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HMA Insights: Your source for healthcare news, ideas and analysis.

HMA Insights 鈥 including our new podcast 鈥 puts the vast depth of HMA鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Child and family wellbeing: family resilience

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This is part of an ongoing series highlighting efforts in human services and family wellbeing. 

For decades, practitioners have recognized that child neglect was often interconnected in some families with stressors associated with familial poverty. Poverty is often a stressor in cases of child neglect, poor health, and even youth incarceration. Food insecurity, housing instability, and family stressors often related to unemployment, incarceration, and domestic violence can in some circumstances, result in parental burnout and lead to poor parenting decisions. There is also a perverse disincentive for families to experience career and wage progression which often results in steep fiscal cliffs with benefits that are needed to stabilize families and guide them towards economic self-sufficiency[1]. There is advocacy and increasing recognition through efforts such as Universal Basic Income Pilot programs and experiments with expanding Earned Income Tax Credits and Child Tax Credits attempting to mitigate catastrophic benefits cliffs that impact child and family wellbeing and economic self-sufficiency.

Public Safety Net programs such as Temporary Assistance to Needy Families, Supplemental Nutrition Assistance Program, WIC, Free and Reduced School Meals, Child Care Subsidies, Earned Income Tax Credit, Eviction Prevention Grants, and a host of other federal, state, and local programs are intended to support and strengthen families and increase protective factors for children[2].   

Recent investments in the safety net including the childcare tax credit and the Pandemic Electronic Benefit Card (P-EBT) have shown that when concrete supports are provided to families, child maltreatment rates significantly decrease.[3]  

During the height of the COVID-19 pandemic, the federal government implemented a One-Year Expansion of the Child Tax Credit which extended the eligibility to families with little to no income. It helped increase the credit amount families received from $3,600 per qualifying child younger than six years old and $3,000 for qualifying child between the ages of 6 and 17. It also provided monthly payments of $250 to $300 per qualifying child as opposed to an annual payment which aligned with monthly living expenses. According to the , 2021 saw a historic decline in child poverty which lifted one million children under the age of six out of poverty, and 1.9 million for children between the ages of six and 17.  

More recently States are experimenting with Universal Basic Income projects aimed at reducing child poverty, improving protective factors in families and reducing child maltreatment.[4] These experiments are currently being evaluated, but early research is showing promising signs of reduced child poverty in jurisdictions where these projects have gone live. 

There is considerable literature that shows that changes in income alone, holding all other factors constant, have a major impact on the numbers of children being maltreated. Conversely, reduction in income or other economic shocks to the family increase incidents of child maltreatment. 

A study performed by the Nuffield Foundation noted that internationally, evidence has shown a much stronger relationship between poverty and child abuse and neglect. Research has shown that without government and service providers responding to increased pressures on family life will lead to the risk of more children suffering harm, abuse and neglect.[5]

 Another study by Casey Family Programs on predicting chronic neglect, found that the strongest predictors of chronic neglect were parent cognitive impairment, history of substitute care, parent mental health problems, and a higher number of substantiated allegations in the first CPS report[6]. This suggests that families at risk for chronic neglect face multiple challenges and significant financial insecurity that require significant support.

  • Other significant predictors include:
    • Younger parents
    • Families with a higher number of children
    • Families with a child under age 1

Recognizing these challenges to strengthening the protective factors for young moms, there have been several successful efforts around the country to focus on pregnant and parenting teen and young adult moms. From Health Families America, Nurse Home Visiting Programs, there has been a body of evidence created that shows the strengths of providing wrap around services and home-based interventions for moms and babies. These supports strengthen the mom-baby nurturing relationship and reduce risk of maltreatment and increase protective factors. 

One such organization that has demonstrated significant success in disrupting the cycle of generational poverty is . This is a national organization that aids single mothers and their children to provide coaching and assistance in navigating barriers to education, college access and career support, safe and affordable housing, early childhood education and childcare, and empowerment, leadership, and career training. This supportive program helps build up single mothers to achieve their educational and career goals and gain long-term economic prosperity. 

