HEALTH COVERAGE ENROLLMENT IN JAILS: IMPORTANT PROVISIONS AND STRATEGIES 9:00AM 10:00AM

HEALTH COVERAGE ENROLLMENT IN JAILS: IMPORTANT PROVISIONS AND STRATEGIES 9:00AM 10:00AM

Housekeeping Please silence all mobile devices. This session is being recorded. To view the recording please visit www.naco.org/educational-recordings. Questions will be answered at the end of the session.

Workshop Evaluations Workshop evaluations 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!

HEALTH COVERAGE IN JAILS: IMPORTANT PROVISIONS AND STRATEGIES Chief Deputy Glen Matayabas Buncombe County Sheriff s Office 60 Court Plaza, Asheville, NC 28801 Email: glen.matayabas@buncombecounty.org Office: 828-250-4578 Mobile: 828-450-5098 Fax: 828-250-4471

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 JAIL SYSTEM AND POPULATION 6

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) JAIL SYSTEM AND POPULATION 7

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) JAIL SYSTEM AND POPULATION 8

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 JAIL SYSTEM AND POPULATION 9

DETENTION OFFICER MEDICAL PROCESS Jail Intake Medical Screener Brief Jail Mental Health Screener Jail Nurse JAIL SYSTEM AND POPULATION 10

NURSE MEDICAL PROCESS Triage Nurse in Booking Immediate H & P Private Interview Referral FNP JAIL SYSTEM AND POPULATION 11

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 JAIL SYSTEM AND POPULATION 12

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 14

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 MEDICAID ENROLLMENT 15

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 MEDICAL COST SAVINGS 18

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. MEDICAL COST SAVINGS 19

NORTH CAROLINA STATUTES 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. MEDICAL COST SAVINGS 20

NORTH CAROLINA STATUTES 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: glen.matayabas@buncombecounty.org Office: 828-250-4578 Mobile: 828-450-5098 Fax: 828-250-4471

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% 26% COMMERCIAL 16% 21% 32% MEDICAID MEDICAID MANAGED CARE MEDICARE OTHERS UNINSURED 26 NACo Annual Conference I July 2015

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 27 NACo Annual Conference I July 2015

2.5 3.7 4.2 10.9 12.1 13.5 32.3 32.2 36.5 47.7 50 54.4 CCHHS Payor Mix 100 90 Insurance Status of CCHHS Patients CCHHS PAYOR MIX 2013-2015 2013 2014 2015 80 45.6 70 63.5 67.7 60 50 40 30 54.4 20 36.5 32.3 10 0 2013 2014 2015 Uninsured/ self pay Insured 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 28 NACo Annual Conference I July 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 29 NACo Annual Conference I July 2015

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. 30 NACo Annual Conference I July 2015

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. 31 NACo Annual Conference I July 2015

Medicaid Enrollment at the Jail 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. 32 NACo Annual Conference I July 2015

Medicaid Enrollment at the Jail 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. 33 NACo Annual Conference I July 2015

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. 34 NACo Annual Conference I July 2015

What s Next National Health Service Corps Legislation Community-based Crisis Intervention/Triage Centers Polk Bros. Initiative 35 NACo Annual Conference I July 2015

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!