health coverage enrollment in jails: …naco.org/sites/default/files/documents/health...

HEALTH COVERAGE ENROLLMENT IN JAILS: IMPORTANT PROVISIONS AND STRATEGIES

9:00AM – 10:00AM

Housekeeping

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Workshop Evaluations

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Chief Deputy Glen Matayabas

Buncombe County Sheriff’s Office

60 Court Plaza, Asheville, NC 28801

Email: [email protected]

Office: 828-250-4578 Mobile: 828-450-5098 Fax: 828-250-4471

HEALTH COVERAGE IN JAILS:

IMPORTANT PROVISIONS AND STRATEGIES

mailto:[email protected]

BUNCOMBE COUNTY DETENTION FACILITY

The Buncombe County Detention Facility is a

604-bed, adult local confinement facility utilizing a

direct supervision style of inmate management.

The facility confines pre-trial and sentenced local,

state and federal inmates. In 2014, the facility

booked 13,825 inmates and had an average daily

population of 438 inmates.

JAIL SYSTEM AND POPULATION 5

POPULATION SNAPSHOT

• Total Inmate Population 455

Male Inmates 403

Female Inmates 52

• Pre-Trial Inmates 339

• Sentenced Inmates 116

• Federal Inmates 38

• Statewide Misdemeanant Confinement Program 45


ACCESS TO MEDICAL CARE

“From the moment an inmate enters a county jail, whether awaiting trial or

convicted, they gain access to complete medical care including prescriptions,

dental and mental health.”

Sheriff Ed McMahon of the New Hanover County Sheriff’s Office.

(5/14/14 Web Article from WECT TV6)


LEGAL DUTY OF THE SHERIFF

• Deliberate Indifference…A jail official is deliberately indifferent

to an inmate’s serious medical needs only if the official actually

knows that the inmate has a serious medical need and fails to

take reasonable steps to deal with it. (Farmer v. Brennan, 511

U.S. 825, 1970)

• Federal courts have held that a serious medical need is “one

that has been diagnosed by a physician as mandating

treatment or one that is so obvious that even a lay person

would easily recognize the necessity for a doctor’s attention.”

Estelle v. Gamble, 429 U.S. 97 (1976)


http://en.wikipedia.org/wiki/United_States_Reports

OUR JAIL MEDICAL PHILOSOPHY

• Contracted medical services with 24/7 medical staff coverage

• Contract for medical services only – cost pool for outside services not

included and focused on cost saving strategies

• Medical services based on National Commission on Correctional Health

Care Standards

• The Sheriff’s Office and County takes a proactive approach to address

the medical needs of the inmates at the point of intake/booking

• Collaborative effort utilizing all available county services with EMS, HHS,

Jail, LME and case management through RHA


DETENTION OFFICER

MEDICAL PROCESS

Jail Nurse

Jail

Intake

Medical

Screener

Brief Jail Mental

Health Screener


NURSE MEDICAL PROCESS

Referral FNP

Triage Nurse in Booking

Immediate H & P

Private Interview


NURSE MEDICAL PROCESS

• Immediate review of inmates history and medical needs no fourteen day waiting period or

having to sign up for sick call – proactive approach

• Address internal medical needs early to reduce outpatient costs

• Assess insurance along with determination for qualifications for disability or medicaid

• Inmates with high risk health concerns are seen early to prevent any inmates that are

contagious don’t put other inmates or staff at risk

• Inmates with drug and alcohol abuse are seen early placed on withdrawal protocols in order not

to experience a catastrophic event because of appropriate detoxification procedures

• Stabilize patients, catch contagions diseases quicker, know how to house inmates, reduced ER

visits and outpatient sourcing

• Early detection, early recognition, early advanced life support and early distribution of services


MEDICAID ENROLLMENT

• Population of Buncombe County is 247,912 of which 44,000 have been

determined eligible and approved for Medicaid.

• Almost eighteen percent of the county residents qualifies for Medicaid under

the NC Fast Track System.

• Jail Triage Nurse immediately reviews availability of insurance and eligibility

for Medicaid under NC Fast.