As child welfare and poverty policies intersect, the current thought leadership is focused on recognizing that economic and concrete supports reduce involvement in child welfare.[7] As the science and voices of children and families with lived experience intersect and rise up, the federal and state policy landscape around alleviating poverty to improve child wellbeing will continue to gain momentum. Family and Child Well-Being indicators significantly reflect racial and ethnic inequalities both in child welfare and across the poverty landscape. Economic stability is also a key strategy to address racial and ethnic inequalities and closing the opportunity gap for all. Over the next 3-5 years we believe there will be a fundamental shift in policy, financing, and outcomes tracking that reflect our commitment to our society鈥檚 most vulnerable children and families. That is why it is crucial for States and Local governments to enact policies that would support programming to alleviate poverty and improve child and family resilience and protective factors.

HMA consultants have decades of experience working hand-in-hand with public health, social services, behavioral health, Medicaid, and human services agencies. We help strengthen relationships surrounding policy, practice and revenue maximization in the human services space. Our experts work to help support programs in areas of Nutrition: Women, Infants & Children (WIC), Supplemental Nutrition Assistance Program (SNAP); Financial Support: Child Support, Temporary Assistance for Needy Families (TANF); Child and Adult Welfare Services; Medicaid; Housing and Weatherization; Early Education: Childcare Subsidy, Child Care and Development Block Grant (CCBDG) programs; and Workforce Development and Workforce Innovation and Opportunity Act (WIOA) programs.

If you have questions on how HMA can support your efforts in Child and Family Wellbeing, please contact our experts below.


[1]

[2]

[3]

[4]

[5]

[6] Predicting Chronic Neglect 鈥 Casey Family Programs

[7]


Resources for Medicaid 1115 Waivers: creating new programs for justice-involved individuals

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HMA created a comprehensive series of webinars discussing the potential for using 1115 demonstrations to expand and improve healthcare services for the justice-involved population. Replays of the webinars and other justice-involved healthcare resources are now available.

What鈥檚 next for 1115 Waivers in your organization?

If your organization or state agency is ready to create new initiatives to improve carceral healthcare delivery and facilitate smoother transitions back into communities, HMA can help. Our consultants bring unparalleled expertise in Medicaid policy and correctional health as well as a deep understanding of the unique needs of this population. We have the operational knowledge and experience with technology and digital health solutions 鈥 and the ability to collect and analyze the right data to drive meaningful improvements in equity and access to care.

If you have questions or want to discuss options, please contact any of the speakers from the series:

  • Linda Follenweider, Managing Director, Justice Involved Services
  • Tonya Moore, Senior Consultant
  • Margaret Tatar, Managing Principal
  • John Volpe, Principal
  • Julie White, Principal 
  • Michael DuBose, Principal
  • Rich VandenHeuvel, Principal
  • Bren Manaugh, Principal
  • Caitlin Thomas-Henkel, Principal
  • Jon Rubin, Principal

Register today for HMA’s 6th annual conference聽on Trends in Publicly Sponsored Healthcare, Oct. 30-31 in Chicago. The event will feature the session,聽Medicaid and Individuals in Carceral Settings: Improving Coordination, Managing Transitions.聽

HMA publishes white paper, 鈥淚mplementing the National Diabetes Prevention Program Lifestyle Change Program in Correctional Settings鈥

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Correctional facilities can decrease the number of individuals with prediabetes who progress to type 2 diabetes by offering the National Diabetes Prevention Program (National DPP) lifestyle change program. HMA has published a white paper describing (1) the financial and individual impact of type 2 diabetes, (2) the prevalence of type 2 diabetes risk factors in correctional settings, and (3) how the National DPP lifestyle change program, which was created by the Centers for Disease Control and Prevention (CDC), can be used to achieve cost savings and better health for people at risk of developing type 2 diabetes in correctional settings.

This white paper also features a program spotlight from the Wisconsin Department of Corrections (DOC), where the National DPP lifestyle change program has successfully been implemented in three state correctional facilities. Wisconsin’s DOC is currently the only correctional system in the United States providing this program that has been awarded full-recognition status as a supplier of the National DPP lifestyle change program by CDC. A total of 131 individuals have participated in the program, and people who completed the program in 2018-2019 lost an average of 8.3 percent of their body weight.

