Technical Assistance Partnership for Child and Family Mental Health MEDICAID AND JUVENILE JUSTICE...

Technical Assistance Partnership for Child and Family Mental Health

MEDICAID AND JUVENILE JUSTICE

MEDICAID AND JUVENILE JUSTICE

Mary B. Tierney, MD

May 27, 2004

Mary B. Tierney, MD

May 27, 2004


OVERVIEW OF THE ISSUEOVERVIEW OF THE ISSUE

More than 16% of jail inmates have a mental illness

Youth in the juvenile justice system have higher rates of mental health disorders than the general population

One in five has a serious mental health problem

More than 16% of jail inmates have a mental illness

Youth in the juvenile justice system have higher rates of mental health disorders than the general population

One in five has a serious mental health problem


OVERVIEW OF THE ISSUEOVERVIEW OF THE ISSUE

A study of States with the highest mental health utilization rate had the lowest incarceration rate

Interruptions of Medicaid coverage are associated with higher rates of psychiatric hospitalization

A study of States with the highest mental health utilization rate had the lowest incarceration rate

Interruptions of Medicaid coverage are associated with higher rates of psychiatric hospitalization


OVERVIEW OF MEDICAIDOVERVIEW OF MEDICAID


MEDICAIDMEDICAID

Federal/State Partnerships State Agency Requirements Eligibility Services Payment for Services

Federal/State Partnerships State Agency Requirements Eligibility Services Payment for Services


MEDICAID FEDERAL/STATE PARTNERSHIP

MEDICAID FEDERAL/STATE PARTNERSHIP

Federal Statute and Regulations Govern Overall Program

State Plan Requirements State Plan Flexibility Federal Match

Federal Financial Participation (FFP)Federal Medical Assistance Percentage (FMAP)

Federal Statute and Regulations Govern Overall Program

State Plan Requirements State Plan Flexibility Federal Match

Federal Financial Participation (FFP)Federal Medical Assistance Percentage (FMAP)


STATUTORY, REGULATORY REQUIREMENTS

STATUTORY, REGULATORY REQUIREMENTS

There are stringent Federal requirements on Medicaid State agencies with regard to:

Administration of the program, i.e., State Plan Hiring and subcontracting Submitting correct and valid reports [Sections 1902 (a) (4) – 1902 (a) (6)]

There are stringent Federal requirements on Medicaid State agencies with regard to:

Administration of the program, i.e., State Plan Hiring and subcontracting Submitting correct and valid reports [Sections 1902 (a) (4) – 1902 (a) (6)]


STATE PLAN REQUIREMENTS AND FLEXIBILITY

STATE PLAN REQUIREMENTS AND FLEXIBILITY

States must meet all Federal mandates with regard to eligibility, services, administration

States have flexibility to design their programs in those areas where the Federal statute and regulations gives them latitude in eligibility and services

States must meet all Federal mandates with regard to eligibility, services, administration

States have flexibility to design their programs in those areas where the Federal statute and regulations gives them latitude in eligibility and services


FEDERAL MATCHFEDERAL MATCH

FFP

FMAP

FFP

FMAP

Generally at 50% 75% for Case

Management, Maintenance of MIS

Ranges from 50 – 83%

Generally at 50% 75% for Case

Management, Maintenance of MIS

Ranges from 50 – 83%


FINANCIAL STANDARDSFINANCIAL STANDARDS

Income Standard – maximum amount of income a person can have and be eligible for Medicaid including wages, salary and unearned income such as social security

Resource Standard – anything a person owns that can be converted into cash including automobiles, real estate

Income Standard – maximum amount of income a person can have and be eligible for Medicaid including wages, salary and unearned income such as social security

Resource Standard – anything a person owns that can be converted into cash including automobiles, real estate


CATEGORIES OF ELIGIBILITYCATEGORIES OF ELIGIBILITY

Mandatory Coverage

Optional Groups with FFP

Mandatory Coverage

Optional Groups with FFP


MANDATORY COVERAGEMANDATORY COVERAGE

Categorically Needy Families and Children

Aged, Blind and Disabled

Categorically Needy Families and Children

Aged, Blind and Disabled


FAMILIES AND CHILDRENHIGHLIGHTS

FAMILIES AND CHILDRENHIGHLIGHTS

Low Income Families with Children

TANF/AFDC Recipients Families that Lost

TANF/AFDC because of Employment

Qualified Pregnant Women and Children

Low Income Families with Children

TANF/AFDC Recipients Families that Lost

TANF/AFDC because of Employment

Qualified Pregnant Women and Children

Newborn Children of Medicaid Eligible Children

Low Income Children under Age Six

Low Income Children under Age Nineteen

Foster Care and Adoption Assistance

Newborn Children of Medicaid Eligible Children

Low Income Children under Age Six

Low Income Children under Age Nineteen

Foster Care and Adoption Assistance


AGED, BLIND & DISABLEDAGED, BLIND & DISABLED

SSI Recipients

Disabled Adult Children

Zebley v. Sullivan Decision

SSI Recipients

Disabled Adult Children

Zebley v. Sullivan Decision


OPTIONAL GROUPS HIGHLIGHTSOPTIONAL GROUPS HIGHLIGHTS

Infants to age 1 year and Pregnant Women below 185% FPL

Individuals Eligible for assistance who are in institutions

Individuals Receiving Home and Community Based Services

Infants to age 1 year and Pregnant Women below 185% FPL

Individuals Eligible for assistance who are in institutions

Individuals Receiving Home and Community Based Services

Noninstitutionalized Disabled Children (Katie Beckett)

