Six months ago, I built the logic for a simple change in federal Medicaid law: Permit expenditure of federal Medicaid funds for care of persons who actually are incarcerated in a cell and who are pre-adjudicated.
The Constitutional case to do this is very strong; the need, overwhelming. The vast preponderance of the 730,000 persons currently incarcerated in our county and city jails suffer from a mental health, substance use, or intellectual/developmental disability condition, or some combination of these problems. About two-thirds are pre-adjudicated. Provision of good care will be essential in order to restore these people to the community and to conserve our care dollars. Failure to do so will continue to promote the revolving door in and out of our county and city jails, at ever increasing cost.
I am delighted to report that significant progress is being made to advance this proposal.
The New York State Department of Health announced last week that it is submitting an application to CMS to provide Medicaid services to incarcerated persons about to be released from county jails and New York State prisons. The services will be provided beginning 30 days prior to the release date for people with serious health conditions enrolled in Medicaid.
The New York Waiver Amendment is posted online for public comment. This comment period is the final requirement before the state can submit the application to amend its Medicaid Redesign program.
Quite importantly, if approved, Medicaid-covered services will include care management, such as "in-reach," a care needs assessment, development of a discharge care plan, referrals and appointments with physical and behavioral health providers, and linkages to other critical social services and peer supports. Through the initiative, incarcerated individuals also will receive clinical consultation services provided by community-based medical and behavioral health practitioners, to facilitate continuity of care post release. They will also receive a medication management plan and certain higher priority medications for chronic conditions, to support longer-term clinical stability post release.
In a separate development, the DC-based Consensus Workgroup on Behavioral Health Issues in Criminal Justice (see Workgroup policy recommendations), comprised of representatives from major national mental health and substance use entities, is endorsing the Paul Tonko (D-NY)-Michael Turner (R-OH) Medicaid Re-entry Act (House Resolution 1329). This bill would employ the same 30-day period to initiate pre-release care funded by Medicaid, with federal financial participation.
In making this endorsement, the Workgroup has been very clear that any funds for these services be designated to county and community providers external to the jail system. This has been done with two specific goals in mind: Create an incentive for community providers to accelerate the decarceration of persons for whom they are providing care, and prevent an incentive for county or city jails to develop their own behavioral health systems. Clearly, it would be a serious mistake to develop a new parallel care system.
To date, these efforts reflect an important confluence of waiver and legislative goals. When such agreement occurs, the momentum for action is strengthened considerably.
Please join the growing number of organizations and persons calling for this important change to Medicaid law and practice.