Releases 4   2006 2007 2008 2009 2010 2011 2012 Total Approved / Released 1 5 10 9 34 Currently Active Medical Parole Releases 22   2006 2007 2008 2009 2010 2011 2012 Total Released during year 1 4 5 14 10 34

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.

Multi-Agency Collaborations OBH and DOC collaboration for expedited mental health services for releasing offender with severe mental illness DHH and DOC worked together to expand and improve the Medicaid application process for releasing offenders DHH and DOC data exchange placing Medicaid services on hold for incarcerated offenders SSA and DOC collaborate to improve the application process for releasing offenders DCI Discharge Program for releasing offenders

Article: Medicaid for Prisoners http://www.pewstates.org/projects/stateline/headlines/states-missing-out- on-millions-in-medicaid-for-prisoners-85899485969 So 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.

Impact of ACA CMS is not changing the exceptions when FFP is allowed for actively incarcerated offenders. Discharge planning and continuity of care Mental health parity

And Going Forward……