Slides from a webinar Enroll America co-hosted (April 9, 2014) with The California Endowment and Californians for Safety and Justice to discuss the work currently being done to ensure that criminal justice populations are connecting to the new coverage options available as a result of the Affordable Care Act. Watch the recording above — and check out the slides and related resources below — to learn about successful partnerships between criminal justice and health care systems in three states, best practices for setting up a health care enrollment program for people in the justice system, and resources for taking this work to the next level.

1. © 2014 Enroll America | EnrollAmerica.org
The Enrollment Opportunity
for Criminal Justice Populations
April 9th, 2014

2. © 2014 Enroll America | EnrollAmerica.org2
AGENDA
I. Introduction
Jenny Sullivan
Enroll America
II. ACA and Criminal Justice
Populations
Jenny Montoya Tansey
Californians for Safety & Justice
III. View from the Ground
• Los Angeles, CA Jenny Montoya Tansey
• Cook County, IL
Maureen McDonnell
TASC, Inc.
• Denver, CO
Sheriff Gary Wilson
Denver Sheriff Department
IV. Resources Jenny Sullivan
V. Q&A Submit your questions via chat.

3. © 2014 Enroll America | EnrollAmerica.org
ACA AND CRIMINAL
JUSTICE POPULATIONS
and
VIEW FROM THE GROUND:
LOS ANGELES
Jenny Montoya Tansey
Health Matters Program Director
Californians for Safety and Justice

4. SAFEANDJUST.ORG
Increasing Public Safety and
Health and
Reducing Costs through
Health Coverage Enrollment
The California Endowment/Enroll America Webinar
April 9, 2014

5. ACA
and Criminal Justice Populations
Agenda
1. High Recidivism, High Costs: Justice Populations and
Health Coverage
2. The ACA Opportunity
3. Los Angeles Jail Enrollment Model
4. Los Angeles Probation Enrollment Model
5. Key Considerations and Next Steps

6. High recidivism, high costs: County
justice system and health issues
• Justice populations = high rates of chronic disease,
including mental illness and substance use disorders
SAFEANDJUST.ORG | 6

7. High recidivism, high costs: County
justice system and health issues
• Mentally ill = longer jail stays, higher custody costs
SAFEANDJUST.ORG | 7

8. High recidivism, high costs: County
justice system and health issues
• People with substance use disorders/mental illness =
higher rates of recidivism
SAFEANDJUST.ORG | 8

9. High recidivism, high costs: County
justice system and health issues
• Few have health coverage/access to ongoing treatment
SAFEANDJUST.ORG | 9

10. The ACA Opportunity: Reduce recidivism
and costs, improve health outcomes
1) New eligibility = more people in the justice system can get
health coverage and treatment
2) New federal funds = new federal money to subsidize health
care costs and to help pay for cost of administering
enrollment
3) Enhanced benefits for mental health and substance abuse
treatment = more treatment can be covered
SAFEANDJUST.ORG | 10

11. The ACA Opportunity: Medicaid
California opted to expand our state Medicaid Program
(Medi-Cal) under the ACA. A new state law (AB 720) directs
suspension, not termination, of Medi-Cal when people are
incarcerated and also establishes a process for jail-based
enrollment.
SAFEANDJUST.ORG | 11
Criminal
Justice
Population
Medi-Cal
Newly-
Eligible
Population
(Medicaid will not pay
for health care while
individuals are
incarcerated, except
for inpatient stays in a
non-correctional
hospital.)

12. Covered California is our state’s health
benefits marketplace and offers financial
assistance to pay for private insurance.
SAFEANDJUST.ORG | 12
The ACA Opportunity: Health Benefits Exchange
Not eligible to enroll in an exchange health plan:
Individuals serving a sentence in jail at time of
application. Release from incarceration is a
qualifying event that enables sign up outside of
open enrollment.

13. Enrolling the LA Jail Population
Reentry to Community
For targeted high needs individuals: implementation of discharge plan, including information sharing with
provider, coordination of services.
During jail stay
On-site eligibility worker checks for existing Medi-Cal case. Custody assistant uses existing jail and social
services data and works with inmate to collect additional information needed to complete application. Medi-Cal
application is submitted through county online system.
Inmate Reception Center (Booking)
At medical screening, jail medical staff determine health insurance status and current provider, if any. Assess
health care needs, including mental health and SUD.

