The Affordable Care Act and the Pretrial System July 13, 2014 Lore Joplin
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1 The Affordable Care Act and the Pretrial System July 13, 2014 Lore Joplin Photo: Nicolas Raymond
2 Agenda 1. Overview of the ACA 2. Opportunities for pretrial 3. What next? 4. Resources Photo: Miguel Pires da Rosa on Flickr
3 Agenda Overview of the ACA Photo: jhritz on Flickr
4 Two Pathways Agenda to Coverage 1. Marketplace for private insurance Available in all states 2. Medicaid expansion Not in all states Photo: laffy4k on Flickr
5 Agenda The Insurance Marketplace Enrollment Open enrollment period Life events Costs & Credits Income % of Federal Poverty Limit (FPL) Lower premiums Tax credits Photo: Ofer Deshe on Flickr
6 Agenda Marketplace Type by State Map: Kaiser Family Foundation
7 Medicaid: Expansion Agenda of Eligibility Open Enrollment Citizenship (most states) < 133/138% FPL
8 Agenda Medicaid Optional by State Map: Kaiser Family Foundation
9 Agenda Who s Covered under the ACA? Status & Coverage Status Medicaid Expansion (participating states) Insurance Marketplace (all states) Pretrial (not detained) Yes (under 138%* of FPL) Yes (133%-400% of FPL) Pretrial detainees Other criminal justice involved individuals in the community Individuals sentenced to and incarcerated in jail or prison No (unless in community-based hospital care for >24hrs) Yes (under 138%* of FPL) No (unless in community-based hospital care for >24hrs) Potentially (depends on specific policies of the selected QHP and the network status of the jail health services provider.) Yes (133%-400% of FPL) No *The threshold is 133% FPL, but 5% of an individual s income is disregarded, effectively raising the limit to 138% FPL
10 Essential Agenda Health Benefits Ambulatory patient services Emergency services Hospitalization Prescription drugs Lab services Rehabilitative and habilitative services and devices Maternity and newborn care Photo: dinostock on PhotoXpress
11 Essential Health Agenda Benefits cont d Pediatric services, including oral and vision care Preventive & wellness services & chronic disease management Behavioral health (mental health and substance abuse treatment) Photo: dinostock on PhotoXpress
12 No Wrong Door!
13 Crisis Teams Diversion Specialty Courts Law Enforcement Contact Arrest & Booking Initial Detention First Court Appearance Dispositional Court Jail Reentry Pretrial Release Prison Reentry Probation Parole Community Cite & Release Detained Pretrial Healthcare Enrollment Intercepts in the Criminal Justice System Sample Decision Points INTERCEPT 1 Law Enforcement/ Emergency Services INTERCEPT 2 Initial Detention & Court Hearings INTERCEPT 3 Jails / Courts INTERCEPT 4 Reentry INTERCEPT 5 Community Corrections Violation Violation Opportunities for Eligibility Determination and Enrollment Crisis teams enroll or refer for enrollment Hospital enrolls Local booking determines eligibility/enrolls Bail entity determines eligibility/enrolls Public defender refers for enrollment Treatment providers determine eligibility/enroll Pretrial Services/ DSS determine eligibility/enroll Bail entity determines eligibility/enrolls Public defender refers for enrollment Enrollment for individuals diverted at disposition Specialty court worker (or treatment provider) enrolls at intake Jail intake determines eligibility/enrolls DOC intake determines eligibility/enrolls DOC/Jail discharge planners determine eligibility/enroll Parole/probation determines eligibility/enrolls prior to discharge Transitional/halfway houses determine eligibility/enroll Parole/probation determines eligibility/enrolls prior to discharge Treatment providers determine eligibility/enroll Pretrial detainees enrolled upon release National Institute of Corrections
14 Opportunities for Pretrial Photo: jhritz on Flickr
15 Pretrial as a Gateway To Care Widest net in the CJ system Opens access to: Medical Mental Health Substance Abuse Increases opportunities for pretrial release Photo: ladot on Flickr
16 Benefits of Agenda Access at Pretrial Public health Public safety Health care & custody cost savings for jails; and Decreased barriers to treatment Photo: Gwyn Fisher on Flickr
17 Examples: Agenda Cook County Collaborative process Enrollment at booking TASC, Inc. staff co-located in jail Case Study: Photo: Contemplative Imaging Flickr
18 Examples: Agenda Connecticut MH Diversion Post-arraignment Enrollment DOC Intake Reentry Photo: Doug Kerr on Flickr
19 More Agenda Examples Denver Alameda County San Diego Probation Multnomah County Others Photo: Kal Hendry on Flickr
20 Agenda What Next? Photo: jhritz on Flickr
21 Collaborative Agenda Planning Build on what you re already doing Choose a convener Bring the right people to the table Be clear about your goals and expectations
22 Address Large Agenda Policy Questions Where do we start? How can we work together? What are your state s Medicaid rules? Are providers prepared? Is there sufficient community capacity? Photo: Tom on Flickr
23 Agenda Resources Photo: jhritz on Flickr
24 More Agenda Info Federal Marketplace ( Centers for Medicare & Medicaid Services ( ) Substance Abuse & Mental Health Services Administration ( Kaiser Family Foundation ( National Association of Pretrial Services Agencies (
25 Contact Lore Joplin om m
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