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Tracie Gardner and Gabrielle de la Gueronniere, Legal Action Center Keith Brown, Katal Center for Health, Equity, and Justice June 26, 2019
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Some Logist stica cal Inform rmati tion
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Welcome to Turn On Care! National Strategy Discussion on NY's - - PowerPoint PPT Presentation
Welcome to Turn On Care! National Strategy Discussion on NY's - - PowerPoint PPT Presentation
Welcome to Turn On Care! National Strategy Discussion on NY's Application to Waive the Medicaid "Inmate" Exclusion Provision Tracie Gardner and Gabrielle de la Gueronniere, Legal Action Center Keith Brown, Katal Center for Health,
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Today’s Presenters
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Tracie M. Gardner, Vice President of Policy Advocacy Gabrielle de la Gueronniere, Policy Director Keith Brown, Director of Health & Harm Reduction
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Legal Acti tion Cente ter
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➢ LAC is a 45+ year old national law/policy organization working to promote
- pportunities for and fight discrimination against people with histories of
addiction, HIV/AIDS, and/or criminal records
➢Providing technical assistance in a number of policy and practice areas ➢Leading advocacy coalitions and campaign ❑No Health = No Justice campaign
❑Recognizing the link between mass incarceration, poor health access,
and systemic racism in the health care and criminal justice systems and working nationally to promote greater access to health and justice
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Kata tal Cente ter r for Health th, Equity ty, and Justice ce
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➢ Katal works to strengthen the people, policies, institutions, and movements that
advance health, equity, and justice for everyone. We are focused on three big, inter-related goals:
➢Ending mass criminalization, mass incarceration, and the war on drugs. ➢Advancing evidence-based solutions to promote health and safety, eliminate
unwarranted racial disparities, and secure equitable communities and
- utcomes.
➢Building leadership and organizing capacity of neighborhood residents, as well
as organizers, advocates, and community groups, to effectively drive and shape real change
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What We’ll Cover Today
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➢Discussion of New York State’s pursuit of a CMS waiver of the Medicaid
“inmate” exclusion for people preparing for release from incarceration
➢Review of how we got here: the problems we face and what the New York
waiver seeks to achieve
➢Specifics of the New York proposal ➢Next steps
❑What could New York’s work mean for reform efforts in your state? ❑How can national stakeholders help to promote health and justice?
➢Questions, answers, and discussion
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The Proble blems ms We Face ce: No Health lth = No Just stice ce
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➢ The vast majority of people leaving prisons/jails have significant untreated health needs, including mental
health and substance use disorders (MH/SUD)
➢ Within the first two weeks of release, returning citizens are 40 times more likely than other people in the
community to die of an overdose
➢ People leaving incarceration have higher rates of HIV/AIDS and hepatitis C, which also has an impact on
the health of families and the community
➢ Black and brown people are overrepresented at every stage of the criminal justice system and, coupled
with systemic racism in the health care system, have disproportionate unaddressed health needs
➢ Behind the walls, addressing health conditions is often not prioritized and effective interventions are
seriously underresourced
➢ There are barriers to using certain funding streams for care provided in prisons/jails
❑ Community-based providers are often unable to provide in-reach health care services to
incarcerated people due to the Medicaid “inmate “exclusion provision
➢ Many people are rearrested and reincarcerated because of unmet SUD/MH care needs
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The Goal: : Improvi ving Health and Preven venting Additional Contact with the Criminal Justice System
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➢ Prior to release from incarceration, provide people who need MH/SUD care with
certain medications, clinical services, and care management to strengthen reentry
➢ Expand funding for these important transitional services ➢ Promote connections for soon-to-be returning citizens with community-based
MH/SUD care providers
➢ Reduce the likelihood that individuals will have additional contact with law
enforcement/corrections by addressing underlying health needs
➢ Improve the health of individuals, their families, and the community
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The Mechanism: Waiver of the Medicaid “Inmate” Exclusion
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➢Why is Medicaid important for justice-involved people?
➢Medicaid is the single largest payer for mental health and substance use
disorder care in the United States
❑Close to 30 percent of people receiving coverage through the Medicaid expansion have a MH
and/or SUD ➢In the states that expanded their Medicaid population under the ACA, it is
estimated that between 80 and 90 percent of incarcerated individuals are eligible for Medicaid
➢There is a significant opportunity for states/localities to leverage the 90
percent federal financing of the Medicaid expansion to improve health
- utcomes for this population
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The Mechanism: Waiver of the Medicaid “Inmate” Exclusion (cont’d)
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➢ What is the Medicaid “inmate” exclusion provision?