Administrators of correctional settings, where the length of stay is a year or longer, might consider implementing the National DPP lifestyle change program in their facilities. A cogent argument can be made that type 2 diabetes prevention provides a good return on investment in downstream costs. Offering the program would also be an important step in promoting health equity within correctional settings.

For help starting the National DPP lifestyle change program in a correctional facility, contact the white paper鈥檚 authors below.                 

Webinar replay: Medicaid 1115 justice waivers and special populations: meeting the needs of justice-involved youth

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This webinar was held on August 17, 2023.聽

HMA鈥檚 webinar series, 1115 Medicaid Justice Demonstration Waivers: Bridging Healthcare, focused on helping stakeholders optimize care for persons in carceral settings and during their transition back to the community.

Youth in juvenile correctional settings often have complex medical, behavioral health, developmental, social, and legal needs. Many youth have been exposed to adverse childhood experiences, unsupervised home environments and have lacked access to behavioral health services. Transitioning youth from correctional facilities require high quality transition planning services for successful reentry into the community. 聽Part 5 of this webinar series delved into the types of care and services needed for youth, so that a whole-person approach can be applied to facilitate successful reentry to the community.

Learning objectives:

  • Understand the unique needs of juveniles in correctional settings
  • Discuss opportunities under CMS State Medicaid Director Level 1115 guidance to support reentry for justice involved youth
  • Discuss effective state models for justice-involved youth
  • Learn how to create a whole-person approach to health needs of juveniles in the justice setting

Other webinars in this series:

Webinar replay: Medicaid 1115 justice waiver opportunities- medication assisted treatment for substance use disorder in carceral settings

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This webinar was held on July 13, 2023.

HMA鈥檚 webinar series, 1115 Medicaid Justice Demonstration Waivers: Bridging Healthcare, focuses on helping stakeholders optimize care for persons in carceral settings and during their transition back to the community.

Part 4 focused on access to medication assisted treatment (MAT) for substance use disorder (SUD) during and after transition from a carceral setting into the community, to ensure continuity of care for those leaving incarceration to reduce overdose and recidivism.

Learning Objectives:

  • MAT Trends: Understand benefits of MAT for incarcerated individuals and related risk management for correctional facilities, providers, counties, and health plans.
  • Building Connections to Community-Based SUD Care: Discover approaches to release planning for successful community re-entry for those on MAT to support recovery and reduce recidivism.
  • Integrated and Coordinated Care: Understand the role of community-based and health plan care managers and persons with lived experience in supporting access to MAT and successful community re-entry.

Other webinars in this series:

Watch a replay of Part 1: Medicaid Authority and Opportunity to Build New Programs for Justice-Involved Individuals

Watch a replay of Part 2: 1115 Justice Waivers to Improve Carceral Healthcare Delivery Information

Watch a replay of Part 3: 1115 Justice Waivers: Connecting Community Partners to Improve Transitions of Care

Save the Date – Thursday August 17, 2023, 2 p.m. ET: Part 5: 1115 Justice Waivers and Special Populations: Meeting the Needs of Justice-Impacted Youth

Webinar replay: connecting community partners to improve transitions of care

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This webinar was held on June 15, 2023.

HMA鈥檚 webinar series, 1115 Medicaid Justice Demonstration Waivers: Bridging Healthcare, focused on helping stakeholders optimize the continuity of care for persons in carceral settings and during their transition back to the community.

Part 3 focused on optimizing key partnerships before, during and after transition from a carceral setting into the community to ensure the best outcomes for individuals eligible for 1115 approved waiver services.

Learning Objectives:

  • Health Assessments and Transition Planning: Understand the health and resource needs of returning citizens (health, behavioral health and social issues).
  • Collaboration with Community Providers: Identify key partners and formalize collaborations to strengthen the quality of transitions care and support provided to individuals transitioning to the community.
  • Insurance Enrollment Strategies: Develop Medicaid enrollment strategies that apply to your state and local framework.

