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

Today, the U.S. Department of Health and Human Services (HHS), through California's Centers for Medicare & Medicaid Services (CMS), approved a first-of-its-kind substantive amendment to Section 1115. -Discharge services and improve access to urgently needed care for people returning home from prison and prison.

For example, Medi-Cal may cover substance treatment before a Medicaid beneficiary's release from prison, prison, or juvenile detention center. In addition, the state may connect the person to a community-based Medicaid provider 90 days before her discharge so that she can continue treatment when she returns to the community.

"The Biden-Harris administration is focused on expanding access to healthcare across the country, and it does so with equity in mind," HHS Secretary Xavier Becerra said. In partnership with California, California is leading the way in providing compensation for those who serve law enforcement. This is the first time in history Medicaid will be providing coverage to justice-involved individuals before they're released. It is a step forward in closing gaps in services this underserved community experiences, and I encourage other states to follow California's lead.”

“Today, we achieved a significant milestone in the expansion of health care coverage,” said CMS Administrator Chiquita Brooks-LaSure. “This demonstration allows us to make historic changes for incarcerated individuals who are eligible for Medicaid or CHIP. By helping these individuals access essential services and care coordination prior to release, we will also prevent gaps in care as they rejoin their communities.”

In this first-of-its-kind approval, California will have authority to cover pre-release services to incarcerated individuals, which is consistent with coverage under the demonstration opportunity provided for in by section 5032(b) of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. This work also builds on President Biden's February 2022 executive order to expand affordable, quality health care coverage, which includes strengthening Medicaid and the Affordable Care Act, and his May 2022 historic executive order to advance effective, accountable policing and criminal justice practices, which includes improving treatment and rehabilitation in jails, prisons, and other correctional settings, and supporting successful entry. This is the first time Medicaid will pay for a limited set of health care services provided to justice-involved individuals before they are released—a key component of the President's proposed public safety package, the Safer America Plan.

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

Under the demonstration, California goals to reap the subsequent goals:

Increase insurance, continuity of care, and suitable carrier uptake thru evaluation of eligibility and availability of insurance for advantages in carceral settings simply previous to launch;
Improve get admission to to offerings previous to launch and enhance transitions and continuity of care into the network upon launch;
Improve coordination and verbal exchange among correctional systems, Medicaid and CHIP systems, controlled care plans, and network-primarily based totally providers;
Increase extra investments in fitness care and associated offerings aimed toward enhancing the exceptional of take care of beneficiaries in carceral settings and withinside the network to maximise a hit reentry post-launch;
Improve connections among carceral settings and network offerings upon launch to deal with bodily fitness, behavioral fitness, and fitness-associated social needs;
Provide intervention for positive behavioral fitness situations and use stabilizing medicinal drugs like long-appearing injectable anti-psychotics and medicinal drugs for dependancy remedy for substance use disorders (SUDs), with the purpose of lowering decompensation, suicide-associated deaths, overdoses, and overdose-associated deaths withinside the near-time period post-launch; and
Reduce post-launch acute care utilizations together with emergency branch visits, inpatient hospitalizations, and all-motive deaths amongst these days incarcerated Medicaid beneficiaries and people in any other case eligible for CHIP if now no longer for his or her incarceration repute thru sturdy pre-launch identification, stabilization, and control of positive severe bodily and behavioral fitness situations which can reply to ambulatory care and remedy (e.g. diabetes, coronary heart failure, hypertension, schizophrenia, SUDs), in addition to expanded receipt of preventive and recurring bodily and behavioral fitness care.

Pursuant to the performance requirements of CMS Section 1115, California is required to conduct a comprehensive and rigorous performance evaluation.

California's approval was created by her HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE), which examines the critical healthcare and continuing care needs that people in the legal profession face when they return to their communities. Consistent with reports. These include high rates of SUD, severe mental illness, infectious diseases and other chronic physical health imbalances. B. Medicaid Section 1115 Demonstration to Improve Health and Healthcare Transitions.