• Those inmates that generally qualify under NC Fast:

• Single adults ages 18 to 64 declared disabled by Disability

Determination Services

• Pregnant females

• Low income families

• Suicide attempts with wrap-around services for mental health

MEDICAID ENROLLMENT 13

MEDICAID ENROLLMENT

• Under the Affordable Care Act, North Carolina is a non-expansion state

under Medicaid

• It is important to be able to quickly qualify and enroll inmates in

Medicaid, when these inmates receive outside medical services which

can be costly to the county

• Process for enrolling Medicaid-eligible individual can start in jail allowing

continuity of care

• Sheriff’s Office, Social Services, Probation, Certified Navigators and

Hospitals need to work together to get clients enrolled


MEDICAID ENROLLMENT

• Age and Gender which are most eligible – Low income childless adults

likely to be males and to be under age 35

• Benefits for inmates under Medicaid:

• Emergency Services

• Hospitalization

• Maternity and Newborn Care

• Mental Health and Substance Abuse Services

• Prescription Drugs

• Laboratory Services


INMATE INPATIENT EXCEPTION

• Because of the Affordable Care Act, Medicaid now covers more individuals under the Patient Protection and Affordable Care Act (PPACA). Some that are eligible qualify as low-income adults and includes inmates from local jails such as Buncombe County.

• Federal law prohibits states from obtaining federal Medicaid matching funds for health care services provided to inmates with the exception of when inmates are patients in medical institutions.

• Under this exception, inmates who are eligible for Medicaid are admitted to hospitals for at least 24 hours, qualify for inpatient services under federal Medicaid. The intent of the federal prohibition is to ensure that federal Medicaid funds are not used to finance care that is the responsibility of state and local authorities.

INPATIENT EXCEPTION 16

BUNCOMBE COUNTY MEDICAL COSTS

• Medical Staff Contract $962,652

• Outside Medical Services $366,664

• Medical Supplies $9,648

• Total Cost $1,338,964

• Average Cost Per Inmate $8.37

• Average Daily Population 438

MEDICAL COST SAVINGS 17

BUNCOMBE SAVINGS


NORTH CAROLINA STATUTES

• § 153A-225. Medical care of prisoners.

• May utilize Medicaid coverage for inpatient hospitalization or

for any other Medicaid services allowable for eligible prisoners,

provided that the plan includes a reimbursement process which

pays to the State the State portion of the costs.

• Each unit may establish fees of not more than twenty dollars

($20.00) per incident for the provision of nonemergency

medical care to prisoners and a fee of not more than ten dollars

($10.00) for a 30-day supply or less of a prescription drug. In

establishing fees pursuant to this section, each unit shall

establish a procedure for waiving fees for indigent prisoners.



• § 153A-225.2. Payment of medical care of prisoners.

• Counties shall reimburse those providers and facilities providing

requested or emergency medical care outside of the local

confinement facility the lesser amount of either a rate of seventy

percent (70%) of the provider's then-current prevailing charge or

two times the then-current Medicaid rate for any given service.

Each county shall have the right to audit any provider from whom

the county has received a bill for services under this section but

only to the extent necessary to determine the actual prevailing

charge to ensure compliance with this section.



• § 153A-224, the facility shall pay the cost for emergency

services unless the inmate has third party insurance. The

county is only responsible for costs not reimbursed by third

party insurance such as Medicaid.

• For all medical claims for inmates which are active or eligible

for Medicaid under NC Fast are denied for this reason and

returned.

STRATEGIES TO REDUCE COSTS

• Employ telemedicine technology to reduce outpatient costs

• Initiate outsourcing agreements with discounts

• Coordinate with County Health and Human Services for

inmates admitted to the hospital for eligibility under NC Fast

• Review health and/or hospital contracts annually

• Use performance benchmarks and statistics to review

adequate cost savings

• Ensure all medical bills are scrubbed for accuracy and

pricing

• Review Inmate Catastrophic Insurance

QUESTIONS

Chief Deputy Glen Matayabas

Buncombe County Sheriff’s Office

60 Court Plaza, Asheville, NC 28801

Email: [email protected]

Office: 828-250-4578 Mobile: 828-450-5098 Fax: 828-250-4471

mailto:[email protected]

COOK COUNTY HEALTH & HOSPITALS SYSTEM

Health Coverage Enrollment in Jails

NACo Annual Conference July 12, 2015

System Overview

The Cook County Health & Hospitals System (CCHHS) served more than 300,000 unique individuals this past year. CCHHS at a Glance: • 2 hospitals, • 16 outpatient facilities, • four regional centers with specialty services and advanced

diagnostics, • correctional health services, • a specialty center for persons with infectious disease, • a nationally-certified public health department, • CountyCare, one of the largest Medicaid managed care health

plans in the region with more than 170,000 members.