Other webinars in this series:

  • Watch a replay of Part 1: Medicaid Authority and Opportunity to Build New Programs for Justice-Involved Individuals
  • Watch a replay of Part 2: 1115 Justice Waivers to Improve Carceral Healthcare Delivery Information
  • Part 4: 1115 Justice Waivers and Medication Assisted Treatment (MAT) – July 13 at 2pm ET
  • Part 5: 1115 Justice Waivers and Special Populations: Meeting the Needs of Justice-Impacted

HMA annual conference on innovations in publicly sponsored healthcare

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Innovations in Publicly Sponsored Healthcare: How Medicaid, Medicare, and Marketplaces Are Driving Value, Equity, and Growth

Pre-Conference Workshop: October 29, 2023
Conference: October 30鈭31, 2023
Location: Fairmont Chicago, Millennium Park

黑料网 has announced the preliminary lineup of speakers for its sixth annual conference, Innovations in Publicly Sponsored Healthcare: How Medicaid, Medicare, and Marketplaces Are Driving Value, Equity, and Growth.

Hundreds of executives from health plans, providers, state and federal government, investment firms, and community-based organizations will convene to enjoy top-notch content, make new connections, and garner fresh ideas and best practices.

A pre-conference workshop, Behavioral Health at the Intersection of General Health and Human Services, will take place Sunday, October 29.

Confirmed speakers to date include (in alphabetical order):

  • Jacey Cooper, State Medicaid Director, Chief Deputy Director, California Department of Health Care Services
  • Kelly Cunningham, Administrator, Division of Medical Programs, Illinois Department of Healthcare and Family Services
  • Karen Dale, Chief Diversity, Equity, and Inclusion Officer, AmeriHealth Caritas
  • Mitchell Evans, Market Vice-President, Policy & Strategy, Medicaid & Dual Eligibles, Humana
  • Peter Lee, Health Care Policy Catalyst and former Executive Director, Covered California
  • John Lovelace, President, Government Programs, Individual Advantage, UPMC Health Plan
  • Julie Morita, MD, Executive Vice President, Robert Wood Johnson Foundation
  • Anne Rote, President, Medicaid, Health Care Service Corp.
  • Drew Snyder, Executive Director, Mississippi Division of Medicaid
  • Tim Spilker, CEO, UnitedHealthcare Community & State
  • Stacie Weeks, Administrator/Medicaid Director, Division of Health Care Financing and Policy, Nevada Department of Health and Human Services
  • Lisa Wright, President and CEO, Community Health Choice

Publicly sponsored programs like Medicare, Medicaid, and the Marketplaces are leading the charge in driving value, equity, and growth in the U.S. healthcare system. This year鈥檚 event will highlight the innovations, initiatives, emerging models, and growth strategies designed to drive improved patient outcomes, increased affordability, and expanded access.

Early bird registration ends July 31. Group rates, government discounts, and sponsorships are available.

New experts join HMA in April 2023

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HMA is pleased to welcome new experts to our family of companies in April 2023. This diverse team brings significant expertise in Medicare, Medicaid, regulatory strategies, and managed care, strengthening HMA鈥檚 capabilities in healthcare consulting across areas like actuarial support, regulatory compliance, and strategic leadership in Medicare Advantage and Medicaid programs.

Headshot of Jed Abell

Jed Abell

Consulting Actuary I

Headshot of Elrycc Berkman

Elrycc Berkman

Senior Consulting Actuary I

Headshot of Monica Bonds

Monica Bonds

Associate Principal

Headshot of Yucheng Feng

Yucheng Feng

Senior Consulting Actuary I

Headshot of Ryan McEntee

Ryan McEntee

Senior Consultant II

Child and family wellbeing: May is National Foster Care Month

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This is part of an ongoing series highlighting efforts in Human Services and Family Wellbeing. 

During the month of May, National Foster Care Month provides an opportunity to raise awareness on issues related to foster care and to celebrate those who are dedicated to serving our children, youth, and families. Yet it is important to note that unfortunately issues surrounding children and youth experiencing foster care are not limited to one month a year. As noted in our recent child well-being blog, Child welfare services face challenges every day to prevent, treat, and reduce risk of maltreatment, neglect, trauma, housing instability, and violence in communities. All these issues contribute to the significant number of children and youth who enter or remain in the foster care system. These issues are year-round and decades in the making. They need to be seen as a priority for public health and community wellbeing and not just the jurisdiction and responsibility of child welfare agencies.