Children under 21 years who meet income requirements but not eligible for TANF

Ribicoff Kids

Noninstitutionalized Disabled Children (Katie Beckett)

Children under 21 years who meet income requirements but not eligible for TANF

Ribicoff Kids


FFP VERSUS ELIGIBILITYFFP VERSUS ELIGIBILITY

FFP

Medicaid eligibility

FFP

Medicaid eligibility


FFP FOR PERSONS IN PUBLIC INSTITUTIONS


FFP prohibited for persons in correctional facilities

No distinction made with respect to whether adult or child

No distinction made with respect to size or type of facility- juvenile detention, half-way house

FFP prohibited for persons in correctional facilities

No distinction made with respect to whether adult or child

No distinction made with respect to size or type of facility- juvenile detention, half-way house




No distinction made as to whether the facility is run through the public or private sector

Individuals on probation or parole are not considered residents of a correctional facility and are eligible for FFP for health services

No distinction made as to whether the facility is run through the public or private sector

Individuals on probation or parole are not considered residents of a correctional facility and are eligible for FFP for health services


EXCEPTIONS TO FFP RULEEXCEPTIONS TO FFP RULE

Persons in public institutions “for a temporary period of time pending other arrangements appropriate to his needs”

Persons who are transferred from jail into an inpatient medical facility such as a nursing facility, intermediate care facility for the mentally retarded (ICF/MR)

Persons in public institutions “for a temporary period of time pending other arrangements appropriate to his needs”

Persons who are transferred from jail into an inpatient medical facility such as a nursing facility, intermediate care facility for the mentally retarded (ICF/MR)


MEDICAID ELIGIBILITY CATEGORIES

MEDICAID ELIGIBILITY CATEGORIES

Not enrolled but eligible upon release

Enrolled in Medicaid when incarcerated and eligibility is NOT affected

Enrolled in Medicaid and eligibility is affected

Not enrolled but eligible upon release

Enrolled in Medicaid when incarcerated and eligibility is NOT affected

Enrolled in Medicaid and eligibility is affected


NOT ENROLLED BUT ELIGIBLE UPON RELEASE

NOT ENROLLED BUT ELIGIBLE UPON RELEASE

Under 1902 (a) (8), may apply for Medicaid at any time during incarceration

Will become eligible upon release from the correctional facility

90-day filing rule for SSI versus 45-day rule for all other categories

Under 1902 (a) (8), may apply for Medicaid at any time during incarceration

Will become eligible upon release from the correctional facility

90-day filing rule for SSI versus 45-day rule for all other categories


ELIGIBILITY NOT AFFECTEDELIGIBILITY NOT AFFECTED

Mandatory and optional categories for low-income pregnant women and youth

“Spendowners” Optional eligibility categories including

those enrolled or eligible for a home and community-based program

Mandatory and optional categories for low-income pregnant women and youth

“Spendowners” Optional eligibility categories including

those enrolled or eligible for a home and community-based program


ELIGIBILITY IS AFFECTED ELIGIBILITY IS AFFECTED

Those qualified through the Supplemental Security Income (SSI) program

Those qualified through Temporary Assistance to Needy Families (TANF)

Those qualified through the Supplemental Security Income (SSI) program

Those qualified through Temporary Assistance to Needy Families (TANF)


TAKE AWAY MESSAGETAKE AWAY MESSAGEINDIVIDUALS WHO RESIDE IN CORRECTIONAL FACILITIES

SHOULD NOT BE DISENROLLED ONLY BECAUSE THEY ARE IN A

FACILITY

INDIVIDUALS WHO RESIDE IN CORRECTIONAL FACILITIES

SHOULD NOT BE DISENROLLED ONLY BECAUSE THEY ARE IN A

FACILITY


TANFTANF

Eligibility is suspended but should be reinstated prior to release provided they fit into the State Plan’s eligibility requirements and TANF regulations

Custodial parents

Eligibility is suspended but should be reinstated prior to release provided they fit into the State Plan’s eligibility requirements and TANF regulations

Custodial parents


SSISSI

Individuals living in “209 (b)” States can continue eligibility and receive services upon release

Individuals on SSI in non- 209 (b) States continue SSI cash payments and are Medicaid eligible for a period of up to 1 month following incarceration

Individuals living in “209 (b)” States can continue eligibility and receive services upon release

Individuals on SSI in non- 209 (b) States continue SSI cash payments and are Medicaid eligible for a period of up to 1 month following incarceration


SSISSI

12- Month suspension of eligibility and re-determination of continued disability

When SSI and therefore are activated, cash payments and Medicaid eligibility are reinstated from the time of release or the time of initial application/re-application

12- Month suspension of eligibility and re-determination of continued disability

When SSI and therefore are activated, cash payments and Medicaid eligibility are reinstated from the time of release or the time of initial application/re-application


FINAL TAKE HOME MESSAGESFINAL TAKE HOME MESSAGES

Do not disenroll individuals who are Medicaid eligible, eligibility is only suspended

FFP is affected, not eligibility Initial application for Medicaid can begin at

any time during incarceration Re-application should begin well in advance

of discharge

Do not disenroll individuals who are Medicaid eligible, eligibility is only suspended

FFP is affected, not eligibility Initial application for Medicaid can begin at

any time during incarceration Re-application should begin well in advance

of discharge


CONTACT INFORMATION CONTACT INFORMATION

Mary B. Tierney, MD

202-403-5620

[email protected]

Mary B. Tierney, MD

202-403-5620

[email protected]

Technical Assistance Partnership for Child and Family Mental Health MEDICAID AND JUVENILE JUSTICE...

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