Welcome to Inmate Eligibility Overview

1. Welcome to Inmate Eligibility Overview

2. Medi-Cal Inmate Eligibility Program (MCIEP) Update & Recent Changes March 7, 2013 MCIEP@dhcs.ca.gov

3. Overview Today we will cover: A brief background on the California state prison inmateMCIEP and LIHP programs Overview of roles and responsibilities for the processing of Medi-Cal and LIHP eligibility for both state and county inmates Suggestions for county adaptation of MCIEP and LIHP for county inmates Background and information on Medical Parole, Medical Probation, Compassionate Release, and the Juvenile Inmate Medi-Cal Program (JIMP) Medi-Cal eligibility for the LIHP population under the Affordable Care Act (ACA)

4. Inmate Program SummaryCenters for Medicare and Medicaid Services (CMS) criteria allows for federal financial participation (FFP)consideration for inmates only when they are an inpatient, off the grounds of the correctional facility who are otherwise eligible. Programs for State correctional facility Inmates: Programs for County correctional facility Inmates: • Adult inmates eligible for Medi-Cal –  April 2011 • Adult inmates eligible for LIHP – October 2011 • Medical Parole – June 2011 • Juvenile inmates eligible for Medi-Cal • Adult Inmates eligible for Medi-Cal • Juvenile inmates eligible for Medi-Cal • Medical Probation/ Compassionate release for county inmates

5. Federal guidelines for Medicaid coverage for inmates In accordance with federal guidelines, an inmate must meet ALL of the following criteria to be eligible for MCIEP: Receive inpatient hospital services Off the grounds of the correctional facility Meet all Medi-Cal or LIHP eligibility requirements

6. State Inmates

7. Medi-Cal Inmate Eligibility Program (MCIEP) • Assembly Bill (AB) 1628 (Chapter 729, Statutes of 2010) and Senate Bill (SB 92)(Chapter 36, Statutes of 2011) authorize the California Department of Corrections and Rehabilitation (CDCR) and the Department of Health Care Services (DHCS) to draw down federal funds for Medi-Cal-covered inpatient hospital services provided to eligible State and County adult and juvenile inmates off the grounds of the correctional facility. • Section 1115(a) of the Medicaid Bridge to Reform Waiver extended health care benefits to Low Income Health Program (LIHP) eligible inmates. In October 2011, the Department began receiving applications to enroll inmates into LIHP.

8. How does the application process start? • A state inmate is admitted into a hospital off the grounds of the correctional facility • An application (MC 210) is initiated by the California Correctional Health Care Services (CCHCS) on behalf of the inmate and submitted to DHCS. • CCHCS is the court-appointed receivership responsible for the health care provided to state inmates.

9. What CCHCS staff does prior to submitting state inmate application to DHCS Medical Eligibility Division (MCED) staff? • Identify state inmates admitted for inpatient services off the grounds of the correctional facility • Forward completed state inmate MC 210 applications to DHCS • Forward all needed documentation such as Social Security Number (SSN) verification • Forward medical records, if a disability determination packet is needed

10. When DHCS staff receives an application… Applications are first reviewed for possible Medi-Cal eligibility. Citizenship, identity, and immigration status are verified following Deficit Reduction Act (DRA) protocol. Wage, unemployment, Social Security, and property information reported in the Income Eligibility Verification System (IEVS)are evaluated. If Medi-Cal linkage is established and the client is found to be eligible, the client is approved for Medi-Cal in MEDS. CCHCS is notified of the eligibility determination for program administration purposes.

11. When DHCS staff receives applications… • If the applicant is found to be ineligible for Medi-Cal, an evaluation for LIHP is performed. • If the client is found to be eligible, enrollment information is forwarded to the appropriate county for enrollment in the local LIHP. • Annual redeterminations and ongoing case maintenance are completed by MCEDstaff. • SB 87 guidelines are followed when a Medi-Cal eligible inmate paroles. • Eligibility is discontinued in MEDS when a LIHP eligible inmate paroles. • The county and CCHCS are notified when LIHP eligibility is discontinued in MEDS for a state inmate.

12. What role does local LIHP staff have? Enroll eligible State inmates into local LIHP system Suppress issuance of the LIHP card (if any) Notify MCED of confirmation of enrollment into local LIHP program

13. Pregnant State MCIEP inmates • When a pregnant inmate is eligible for and receiving Medi-Cal at the time of the infant’s birth, the infant is automatically deemed eligible for Medi-Cal without separate Medi-Cal application until age one, as long as the infant resides in California. • DHCS will notify the county of the infant’s birth through the MCIEP/County transmittal form and the Newborn Referral form (MC 330). • The county of responsibility will be where the infant resides, unless the infant is under foster care placement or pending the adoption process. • The County should follow the current process for deemed eligible infant, foster care, and/or adoption eligibility.

