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 older
Blind
Pregnant
Woman needing treatment for breast cancer
Disabled – meet Social Security Administration’s (SSA) disability criteria

4. 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.

5. 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

6. 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

7. 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.

8. 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 %
Heart Disease
305 2%
Pulmonary Disease
1,196 7%
HIV +
525 3%
Serious Mental Illness
3,332 18%
Substance Abuse
13,480 73%

9. Advantages of Medicaid : Access and cost

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

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

12. 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

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 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

15. Article: Medicaid for Prisoners
on-millions-in-medicaid-for-prisoners
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.

16. 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

17. And Going Forward……