JUSTICE INVOLVED
Across the country, two million adults and youth occupy nearly 6,400 facilities, including state prisons, federal prisons, local jails, juvenile correctional facilities, immigration detention facilities, and Native American Country jails, military prisons, civil commitment centers, and state psychiatric hospitals.
The Centers for Medicare and Medicaid (CMS) has approved 3 of 15 waiver applications from states for coordinated reentry services through the 1115 demonstration waivers.
California is the first state to receive approval, and is preparing to implement a pre- and post-release coordinated re-entry model in state prisons, county jails, and juvenile detention facilities. The demonstration waiver authorizes California to leverage matching federal funds to reimburse correctional facilities for delivering a specific set of services to all youth and eligible adults, up to 90 days prior to release.
The justice involved initiative is divided into two phases, and is intended to improve health outcomes and reduce health disparities.
ENHANCED CARE MANAGEMENT
Enhanced care management services for justice involved populations began on 1/1/2024.
The Medi-Cal managed care health plans are expanding the enhanced care management benefit to the justice involved populations (all youth and eligible adults). The enhanced care management benefit, referred to as "ECM", and includes the following services:
- Outreach and Engagement
- Comprehensive Assessment and Care Management Plan
- Enhanced Coordination of Care
- Health Promotion
- Comprehensive Transitional Care
- Member and Family Supports
- Coordination of and Referral to Community and Social Support Services
The ECM benefit is administered by the Medi-Cal managed care plans through provider networks that are contracted to administer services in each county. The ECM providers are responsible for coordinating care with service providers -- such as the medical, mental health, substance use, housing, and other service providers that address the social determinants of health. The ECM benefit is linked to a whole-person care approach to treating people with services they need to live a higher quality of life. And the linkage into the specialty mental health services is a major service component, enabling a better experience for the patient.
PRE-RELEASE SERVICES
Between October 2024 and September 2026, California's correctional facilities will launch a new set of services up to 90 days prior to release. Complex case management, release medications, durable medical equipment, transportation, linkages to community providers, and reentry care plans will be integrated into the custody operations.
In the new model of care, the inmate's health status and needs are determined, and a warm handoffs occur as the individual is released, whether by parole or probation; a combination of data exchange and discharge planners meeting to review the patient's needs. Connections to primary care are initiated, and a continuity of care plan is used as a centerpiece to ensure that appropriate and timely care is arranged. The health information about the inmate is shared with the managed care health plan for coordination through the Medi-Cal enhanced care management benefit (i.e., medication assisted treatments, psychotropics & other medications, health condition, treatment history while incarcerated). Lastly, a post-release treatment plan is incorporated into the discharge planning process, and handed off to the Medi-Cal managed care health plan upon release from incarceration.
Correctional facilities must complete a go-live readiness assessment with the California Department of Health Care Services (DHCS) in advance of launching the pre-release services. The DHCS is allowing correctional facilities up to two years to complete the readiness and go-live by March 2026. County health officials will need to consider the cost of delaying the go-live dates, as the health-related expenses would be the responsibility of the local agencies until the DHCS approves through the readiness process.
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* CMS waiver applications submitted by California, Arizona, the District of Columbia, Kentucky, Massachusetts, Montana, New Hampshire, New Jersey, New Mexico, Oregon, Rhode Island, Utah, Vermont, and Washington.
