Billing the Medi-Cal program for pre-release services is a new opportunity for the county agencies overseeing the custody operations and delivering health care services in the correctional facilities. The CalAIM program authorizes the Medi-Cal program to fund a specific set of health services during the last 90 days of incarceration for youths and adults. The CalAIM pre-release services are arranged into clinical services and care management bundles, and revenues are earned as services are rendered in the detention facility. The DHCS has identified approximately 150 billable codes in the Medi-Cal rates for outpatient-based screenings and assessments, physical health services, mental health services, substance use treatments, pharmaceuticals, and other Medi-Cal covered benefits.

Behavioral health agencies are being incentivized for clinical services during the pre-release period, and in addition, for the post-release linkages to specialty mental health and substance use treatment services. Conversely, the correctional facilities are seeking to generate most of the revenues from the pre-release services, and to offset the costs for embedded health services. Sustaining the pre-release services is dependent on the ability to draw down the Medi-Cal funding to cover the additional expenses, and represents an area of interest.

The Medi-Cal fee-for-service program pays for pre-release services, and the Medi-Cal Short Doyle program pays for the post-release services. In addition, the Medi-Cal managed care health plans are contracted with the DHCS to administer the health benefits following the individual’s release from the detention facility. Medi-Cal fee-for-service rates, coding, modifiers, and reconciliations are the most complicated parts of the billing cycles, and the Serrano team has developed a framework to maximize revenues for correctional facilities and behavioral health agencies.

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