To positively impact the number of children and youth experiencing foster care, there are some strategies that can be implemented now to promote change:

  • We must meaningfully elevate the voices of those with lived experience to help us design systems that meet their needs. For foster care, working to hear and understand the voices of youth based on how they have experienced foster care will help create opportunities to improve the system from those most impacted. Further, the meaningful elevation of these voices helps to ensure their input is not contributing towards tokenism and re-traumatization.
  • Multi-system involvement is important. We can work together to enhance access, increase prevention-oriented services, improve community health, and well-being, and achieve better outcomes using an equity lens, but proposed system reforms cannot be successful without shared ownership within the community and across government agencies. This requires building a responsive and integrated system of care approach to allow communities to seek solutions with the necessary support of the highest leadership within their organizations.   
  • Continue to find ways to assure that mandated reporters and staff who work within child welfare understand that poverty is not neglect, and poverty alone should not be a reason children and youth are removed from their home(s).
  • System redesign is needed. From front end reporting and assessment, to working with court systems, to building up networks of caring service providers, each component of the current child welfare system and human services partners can strive to find areas needing improvement and collectively change the experiences for children and youth engaged in the child welfare system.
  • Focus on mental health. This year鈥檚 theme from the Children鈥檚 Bureau for national foster care month is 鈥淪trengthening Minds, Uplifting Families鈥 and is dedicated to supporting children and youth mental and behavioral health as the largest unmet need related to foster care. According to the Children鈥檚 Bureau, , compared with approximately 18 to 22 percent of the general population.[1]

HMA can help public sector and community partners align themselves to improve and develop new delivery systems that will work to address inequalities and disparities as communities strive to meet the needs of children, youth and families impacted by issues like mental health and substance use disorder, domestic violence, child abuse and neglect, food insecurity, housing instability, incarceration and other traumas that impact them greatly.

HMA can help support foster care prevention or reunification program efforts in the following ways:

  • Creating additional human service system integration of prevention services to help support families and youth experiencing child welfare interventions or foster care.
  • Increasing Medicaid providers who offer more Evidenced Based and Informed Practices (EBP) among Community Based Organizations (CBO), Providers, and Local Government. 
  • Supporting Managed Care Organizations to develop programs specifically designed to support the wellbeing of children and youth in the foster care system and their families.
  • Connecting the Family First Prevention Services Act (FFPSA) & Medicaid funding together to ensure that funding supports the need and enhance service implementation.
  • Working to implement School Based Mental Health programs in communities.  We can help convene stakeholders, create process flows, and support the development of sustainable funding for such programs.
  • Increasing the meaningful use of youth voice for true collaboration in system redesign.
  • Enhancing judicial engagement with the child welfare system in a way that supports meaningful youth and family voice and representation in court while maintaining the child welfare system鈥檚 responsibilities around assuring child safety.  Making the court process less traumatic for children and youth and more part of a solution for them will support better outcomes.
  • Recognizing longstanding racial inequities in foster care experiences that can and should be addressed holistically in communities and supporting efforts to understand the root causes for the disparities in foster care placement.

Read other parts of this blog series:

If you have questions on how HMA can support your efforts in Child and Family Wellbeing, please contact our experts below.


[1] Data:  National Foster Care Month Outreach Toolkit | Child Welfare Information Gateway

Illinois requests Section 1115 waiver extension to address HRSNs and eliminate inequities

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This week our In Focus section reviews the Illinois Healthcare Transformation 1115 Waiver Extension request, posted for review on May 12, 2023.

In pursuing this waiver extension, Illinois joins a growing list of states taking advantage of new Centers for Medicare & Medicaid Services (CMS) policy flexibilities to address health-related social needs (HRSNs) through Medicaid and test community-driven initiatives that are focused on improving health equity, improving access to care, and promoting whole-person care.

The Illinois waiver incorporates two of the most significant new opportunities in the CMS demonstration waiver flexibilities by proposing to incorporate housing supports for people who are experiencing or at risk of homelessness. The waiver also would extend community reintegration services for justice-involved adults and youths for up to 90 days before their release from incarceration. For a full list of proposed benefits and demonstrations, see Table 1.

Table 1. Summary of Illinois Medicaid 1115 Waiver Extension 

Source: Illinois Department of Health and Family Services. .