14. When a State MCIEP inmate paroles • When a State MCIEP beneficiary is released from prison, this is considered a change in circumstances. • DHCS notifies the county of the inmate’s date of release. • If a state inmate is on Medi-Cal and paroles, county staff must follow the SB 87 process to evaluate the case for ongoing eligibility. Note: When an eligible inmate is paroled, Medi-Cal-covered services are no longer limited to patient services. • If a state inmate is on LIHP and paroles, benefits areterminated by MCEDwith proper notice.

15. State MCIEP aid codes Aid Code F1Medi-Cal no share-of-cost (SOC) for State Inmates. Medi-Cal benefits are limited to inpatient hospital services only, for inmates in state correctional facilities who receive those services off the grounds of the correctional facility. Aid Code F2Medi-Cal no SOC for undocumented State Inmates. Medi-Cal benefits are limited to inpatient hospital emergency and pregnancy-related services, for inmates in state correctional facilities who receive those services off the grounds of the correctional facility.

16. State LIHP aid code Aid Code F5LIHP State Inmates. Benefits are limited to hospital inpatient services for inmates in state correctional facilities who receive those services off the grounds of the correctional facility.

17. New 2014 ACA aid codes for State adult inmates Aid Code N5--Title XIX, Medi-Cal no share-of-cost (SOC) for State Adult Inmates. Medi-Cal benefits are limited to covered inpatient hospital only, for eligible adult inmates aged 19 through 64 years of age in state correctional facilities who receive those services off the grounds of the correctional facility. Aid Code N6--Title XIX/Title XXI, Medi-Cal no SOC for eligible undocumentedState Adult Inmates. Medi-Cal benefits arelimited to covered inpatient hospital emergency and inpatient pregnancy-related (Title XXI) services only, for adult inmates aged 19 through 64 years of age in state correctional facilitieswho receive those services off the grounds of the correctional facility.

18. Medical Parole

19. Medical Parole for State Inmates • SB 1399 (Chapter 405, Statutes of 2010) authorizes the California Department of Corrections and Rehabilitation (CDCR) to grant medical parole to eligible state inmates who have been deemed permanently medically incapacitated by the medical parole board and by the head physician of the institution where the inmate is located. • An inmate granted medical parole is potentially eligible for full scope Medi-Cal. • Inmates who are medically paroled are typically placed into Long Term Care (LTC) facilities off the grounds of the correctional facility.

20. Who is eligible for Medical Parole? To be eligible for medical parole, an inmate must be permanently medically incapacitated with a medical condition that renders the inmate unable to perform activities of basic daily living and requiring 24-hour care. The incapacitation must not have existed at the time of sentencing. The Board of Parole Hearings must determine that by releasing the prisoner it would not reasonably pose a threat to public safety. Medical Parole may end if the inmate’s medical condition changes or improves, the inmate is released from the LTC facility and returned to CDCR, or if the inmate is granted regular parole.

21. Medical Parole Aid Code • The department has implemented a dedicated aid code “G0” (G-zero) for eligible Medical parolees. • To identify medical parolees for claiming purposes, the Other Health Coverage (OHC) indicator code “G” is added to the MEDS record. • The “G” OHC code and the medical parole aid code are removed when the inmate is no longer on medical parole.

22. County Inmates

23. Enrolling County Inmates into Medi-Cal or LIHP The county will be responsible for the non-federal share of inpatient costs for eligible county inmates. While CDCR has been granted authority to act on behalf of state inmates in Medi-Cal application completion, county jail staff do not have this statutory authority. Title 22 California Code of Regulations (CCR) Section 50163 provides that the applicant or the spouse of the applicant signs the Statement of Facts, with some exceptions.