14. Enrolling LA Probationers
Probation officer
screens probationer
for insurance status,
makes referral to on-
site enrollment
assistance
Probationer meets
with enrollment
counselor, who
provides assistance
to complete
application
Counselor assists
probationer to select
a plan and provider,
make first
appointments, if
desired.
Community health clinics and organizations will provide on-site enrollment
assistance at LA probation department’s 19 area field offices.

15. Funding Justice Population
Enrollment
• Medi-Cal Administrative Activities (MAA)
Program
• Covered California In-Person Assistance
Program
• Inmate Inpatient Hospitalization Reimbursement
• County General Funds
• AB 109 (California criminal justice funding to
counties)
• Philanthropic support

16. Key Considerations and Next Steps
• Fostering a “culture of coverage” amongst
justice populations
• Maximizing the use of existing county and
state data to complete applications
• Ensuring that enrollment translates into
access to care
• Developing additional high-quality treatment
capacity
• Creating a long-term model for investing in
enrollment efforts for justice populations

17. Questions?
SAFEANDJUST.ORG | 17
For more information, please visit:
www.safeandjust.org
Or contact me:
Jenny Montoya Tansey
Health Matters Project Director
Californians for Safety and Justice
jenny@safeandjust.org

18. © 2014 Enroll America | EnrollAmerica.org
VIEW FROM THE GROUND:
COOK COUNTY
Maureen McDonnell
Director for Business and Health Care Strategy Development
Treatment Alternatives for Safe Communities, Inc. (TASC)

19. Leveraging National Health Reform to
Build Public Safety and Public Health:
ACA in Action in the Justice System
Center for Health and Justice at TASC

20. National public policy group focused on nexus
of criminal justice and public health
Expertise grounded in science and practical, on-the ground
experience of TASC, providing alternatives to incarceration
since 1976 – TASC reaches 27,000 clients per year
Collaborations with broad network of public policy leaders,
researchers, criminal justice practitioners, and clinicians

21.
Cook
County
Jus+ce
&
Health
Ini+a+ve
• August
2012
–
Planning
process
convened
by
the
Honorable
Paul
P.
Biebel,
Jr.,
Presiding
Judge
of
the
Criminal
Division
• The
JusDce
and
Health
IniDaDve
(JHI)
Steering
CommiIee
includes
leadership
from
– All
Cook
County
jusDce
agencies
– County
Health
and
Hospitals
System
– Community
substance
abuse
and
mental
health
providers
– Community
foundaDons
• Builds
on
Cook
County’s
early
expansion
of
Medicaid
(2012)
• JHI
was
developed
and
led
by
TASC
with
Chicago
Community
Trust
funding;
other
foundaDons
joined

22. Jus+ce
&
Health
Ini+a+ve
Goals
• Determine
how
to
facilitate
applicaDons
for
all
eligible
persons
entering
the
jusDce
system
• Develop
infrastructure
and
processes
that
support
universal
linkage
to
medical,
mental
health,
and
substance
abuse
treatment
• Support
expansion
of
care
in
the
community
that
meets
the
needs
of
people
under
supervision
• Expand
diversion
from
jail
and
prison
to
care
in
the
community
under
appropriate
supervision

23. Jail
Intake
Applica+on
Process:
Partnership
between
Cook
County
Health
&
Hospitals
System,
Cook
County
Sheriff’s
Office
and
TASC
Opera+onal
Goals:
Maximize
Applica+ons
&
Use
of
Care
• Complete
full
applicaDon
during
intake
– Fingerprint-­‐based
idenDfying
informaDon
used
to
verify
inmate
idenDty
– ApplicaDons
are
completed
online
using
state
and
county
Medicaid
applicaDon
websites
and
jail
management
system
records
• Process
must
fit
in
fast-­‐paced
secure
environment
– 200-­‐300
new
detainees/day
– Cannot
impede
security
or
medical
flow
– Each
applicaDon
takes
approximately
ten
minutes
• Encourage
applicants
to
use
care
aer
release
Results:
Over
14,000
Medicaid
applicaDons
have
been
iniDated
to
date
(April
2013
–
March
2014)

24. Jail
to
Community
Con+nuity
of
Care
• Planning
Process:
How
to
establish
processes
that
link
people
with
serious
mental
illness,
severe
substance
use
disorders
and
chronic
medical
condiDons
to
needed
care
in
the
community,
given
jail
release
Dmeframes?
• DemonstraDon
Project:
Link
30
people
with
serious
mental
illness
released
each
day
to
care
in
the
community
• Partnership
between
Sheriff’s
Office,
Cermak
Mental
Health
Services
and
TASC
“Health
Care
Reform
Ready”
Court
• Court
that
uses
all
available
funding
streams
and
all
community
resources
to
link
probaDoners
to
services
• Prison
diversion
court
• Model
for
all
felony
courtrooms
aer
tesDng
Under
Development:
Further
Approaches
to
Jail
and
Prison
Diversion