➢Federal law that prevents federal Medicaid dollars from paying for health care for
incarcerated people
➢Significant barrier to care, including for those preparing to return home from
incarceration
➢ Why pursue a Medicaid 1115 waiver of the “inmate” exclusion provision?
➢Wholesale policy change at the federal level is difficult to achieve and slow ➢Use of waivers and demonstration projects is a way to test new things, evaluate
effectiveness, and make the case for broader policy reform
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New York’s 1115 Medicaid Waiver Proposal
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➢ In April of this year, New York’s Department of Health (DOH) posted a notice
requesting public comments on a proposal for the state to seek a waiver of federal law for Medicaid matching funds for certain transitional services provided 30-days before release to certain incarcerated people
➢ New York submitted a similar 1115 amendment application to CMS in 2016; the waiver was
later withdrawn since it was unclear how the then newly installed Trump Administration would have responded ➢ Now that NY DOH’s public comment period has expired, the state can next
submit its (potentially revised) application to CMS (the federal Centers for Medicare and Medicaid Services); this would trigger a second public comment period for national stakeholders to CMS
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New York’s 1115 Medicaid Waiver Proposal (cont’d)
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➢ New York’s draft 1115 Medicaid waiver proposes to cover:
➢ Incarcerated people with “serious behavioral and physical health conditions” who are eligible
for NY’s Medicaid Health Home program
➢ Certain medications, health home care management services, and limited clinical services
➢ LAC & P2PH recommendations to New York State:
➢ Enroll all individuals with substance use disorder and/or at risk of homelessness to address
the high rate of opioid related overdoses upon reentry into the community
➢ Prioritize jail populations because they are most in need of care continuity planning; allow for
Medicaid billing during the first 15 days of incarceration
➢ Allow Medicaid to cover targeted case management and wrap-around services including peer
support services and access to all forms of SUD medication-assisted treatment (MAT)
➢ Prioritize enrollment in managed care prior to reentry into the community
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Other Healt lth & Crimi minal l Just stice ce Consi siderations
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➢Initiation of HCV, HIV Care ➢SUD and Mental Health ➢MAT (Albany continuum model) ➢Overdose Prevention ➢Creates Accountability (CMS Quality Standards) ➢Saves $?
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Next t Ste teps
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➢Watch for LAC and Katal updates on next steps in NY’s process
➢Weigh in with your public comments
❑Comments from national stakeholders will be needed to encourage CMS to approve
New York’s application and to prioritize the health care needs of justice-involved people ➢Share NY’s activity with health and justice decision-makers in your state
❑Encourage other state Medicaid agencies to seek a waiver of the Medicaid “inmate”
exclusion
➢Keep an eye on federal activity
➢Monitor the Medicaid Reentry Act, federal legislation that would waive the
Medicaid inmate exclusion for the 30-day period pre-release
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The Work Continues
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➢ Work with states and localities to build strong, coordinated systems to
provide care for justice-involved people
➢Promote health insurance eligibility screening and enrollment throughout
the criminal justice system
❑Goal = seamless continuous coverage
➢Foster continuity of care
❑Ensure people can receive care without delay or interruption as people move within
parts of the criminal justice system and between the criminal justice system and the community ➢Incentivize diversion from law enforcement/corrections into health care,
including MH and SUD care, as early and as often as possible
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The Work Continues
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➢ Protect and leverage Medicaid ➢ Improve access to the full continuum of evidence-based mental health and
SUD services, medications, and supports
➢Enforce the federal Mental Health Parity and Addiction Equity Act to strengthen
coverage of MH and SUD services/medications
➢Strengthen the capacity of the community-based systems of high quality
evidence-based MH, SUD and physical health care
➢Ensure there is culturally competent care that meets the complex health care
needs of justice-involved individuals
❑ Support programming led by peers
➢ Address the impact of criminal record barriers to successful community reentry
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Fo For more inform rmati tion
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➢LAC's No Health = No Justice page:
https://www.lac.org/major-project/no-health-no-justice
➢LAC: www.lac.org, twitter: @lac_news ➢Katal Center for Health, Equity and Justice:
https://www.katalcenter.org/, twitter: @katalcenter
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Questi tions, s, Answers rs, and Discu cuss ssion
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