24. Inmate signs authorized representative form County jail submits application to county welfare department (CWD) CWD determines eligibility for Medi-Cal County pays hospital for inpatient services at contracted rate County submits claims through DHCS Fiscal Intermediary (FI)via data exchange* DHCS FI adjudicates claim to determine Medi-Cal rate and payment data* DHCS generates invoice & forwards invoice to DHCSAccounting* DHCS Accounting claims federal funds based on Medi-Cal rate and authorizes the State Controller’s Office (SCO)to issue check for federal reimbursement to County* DHCS claims FFP (claimable) 50/50 (FFP back to County)* Overview of County Inmate Medi-Cal Process *County claiming process is in review

25. Overview of County Process* *County claiming process is in review

26. County Inmate Eligibility Process • Staff at the hospital or other county health facility may help the inmate complete the Medi-Cal application, if the inmate gives his or her consent by signing an authorized representative document. • County eligibility workers are responsible for eligibility determinations for their county inmate populations. • Applicants determined eligible for Medi-Cal are given an appropriate aid code and eligibility is shown in MEDS and respective county eligibility system(s). • Inmate applicants found eligible for Medi-Cal will not receive a Benefits Identification Card (BIC). The county jail facility should instead be given the eligibility information that is necessary for administration of the program.

27. County Jail Staff Responsibilities County Correctional/Jail facility staff: Identify county inmates admitted for covered inpatient services off the grounds of the correctional facility. Obtain the appropriate Authorized Representative form from the inmate. Work with inmate to complete and sign off Medi-Cal paperwork. Forward completed Medi-Cal applications and documentation to county eligibility workers. Forward medical records, if a disability determination packet is needed. Receive eligibility information from county eligibility workers regarding an inmate’s Medi-Cal determination. Inform the county when the inmate is released, paroled, or transferred.

28. Eligibility Worker Responsibilities for County Inmate Medi-Cal Program Determines eligibility for County inmates Performs annual redeterminations and ongoing case maintenance Performs SB 87 eligibility redeterminations for former County beneficiaries released on parole. Provides infants born to pregnant County beneficiaries with deemed eligibility and processes/forwards disability determination packets to the Disability Determination Services Division-State Programs (DDSD-SP),if required.

29. What is counted as income or property for inmates? • All income and property for an inmate must be counted (or exempted) in accordance with current Medi-Cal rules. No income or property is exempt for an inmate applicant solely because the individual is an inmate.

30. Issues for Counties Enrolling County Inmates into Medi-Cal or LIHP Voluntary completion of the Medi-Cal or LIHP application by the inmate can be a difficult process for determining eligibility for the Medi-Cal and LIHP programs prior to the passage of AB 1628. AB 1628 gives CDCR the authority to sign Medi-Cal and LIHP applications on behalf of state inmates. In order to establish Medi-Cal or LIHP eligibility for a county inmate, the inmate must provide all of the information necessary to determine eligibility.

31. County Inmate Medi-Cal Aid Codes • Aid Code F3Medi-Cal no SOC for County Inmates. Medi-Cal-covered inpatient hospital services only, for eligible inmates in correctional facilities who receive those services off the grounds of the correctional facility. • Aid Code G3Medi-Cal with SOC for County Inmates. Medi-Cal-covered inpatient hospital services only, for eligible inmates in correctional facilities who receive those services off the grounds of the correctional facility. • Aid Code F4Medi-Cal no SOC for undocumented County Inmates. Restricted - Hospital inpatient emergency (Title XIX) and pregnancy-related (Title XXI) services, for eligible inmates who, while in a county correctional facility, receive those services off the grounds of the correctional facility. • Aid Code G4Medi-Cal with SOC for undocumented County Inmates. Restricted - Hospital inpatient emergency and pregnancy-related services, for eligible inmates who, while in a county correctional facility, receive those services off the grounds of the correctional facility.

32. Medical Probation/ Compassionate Release

33. County Medical Probation/Compassionate Release • SB 1462 (Chapter 837, Statutes of 2012) authorizes a county sheriff, or designee, to compassionately release or request the court resentence a prisoner from a county jail to medical probation, if the prisoner: • does not pose a threat to public safety. • has a life expectancy of six months or less. • is physically incapacitated, or needs long term care. • Counties are required to pay the non-federal share of Medi-Cal expenditures for a medical probationer or county inmate compassionately released for the period of time the offender would have otherwise been incarcerated. • If the county determines that the former inmate can provide for their own medical care once compassionately released or granted medical probation, the county is not be required to pay the former inmate’s medical expenses.

34. Who is eligible for Compassionate Release? County Sheriffs are authorized to release a prisoner from a county correctional facility on compassionate release if: • The sheriff in consultation with a physician determines that the inmate has a life expectancy of six (6) months or less. • The sheriff determines the prisoner would not reasonably pose a threat to public safety. • The sheriff notifies the presiding judge of the superior court of his or her intention to release the prisoner. • A placement option for the prisoner is secured and a CWD or other applicable county agency examines the prisoner’s eligibility for Medi-Cal or other medical coverage.