25.
Maureen
McDonnell
Director,
Business
&
Health
Care
Strategy
Development
TASC,
Inc.
1500
N.
Halsted
Street
Chicago,
IL
60642
312.573.8222
mmcdonnell@tasc.org
www.tasc.org

26. © 2014 Enroll America | EnrollAmerica.org
VIEW FROM THE GROUND:
DENVER
Sheriff Gary Wilson, Denver Sheriff Department

27. Affordable
Care
Act
for
County
Jails
Presented
by:
Sheriff
Gary
Wilson
Denver
Sheriff
Department

28. Affordable
Care
Act
• The
Affordable
Care
Act
(ACA)
is
expected
to
help
lower
county
jail
healthcare
costs,
reduce
recidivism,
and
create
healthier
individuals,
families
and
communiDes
partly
because
of
provisions
for
expanded
Medicaid
eligibility
and
other
healthcare
affordability
measures
available
to
previously
uninsured
populaDons,
including
the
offender
populaDon
in
county
jails

29. Community
Oriented
CorrecDonal
Health
Services
• COCHS
esDmates
that
about
2/3
of
the
jusDce-­‐
involved
populaDon
will
be
eligible
for
Medicaid
under
expansion;
many
of
these
individuals
will
have
access
to
affordable
healthcare
for
the
first
Dme.

30. Expected
Benefits
to
Agencies
and
their
CommuniDes
•
A
strengthening
of
the
relaDonships
with
individual
ciDzens
and
communiDes
also
vested
in
public
health,
adequate
medical
care,
healthy
living,
and
reduced
recidivism.
• A
reducDon
in
the
absolute
number
of
incarcerated
individuals
• A
healthier
offender
populaDon
because
of
the
availability
of
care
while
in
the
community;
significant
cost
savings
associated
with
offenders
needing
less
care
and
medicine
upon
arrival
and
while
incarcerated.
• Significant
cost
savings
associated
with
healthcare
and
medicaDons
that
can
be
billed
to
insurance.

31. Prac+cal
Strategies
• Healthcare
enrollment
protocols,
• EducaDon
of
the
inmate
populaDon,
• Enrollment
assistance
and
facilitaDon
of
the
applicaDon
process
upon
inmate
release.
• Enrollment
assistance
and
facilita+on
of
the
applica+on
process
at
Medical
Facili+es.

32. Step
1
• Determine
Offender
Need/Scope
– 71%
of
offenders
did
not
have
insurance
0
500
1000
1500
2000
2500
3000
3500
No
Insurance
Insurance
Drivers
Lic
Birth
cert

33. Step
2
• Assemble
your
team
– Human
Services
Medical
provider(s)
– State
Medicaid
Administrator
– State
Exchange
Plan
Administrator
– Division
leaders
– Legal
Department
– Inmate
Programs
– Finance
(EsDmaDng
projected
savings
short
term/long
term,
expenditures,
budget
issues)
– Technology
Unit
(How
will
we
capture
needed
data
and
report
results?)
– Human
Resources
(Are
addiDonal
personnel
needed
to
support
implementaDon?)

34. Step
3
• Develop
a
SCREENING
PROCESS
and
related
forms.
– Do
you
have
health
insurance?
– Are
you
a
US
CiDzen?
– Are
you
a
resident
of
Denver
County?

35. Step
4
• Limited
Power
of
AIorney

36. Step
5
• Hire
Enrollment
Specialist

37. Step
6
• Educate
Offenders

38. Step
7
• Train
and
Educate
Staff

39. Step
8
• Track,
Measure,
Report
and
REFINE

40. DSD
Outcomes
• County
Jail
– 17
Inmates
enrolled
upon
release
(Medical
and
Food
Assistance)
– Two
Pending
• Downtown
Jail
– 12
Approved
– One
Pending
• Denver
Health
Medical
Center

41. Contact
Informa+on
• Sheriff
Gary
Wilson
• Email:
Gary.Wilson@denvergov.org
• Phone:
720-­‐337-­‐0194

42. © 2014 Enroll America | EnrollAmerica.org
RESOURCES
Find more information at enrollamerica.org/resources/webinars
• Today’s webinar recording
• Today’s slides
• List of related resources

43. © 2014 Enroll America | EnrollAmerica.org
QUESTIONS?
Submit questions via chat.