25 NACo Annual Conference I July 2015

CountyCare Medicaid Health Plan

As the result of the Patient Protection and Affordable Care Act (ACA), for the first time in the CCHHS’ history, a majority of our patients have health insurance coverage.


5%

32%

21%

16%

26% COMMERCIAL

MEDICAID

MEDICAID MANAGED CARE

MEDICARE

OTHERS

UNINSURED

CountyCare Network

More than 130 primary care access sites • all CCHHS facilities • all Federally Qualified Health Centers (FQHCs) in Cook County • American Indian Health Service • 30+ hospitals including every major academic medical center in

Cook County

Access to a comprehensive range of health care services • primary & specialty visits • prescription medications • laboratory, x-ray and other diagnostic services • mental health and substance use treatment services • dental care, vision care, and transportation


CCHHS Payor Mix

28

NACo Annual Conference I July 2015

54.4

36.5 32.3

45.6

63.5 67.7

0

10

20

30

40

50

60

70

80

90

100

2013 2014 2015

Insurance Status of CCHHS Patients

Uninsured/ self pay Insured

54

.4

32

.2

10

.9

2.5

36

.5

47

.7

12

.1

3.7

32

.3

50

13

.5

4.2

S E L F - P A Y M E D I C A I D M E D I C A R E C O M M E R C I A L

CCHHS PAYOR MIX 2013-2015

2013 2014 2015

Correctional Health Services CCHHS operates one of the largest correctional health services in the country. CCHHS provides a comprehensive range of onsite services to detainees at the Cook County Jail. • Primary Care • 11 Specialty Care Clinics • Dental and Mental Health Services • Laboratory Work • Pharmacy • Rehabilitative Care • Dialysis • 129-bed infirmary


Correctional Health Costs

Each year, CCHHS spends upwards of $70 million in providing correctional health services. • 75,000+ intake screenings for new detainees, • 83,000+ primary care, urgent care & specialty care visits for those

in custody, • 6 million doses of medication, • 20-30% of the jail population are monitored for behavioral health

on any given day.


Medicaid Enrollment at the Jail

In keeping with its mission to serve all in need, CCHHS has an obligation to care for detainees not only while incarcerated, but after they are released as well. Enrolling detainees during the intake process ensures that eligible detainees have health coverage upon or soon after release. This promotes continuity of care for these individuals, especially those with chronic conditions, once they are back in their communities.



Inmates upon intake meet with an ‘Application Assistor’ to screen for Medicaid eligibility and assist with completing an online application. Individuals not able to complete an application at the time of intake are identified for follow-up within 72 hours, often post-discharge. Applications are tracked and monitored for successful processing by the State.



In partnership with Treatment Alternatives for Safe Communities (TASC), CCHHS has helped more than 12,000 detainees at the jail enroll in Medicaid. Once enrolled in Medicaid, an individual can choose to join or is otherwise auto-enrolled into one of approximately 15 managed care plans, including CountyCare. Currently, over 4,000 of CountyCare’s members originated from the jail application initiative.


Post-Release Linkage

CCHHS recently enhanced its collaboration with TASC to provide linkage programs to help connect individuals being released from the Cook County Jail with vital services, including: • community based health and behavioral health care providers

and services, • transportation, • shelters and housing resources, • food pantries, • workforce development programs.


What’s Next

• National Health Service Corps Legislation

• Community-based Crisis Intervention/Triage Centers

• Polk Bros. Initiative


Questions and Answers

If you would like to ask a question, please go to the nearest microphone.

Evaluations

NACo values all feedback.

Evaluation forms can be found in the NACo Conference app and online at

www.naco.org/workshopevals.

Please visit iTunes or Google Play to download the 2015 NACo Annual Conference App!

http://www.naco.org/workshopevals

health coverage enrollment in jails: …naco.org/sites/default/files/documents/health...

Documents