35. Who is eligible for Medical Probation? County Sheriffs are authorized to request medical probation if: • A prisoner is physically incapacitated with a medical condition that renders the prisoner permanently unable to perform activities of basic daily living, requiring 24-hour care, if that incapacitation did not exist at the time of sentencing. • A prisoner would require acute long-term inpatient rehabilitation services. • A placement option for the prisoner is secured and applicable county agency determines the prisoner’s eligibility for Medi-Cal or other medical coverage. • If at any time the court determines, based on a medical examination, that the probationer’s medical condition has improved to the extent that the probationer no longer qualifies for medical probation, the court may return the probationer to the custody of the sheriff.

36. Medical Probation and Compassionate Release Process* *County claiming process is in review

37. Juvenile Inmates

38. Juvenile Inmate Medi-Cal Program • Assembly Bill (AB 396) (Mitchell, Chapter 394, Statues of 2011) authorizes DHCS to develop a process to allow counties and CDCR, Division of Juvenile Facilities (DJF), to receive any available FFP for acute inpatient hospital services and inpatient psychiatric services provided to Medi-Cal eligible juvenile inmates admitted into a hospital off the grounds of the correctional facility. • This process must be coordinated, to the extent possible, with the processes implemented in accordance with Welfare and Institutions (W & I) Code section 14053.7 and section 5072 of the Penal Code and can only be implemented for DJF and counties that elect voluntarily to provide the nonfederal share of expenditures for health care services provided to eligible juvenile inmates. • AB 396 took effect on January 1, 2012.

39. State Juvenile Inmate Aid Codes • Aid Code G1--Title XIX, Medi-Cal no share-of-cost (SOC) for State Juvenile Inmates. Medi-Cal benefits limited to covered inpatient hospital and inpatient mental health services only, for juvenile inmates in state correctional facilities who receive those services off the grounds of the correctional facility. • Aid Code G2--Title XIX/Title XXI, Medi-Cal no SOC for undocumented State Juvenile Inmates. Medi-Cal benefits limited to covered inpatient hospital emergency and inpatient mental health emergency (Title XIX) and inpatient pregnancy-related (Title XXI) services only, for juvenile inmates in state correctional facilities who receive those services off the grounds of the correctional facility.

40. County Juvenile Inmate Process* *County claiming process is in review

41. County Juvenile Inmate Aid Codes • Aid Code G5--Title XIX, Medi-Cal no SOC for County Juvenile Inmates. Medi-Cal benefits limited to covered inpatient hospital or inpatient mental health services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility. • Aid Code G6--Title XIX/Title XXI, Medi-Cal no SOC for undocumentedCounty Juvenile Inmates. Medi-Cal benefits limited to covered inpatient hospital emergency, inpatient mental health emergency (Title XIX) and inpatient pregnancy-related (Title XXI) services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility. • Aid Code G7--Title XIX, Medi-Cal SOC for County Juvenile Inmates. Medi-Cal benefits limited to covered inpatient hospital or inpatient mental health services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility. • Aid Code G8--Title XIX/Title XXI, Medi-Cal SOC for undocumentedCounty Juvenile Inmates. Benefits limited to inpatient hospital inpatient mental health emergency (Title XIX) and inpatient pregnancy-related (Title XXI) services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility.

42. Adult and Juvenile County Inmates Similarities • County is responsible for non-federal share of medical expenditures • County inmate must receive covered inpatient services off the grounds of the correctional facility • County inmate must meet all Medi-Cal eligibility requirements such as, linkage, deprivation, alien/citizenship/national status, income, and property Differences • In addition to inpatient hospital health care services, juvenile inmates receive coverage of inpatient mental health services received off the grounds of the correctional facility • The juvenile inmate program is only available for individuals up to age 21

43. The Affordable Care Act (ACA) On January 1, 2014, eligible inmates will transition from the LIHP to Medi-Cal as Medi-Cal “Newly Eligibles”. Medi-Cal Newly Eligible beneficiaries are eligible for 100% FFP.

44. 2014 ACA aid codes for County adult inmates Aid Code N7--Title XIX, Medi-Cal no SOC for County Adult Inmates. Medi-Cal benefits limited to covered inpatient hospital services only, for adult inmates aged 19 through 64 years of age in county correctional facilities who receive those services off the grounds of the correctional facility. Aid Code N8--Title XIX/Title XXI, Medi-Cal no SOC for undocumented County Adult Inmates. Medi-Cal benefits limited to covered inpatient hospital emergency, and inpatient pregnancy-related (Title XXI) services only, for adult inmates aged 19 through 64 years of age in county correctional facilities who receive those services off the grounds of the correctional facility.

45. Q & A’s Thank You!