NY Waiver to Provide Medicaid Services 90 Days Before Prison/Jail Release Moves to Comment Period

NYAPRS Note: New York’s Medicaid Waiver proposal to start Medicaid services to support successful jail/prison to community transitions of ‘vulnerable’ populations has moved into the comment period, subsequent to being sent to the federal Medicaid agency (CMS) for approval.

The waiver allows Medicaid to pay for ‘bridging care’ including care management, such as "in-reach," a care needs assessment, development of a discharge care plan, making referrals and appointments with physical and behavioral health providers, and linkages to other critical social services and peer supports.

This approach will build on what’s been learned from several ‘criminal justice health home’ statewide pilot programs.  

Eligible groups include incarcerated individuals who have two or more chronic physical/behavioral health conditions, a serious mental illness, HIV/AIDS, or opioid use disorder.

NYAPRS has offered comments as a member of the Health Home Criminal Justice Workgroup and strongly welcomes and supports movement of this waiver, viewing it as an essential element in the continuum of prison diversion via Crisis Intervention Teams, essential rehabilitation services as spelled out in the Humane Alternatives to Longterm Solitary Confinement (HALT) legislation and re-entry via this waiver and access to specialized criminal justice health homes.

The application can be viewed at https://health.ny.gov/health_care/medicaid/program/medicaid_health_homes/special_populations/docs/cj_cms_amendment_final.pdf; Comments may be submitted within 30 days by emailing 1115waivers@health.ny.gov.

Governor Cuomo Directs Department of Health to Apply for Federal Waiver to Provide Medicaid Services to Incarcerated Individuals Leaving Prisons and Jails

Initiative Will Reduce Recidivism and Improve Public Health, without Increasing Healthcare Costs

Federal Approval Required

ALBANY, N.Y. (August 14, 2019) - The New York State Department of Health today announced that at Governor Andrew M. Cuomo's direction, it is submitting for public comment an application to the US Center for Medicaid and Medicare Services, to provide Medicaid services to certain incarcerated individuals about to be released from county jails and New York State prisons. The services will be provided beginning 30 days prior to the release date for people enrolled in Medicaid with certain serious health conditions.

The Waiver Amendment will be posted online for public comment for 30 days beginning today. The comment period is the final requirement before the state can submit the application to amend its Medicaid Redesign program.

"For incarcerated individuals leaving prisons and jails, it is critical that they receive the healthcare services they need for a seamless transition to life outside the correctional facility," said New York State Department of Health Commissioner Dr. Howard Zucker. "Ensuring continuous healthcare coverage for criminal justice involved populations with serious health conditions will make our communities both healthier and safer."

The waiver application was highlighted in the 2019 State of the State Justice Agenda. The initiative will apply to incarcerated individuals who have two or more chronic physical/behavioral health conditions, a serious mental illness, HIV/AIDS, or opioid use disorder, and enable them to connect to community-based care prior to release from incarceration. Because criminal justice involved populations have higher rates of emergency department visits and hospitalizations, any increase in Medicaid spending is expected to be offset by reductions in the use of these services.

If the Center for Medicaid and Medicare Services (CMS) grants New York State's waiver request, Medicaid-covered services will include care management, such as "in-reach," a care needs assessment, development of a discharge care plan, making referrals and appointments with physical and behavioral health providers, and linkages to other critical social services and peer supports. Through the initiative, incarcerated individuals will also receive clinical consultation services provided by community-based medical and behavioral health practitioners, to facilitate continuity of care post release. They will also receive a medication management plan and certain higher priority medications for chronic conditions, to support longer-term clinical stability post release.

These services will provide key "bridging care" for the Medicaid members prior to transition to the community and will allow continuous care management through Medicaid Health Homes, a group of health care and service providers working together to make sure Medicaid members get the care and services they need. This effort would further foundational work done by state-funded pilots to link Health Home care management to services for high-risk incarcerated individuals before and after release, in an effort to better coordinate care to avoid hospitalization, reincarceration and other negative outcomes.

Commissioner of the NYS Office of Mental Health Dr. AnnSullivan said, "By enabling individuals with mental illness who are leaving prisons and jails to get the critical healthcare services they need, we are helping to ensure that they will not return to the prison system and will instead make their way on the road to recovery.With access to needed services in the community, they will have the opportunity to live a successful and healthy life."

Department of Corrections and Community Supervision Acting Commissioner Anthony J. Annucci said, "Approval of this Medicaid waiver would provide incarcerated individuals returning home from prison with a continuity of health care, breaking down a significant barrier to a successful reentry and helping to keep our communities healthy and safe."

OASAS Commissioner Arlene González-Sánchez said, "It is critically important that incarcerated individuals affected by addiction have health resources and supports made available to them prior to their release. Approval of this waiver will save lives by increasing the opportunity for them to receive critical services and it will continue to strengthen addiction services across New York State."

Incarcerated individuals with serious health and behavioral conditions use costly Medicaid services such as inpatient hospital stays, psychiatric admissions, and emergency department visits for drug overdoses at a high rate in the weeks and months immediately after release. According to the National Institutes of Health (NIH), one in 70 people are hospitalized within a week of release from prison or jail (2.5 times higher than people who were never incarcerated) and one in 12 is hospitalized within 90 days (nearly twice as high as people never incarcerated),rates which are likely higher for high-cost, high-need inmates targeted by the demonstration waiver. Nationally, nearly a quarter of criminal justice involved populations have a first emergency department visit within one month of release and are more likely than the general population to visit the emergency department due to a mental health condition, substance use disorder, or ambulatory sensitive condition.

The ability to provide Medicaid services to incarcerated individuals during the 30-day period prior to release will complement other initiatives and build-upon the State's current efforts to engage the criminal justice involved population in health care as they re-enter the community. These initiatives include:

  • The Health Home Criminal Justice Workgroup, which is a New York State Department of Health (DOH)-sponsored statewide group convened around the opportunities for the Medicaid Health Homes to engage the criminal justice involved population;

  • The Justice and Mental Health Collaboration Program (JMHCP), administered by the NYS Division of Criminal Justice Services (DCJS), in partnership with the NYS Office of Mental Health (OMH) to improve outcomes for individuals with mental illness by enhancing criminal justice and behavioral health collaboration at the local government level;

  • Various health care, community provider and criminal justice collaborations working with Criminal Justice-Involved Individuals at the local municipality and county level.

New York State is a national leader in building programs that address the needs of people with the most serious and costly physical and behavioral health problems. Such programs include: Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs; integrated Health and Recovery Plans (HARPs) to provide an enhanced managed care benefit to individuals with serious mental illness and substance use disorders; delivery system reform efforts to reduce avoidable hospitalizations and integrate primary care and behavioral health services; and Health Homes to provide intensive care coordination to individuals with multiple chronic conditions, including, importantly, five State-funded criminal justice health home pilots to identify and engage justice-involved individuals in order to reduce their health care costs and improve the quality of care for this population. Medicaid is the core financing stream for each of these efforts.

Beginning August 14th, the application can be viewed here: https://health.ny.gov/health_care/medicaid/program/medicaid_health_homes/special_populations/docs/cj_cms_amendment_final.pdf

Comments may be submitted by emailing 1115waivers@health.ny.gov, or by mail to:

NYS Department of Health
Office of Health Insurance Programs
Waiver Management Unit
99 Washington Avenue
12th Floor, Suite 1208
Albany, NY 12210

https://www.health.ny.gov/press/releases/2019/2019-08-14_federal_waiver.htm