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) received fifteen (15)* waiver applications from states for justice involved, 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.
FIRST PHASE
Enhanced care management services 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 plan through a provider network, and the ECM providers 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 attribute, enabling for a better experience for the patient.
SECOND PHASE
Pre- and Post-Release processes on 10/1/2024.
In October 2024, a defined set of re-entry services will be reimbursed to a correctional facility through Medi-Cal fee-for-service...up to 90 days prior to release of the youth or eligible adult. Products include 30-days of medications, durable medical equipment (i.e., wheelchair, assistive devices, medical supplies, oxygen). Services include physical & behavioral health consultations and treatments, case management & navigation, lab & radiology, and medication management. The pre-release services are administered by the corrections health provider (either county or embedded vendor).
The innovation of the pre- and post-release model interconnects the Office of Sheriff, Behavioral Health, Social Services, Public Health, Probation Department, and the Medi-Cal managed care plans. Historically the inmates received health care through a different system of care, then transitioned back into Medi-Cal following their release, based on meeting eligibility criteria.
In the new model of care, the inmate's health status and needs are determined, and a warm handoff occurs 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.