The Illinois waiver represents an unprecedented opportunity to demonstrate the long-term, positive impact of providing HRSN services to achieve health equity and create a sustainable, community-driven system for delivering those services. The demonstration proposes to offer a range of HRSN services that are focused on the unmet needs of people who are homeless and housing insecure, are justice-involved, have behavioral health conditions, are pregnant, are unemployed, are food insecure, and/or have been exposed to violence or are at risk of violence with the goal of eliminating health disparities.

The waiver projects a five-year total of $4.4 billion in HRSN services expenditures and another $800 million in HRSN-related infrastructure, indicating Illinois鈥 long-term commitment to healthcare transformation and to building an equitable, accessible, and high-quality delivery system.

For additional information, please email [email protected].

Webinar replay: using 1115 justice waivers to improve carceral healthcare delivery information

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This webinar was held on May 18, 2023.

HMA鈥檚 five-part 1115 Justice Waivers: Building Bridges of Health for Persons Leaving Carceral Settings webinar series is designed to help plans and other stakeholders improve the long-term health outcomes of individuals leaving carceral settings. This webinar focused on the carceral settings operational healthcare practices, including intake screenings to aid in risk assignment and facilitate community re-entry. The 1115 justice waivers allow Medicaid programs to support in-carceral care, but to optimize resources, systems need information to translate transition in care best practices to carceral places of service.

HMA consultants with lived leadership experience working inside and outside jails and prisons provided plans and state agencies with a unique perspective on opportunities for transformation.

Learning Objectives:

  • Establishing Health Care Transitions Across Providers: Methods to improve transitions in care through recognizing carceral facilities as a place of service in the continuum of care.
  • Health Risk Assessments to Improve Continuity of Care: Utilizing health screening and risk assessments done at intake and throughout incarceration so Medicaid can improve healthcare transitions from jail into the community.

Other webinars in the “1115 Justice Waivers: Building Bridges of Health for Persons Leaving Carceral Settings” series:聽

Part 1 – Webinar replay: Medicaid authority and opportunity to build new programs for justice-involved individuals
Register now for Part 3 – June 15, 2pm ET – Transitions of care: identifying and connecting the key partners
July 13 2 p.m. ET – Part 4 – 1115 justice waivers and medication assisted therapy (MAT)
Upcoming Part 5 – 1115 justice waivers and special populations: meeting the needs of justice-impacted youth

Biden administration encourages states to apply for Medicaid Reentry 1115 Demonstration for individuals in carceral settings

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This week our In Focus section reviews guidance from the Centers for Medicare & Medicaid Services (CMS), released on April 17, 2023, encouraging states to apply for the new Medicaid Reentry Section 1115 Demonstration Opportunity. The demonstration is aimed at helping improve care for individuals in carceral settings prior to their release.

Background

The United States has approximately 1.9 million individuals incarcerated nationwide. Studies have shown higher rates of mental illness and physical health care needs in incarcerated populations compared to the general population, as well as associations between jail incarceration and increases in premature death rates from infectious diseases, chronic lower respiratory disease, drug use, and suicide.

CMS states that formerly incarcerated individuals with physical and mental health conditions and substance-use disorders (SUDs) typically have difficulty succeeding upon reentry due to obstacles present immediately at release, such as high rates of poverty and high risk of poor health outcomes. These individuals tend to face barriers in obtaining housing, education, employment, and health care access upon release. They often do not seek outpatient medical care and are at significantly increased risk for emergency department (ED) use and hospitalization.

Purpose and Goals

After collecting feedback from stakeholders, including managed care organizations, Medicaid beneficiaries, health care providers, the National Association of Medicaid Directors, and other representatives from local, state, and federal jail and prison systems, CMS designed the Reentry Section 1115 Demonstration Opportunity. The services covered under this demonstration opportunity should aim to improve access to community resources that address the health care and health-related social needs of the carceral population, with the aims of improving health outcomes, reducing emergency department visits, and inpatient hospital admissions for both physical and behavioral health issues once they are released and return to the community.

