HHS Approves California’s Medicaid and Children’s Health Insurance Plan (CHIP) Demonstration Authority to Support Justice-Involved Care


One-of-a-kind initiative will help people get the behavioral health care they need upon release from incarceration

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved a California Section 1115 Demonstration First Amendment that will provide a set of pre-release services and improve access to much-needed care for people returning home from jails and prisons.

For example, Medi-Cal may cover drug treatment before a Medicaid recipient is released from jail, jail, or a youth correctional facility. Additionally, the state may help connect the person to community Medicaid providers 90 days before release to ensure they can continue treatment after returning to the community.

“The Biden-Harris administration is focused on expanding access to health care across the country and is doing so with fairness in mind,” HHS Secretary Xavier Becerra said. “In partnership with HHS, the State of California is leading the way in providing coverage for those involved in the justice system. This is the first time in history that Medicaid will provide coverage for those involved in the justice system before their release. This is a step forward in closing the gaps in services that this underserved community experiences, and I encourage other states to follow California’s lead.

“Today we have taken an important step in expanding health care coverage,” said CMS Administrator Chiquita Brooks-LaSure. “This demonstration allows us to make historic changes for incarcerated people who are eligible for Medicaid or CHIP. By helping these people access essential services and care coordination before they are released, we will also avoid gaps in care when they return to their communities.

In this first-of-its-kind approval, California will have the authority to cover pre-release services to incarcerated individuals, which is consistent with coverage under the demonstration opportunity provided in Section 5032(b) of Prevention of substance use disorders that promotes opioid recovery and treatment for patients and communities (SUPPORT) Law. This work also builds on President Biden February 2022 Executive Order to Expand Affordable, Quality Health Care Coverage, which includes strengthening Medicaid and the Affordable Care Act, and its May 2022 landmark executive order to advance effective and accountable policing and criminal justice practices, which includes improving treatment and rehabilitation in jails, jails, and other correctional facilities, and supporting successful entry . This is the first time that Medicaid will pay for a limited set of health care services provided to those involved in the justice system before their release – a key part of the president’s proposed public safety program, the Safer America plan.

As part of the approval, California will also increase and maintain provider payment rates and Medicaid managed care payment rates in obstetrics, primary care, and behavioral health as a condition of the authority’s approval. to receive State Designated Health Program (DSHP) funding (which allows the state to access federal matching dollars for certain health-related services previously funded only with US dollars) State). In obstetrics alone, this represents the potential to invest $60 million in the health of pregnant and postpartum women by increasing access to providers and thereby improving health outcomes for pregnant women. Coupled with additional support for essential options like home and community services, the demonstration of 1115 holds promise for transforming the nature of care.

As part of the demonstration, California aims to achieve the following objectives:

  • Increase coverage, continuity of care and appropriate use of services through assessment of eligibility and availability of coverage for prison benefits immediately prior to release;
  • Improve access to services before release and improve transitions and continuity of care in the community after release;
  • Improve coordination and communication between correctional systems, Medicaid and CHIP systems, managed care plans, and community providers;
  • Increase additional investments in health care and related services aimed at improving the quality of care for beneficiaries in prison and in the community in order to maximize the success of reintegration after release;
  • Improve linkages between prison facilities and community services upon release to meet physical health, behavioral health and social health needs;
  • Provide intervention for certain behavioral health conditions and use stabilizing medications such as long-acting injectable antipsychotics and drugs for the treatment of substance use disorder (SUD) addiction, with the goal of reducing decompensation , suicide-related deaths, overdoses and short-term overdose deaths after release; and
  • Reduce post-release acute care utilizations, such as emergency room visits, hospitalizations, and all-cause deaths among recently incarcerated Medicaid recipients and those otherwise eligible for CHIP if not for their incarceration status through strong identification, stabilization and management prior to release. certain serious physical and behavioral health conditions that may respond to outpatient care and treatment (eg, diabetes, heart failure, hypertension, schizophrenia, SUD), as well as increased receipt of preventative and routine physical and behavioral health care.

In accordance with CMS requirements for Section 1115 demonstrations, California must undertake a thorough and rigorous evaluation of the demonstration.

California approval coincides with a new report produced by the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) examining the significant health coverage and continuity of care needs that those involved in justice face when returning to the community . These include disproportionately high rates of TUS, serious mental illnesses, infectious diseases, and other chronic physical health conditions. The report discusses opportunities, like Medicaid Section 1115 demonstrations, to improve health and healthcare transitions.



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