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

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Historic Opportunities to Reduce

Recidivism and Costs

Public Safety

Realignment Transfer of

responsibility for most

non-violent individuals

to local jurisdictions

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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

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Key Findings

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• 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

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• 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.

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DHCS is dedicated to working with our county partners to ensure the success of the various

inmate Medi-Cal programs.

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What programs are available to inmates?

The Medi-Cal Inmate Eligibility Program (MCIEP)

The Pre-Release Medi-Cal Application Process

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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.

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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.

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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.

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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)

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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.

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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.

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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

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