The purpose of this demonstration opportunity is to provide short-term Medicaid enrollment assistance and pre-release coverage for certain services to facilitate successful care transitions. The full goals, as quoted from CMS, are as follows:

  • 鈥淚ncrease coverage, continuity of coverage, and appropriate service uptake through assessment of eligibility and availability of coverage for benefits in carceral settings just prior to release
  • Improve access to services prior to release and improve transitions and continuity of care into the community upon release and during reentry
  • Improve coordination and communication between correctional systems, Medicaid systems, managed care plans, and community-based providers
  • Increase additional investments in health care and related services, aimed at improving the quality of care for beneficiaries in carceral settings and in the community to maximize successful reentry post-release
  • Improve connections between carceral settings and community services upon release to address physical health, behavioral health, and health-related social needs
  • Reduce all-cause deaths in the near-term post-release
  • Reduce number of ED visits and inpatient hospitalizations among recently incarcerated Medicaid beneficiaries through increased receipt of preventive and routine physical and behavioral health care鈥

CMS encourages states to engage with individuals who were formerly incarcerated when contemplating the design and implementation of their proposal. CMS also encourages states to design a broadly defined demonstration population that includes otherwise eligible, soon-to-be former incarcerated individuals. States have the flexibility to target population, such as individuals with specific conditions, but are encouraged to be mindful of undiagnosed conditions. States should have a plan to ensure incarcerated individuals will be enrolled in Medicaid upon their release, applying for Medicaid no later than 45 days before the day of release.

Reentry Section 1115 Demonstration Opportunity

To receive approval for the demonstration, the state proposal must include in the pre-release benefit backage:

  1. Case management to assess and address physical and behavioral health needs and health-related social needs;
  2. Medication-assisted treatment (MAT) services for all types of SUD as clinically appropriate, with accompanying counseling; and
  3. A 30-day supply of all prescription medications that have been prescribed for the beneficiary at the time of release, provided to the beneficiary immediately upon release from the correctional facility.

In addition to these three services states may include other important physical and behavioral health services to cover on a pre-release basis, such as family planning services and supplies, behavioral health or preventive services, including those provided by peer supporters/community health workers, or treatment for Hepatitis C. CMS is also open to states requesting Section 1115 expenditure authority to provide medical supplies, equipment, and appliances.

The Reentry Section 1115 Demonstration opportunity is not intended to shift current carceral health care costs to the Medicaid program. CMS will not approve state proposals to receive federal Medicaid matching funds for any existing carceral health care services funded with state or local dollars unless the state agrees to reinvest the total amount of new federal matching funds received into activities or initiatives that increase access to or improve the quality of health care services for individuals who are incarcerated.

CMS also expects states to refrain from including federal prisons as a setting in which demonstration-covered prerelease services are provided under the opportunity.

States with approved demonstrations will need to submit an implementation plan, a monitoring protocol, quarterly/annual monitoring reports, a mid-point assessment report, an evaluation design, and interim/summative evaluation reports.

California

California became the first state to  for a Section 1115 waiver amendment earlier this year to provide limited Medicaid services to incarcerated individuals for up to 90 days immediately prior to release. The approval period runs through December 31, 2026, timed with the expiration of the CalAIM Medi-Cal waiver demonstration. California鈥檚 reentry demonstration initiative aims to provide health care interventions at earlier opportunities for incarcerated individuals to reduce acute services utilization and adverse health outcomes. The state anticipates it will increase coverage and continuity of coverage for eligible beneficiaries, improve care transitions for beneficiaries as they reenter the community, and reduce morbidity and mortality in the near-term post-release.

Pre-release services include comprehensive care management, physical and behavioral clinical consultation, lab and radiology, MAT, community health worker services, and medications and durable medical equipment. A care manager will be assigned to eligible individuals to establish a relationship, understand their health needs, coordinate vital services, and make a plan for community transition, including connecting the individual to a community-based care manager they can work with upon their release. Additionally, all counties implementing Medi-Cal application processes in jails and youth correctional facilities will 鈥渟uspend鈥 the Medicaid status while an individual is in jail or prison, so that it can be easily 鈥渢urned on鈥 when they enter the community.

On April 6, 2023, HMA held a webinar titled, 鈥淢edicaid authority and opportunity to build new programs for justice-involved individuals.鈥 The webinar replay is now available. HMA will announce additional webinars on the topic.

Ready to talk?