CHP: Medicaid Rules For Inmates May Change

NYAPRS Note: The following piece underscores the critical importance of achieving 2 proposals before the Legislature that will greatly enhance the chances of a successful transition from prisons and jails by allowing Medicaid to fund transitional services that would include access to specialized health home networks. As mentioned yesterday (, this is one of our and MHANYS’ top priorities this year and fueled our efforts at the Capital yesterday.

Medicaid Rules For Inmates May Change

Crain’s Health Pulse March 17, 2016

Medicaid benefits are generally suspended for people who are in prison or jail, but a state health home project targeting the criminal-justice population has led some advocates and legislators to push for new exceptions to the rules.

Since late 2012, a handful of health homes across the state have been involved in a pilot project to identify and connect with members who are incarcerated so that they can begin to coordinate their housing and health services prior to their release. The idea is for health homes to collaborate with local correctional facilities to serve some of the hardest-to-reach people on their lists of Medicaid beneficiaries while reducing the rate of recidivism.

But the state Health Department didn't release the $5 million that was dedicated to the program in last year's budget because of concerns about violating federal and state Medicaid laws. The money is in the budget again this year, with new language aimed at creating a loophole, said Sebastian Solomon, director of New York state policy at the Legal Action Center, which coordinates the state'swork group on health homes and criminal justice.

The Brooklyn Health Home, led by Maimonides, has been able to advance with the pilot project through grant funding, including an award of $100,000 in September 2014 from the New York Community Trust. The health home has been working with DOHMH to find Rikers inmates on its list, most of whom have had Medicaid at one point and will need it reactivated upon release.

"Finding [health home members] has been so difficult for everybody," said Hannah Loeffert, the criminal-justice director at the Brooklyn Health Home. "You have to work within the confines of that person's actual life. For a lot of people, that is the justice system."

The health home was finding about 10% of its members through Rikers, Loeffert told the state work group in April 2015.

There has been talk among state officials about the possibility of seeking a federal waiver from CMS that would allow Medicaid funding to be used for the program, said Solomon.

DOH did not respond to a request for comment.

Following lobbying efforts by the Legal Action Center, the Assembly introduceda bill (A. 9320)last month that would require the state to "seek federal authority to provide Medicaid coverage for high-need inmates 30 days prior to their release from incarceration."

The Senate has not followed suit, but both one-house budgets included the $5 million for the program.

Health officials have been renewing calls for Medicaid dollars to flow to inmates for other services as well.

"A key funding opportunity could involve Medicaid waivers to reimburse [the] provision of chronic care inside jails and prisons that was initiated in a community setting," wrote Homer Venters, chief medical officer and assistant vice president of the Division of Correctional Health Services for New York City Health + Hospitals, ina report publishedin the latest issue of theAmerican Journal of Public Health.