Affordable Care Act:

Health Coverage for Criminal Justice Populations

Advocacy DenverSeptember 4, 2014Colorado Center on Law and Policy

Colorado Criminal Justice Reform Coalition

2

Who we are

CCJRC and CCLP have partnered to help Colorado seize this historic opportunity to connect criminal justice populations with needed health care coverage and services. We coordinate a stakeholder group specifically focused on this population and the ACA.

Advances the health, economic security and wellbeing of low-income Coloradans through research, education, advocacy and litigation.

Advocates for criminal justice reforms and serves as a resource for people involved in the criminal justice system.

3

Overview

• Glossary of Criminal Justice terms

• Affordable Care Act (ACA) Overview

• Eligibility and Enrollment Info

• Accessing Healthcare Services

4

By the numbers

On any given day in Colorado, there are over 100,000 people who are involved in the criminal justice system in some form. The majority will be eligible for Medicaid.

Probation – almost 76,000 adults in 2013

Department of Corrections (DOC) – approximately 18,000 adults in prison, 2,000 in community corrections and 8,500 in-state parolees. Approximately 10,000 people a year are released from DOC (850/month)

Community corrections (“halfway house”) - approximately 5,000 clientsDOC transition clients-still considered “inmates”Diversion clients – sentenced to community corrections by court Other – could include condition of probation and condition of parole placements

County jails – ???? Tens of thousands of people are released annually from jail after serving a sentence or being released on bond

5

Criminal Justice Terms – Glossary

ON BONDWhen people are first arrested for an offense, they may be released from jail on bond awaiting trial or other disposition of the criminal case. People on bond are living in the community and they have not been convicted (or yet sentenced) for a criminal offense. ON PROBATIONProbation is a sentence option for people convicted of either misdemeanor or felony offenses where the person is living in the community and under supervision of a probation officer with court oversight. IN COMMUNITY CORRECTIONSA community corrections program is commonly referred to as a “halfway-house”. This refers to the role these programs play in housing people that are “halfway-in” or “halfway-out” of prison. There are two phases of community corrections, a residential phase where people live in the halfway house and a non-residential phase where they are supervised in the community and are living at home and working but are still under some level of supervision.

6

Criminal Justice Terms – Glossary

COMMUNITY CORRECTIONS (cont’d)Diversion client - People who are sentenced directly to community corrections as the result of a felony conviction. After completing the residential phase, a person is supervised on non-residential status Transition client –Approximately 1/3 of people leaving prison will transition through a community corrections program. They are called transition clients and are classified as “inmates” of DOC until they are placed on parole. Condition of probation client- The court may also require someone to complete a community corrections program as a condition of probation. Generally these are people who have been convicted of a felony offense but in some limited circumstances, someone convicted of a misdemeanor drug offense may be placed in a community corrections program to receive residential treatment. Condition of parole client – People sentenced to prison are also required to serve a period of parole after release. The Parole Board may require that a parolee complete a community corrections facility as a condition of parole. These people are on parole status, not inmate status. SB 252 beds-revoked parolees- Some parolees who are revoked are eligible to be placed in a community corrections program rather than being returned to prison. They are considered to be back on “inmate” status.

7

Criminal Justice Terms – Glossary

IN JAIL Jails are operated by the local county, generally the county Sheriff’s Department. People can be in jail for a number of different reasons. It is a very fluid population and people may not be in jail for a very long time. Pre-trial detainees-refers to people that are in jail who have not been convicted of a criminal offense and have not (yet) made bond. Convicted – serving jail sentence – refers to people who have been convicted and sentenced to serve a period of time in jail. Usually this is for a misdemeanor conviction but people can also be sentenced for a felony and required to do some jail time as a condition of probation. Some jails have a work-release program or weekender program that allows people to leave jail to go to work, school, treatment, and then return to jail either at night or over the weekend. Immigration hold/detainer- Some people can be in jail because Immigration Control Enforcement (ICE) has placed a hold or detainer pending a deportation investigation/hearing. Other law enforcement/court detainer/hold –A person can be in jail when another law enforcement agency or court has filed a detainer/hold because of pending criminal action in another jurisdiction.

8

Criminal Justice Terms – Glossary

IN JAIL (cont)

Pending probation revocation - If a person is on probation and is noncompliant, a probation officer can ask the court to revoke a person’s probation sentence for violation of a condition or supervision (or for committing a new crime). In this circumstance, an individual may be held in jail until the court holds a revocation hearing.

Pending community corrections revocation- If a person is sentenced to community corrections and is noncompliant, a probation officer can ask the court to revoke the community corrections sentence. In this circumstance, an individual may be held in jail until the court holds a revocation hearing. Being in jail is usually temporary as the court will impose a new sentence, most often a prison sentence. Pending parole revocation- If a parolee is non-compliant, a parole officer can file a complaint requesting that the Parole Board revoke parole. The parolee may be taken to jail awaiting the parole revocation hearing.

9

Criminal Justice Terms – Glossary

IN PRISON Prisons are operated or under contract with the state Department of Corrections or federal Bureau of Prisons. People in prison have been convicted of a felony and sentenced to serve a period of time in prison.

ON PAROLEParole is a period of supervision following release from prison. People on parole are still under the jurisdiction of the Department of Corrections and supervised by a parole officer and are considered parolees – not inmates.

10

ACA is a Game Changer

ACA expands coverage to nearly everyone.

• People involved in the criminal justice system have substantially higher rates of medical, psychiatric, and addiction problems as compared to the general public.

• Majority of justice involved population – 70 to 90 percent – do not have private or public health insurance.

11

Medicaid & Connect for Health Colorado

Medicaid• Free or low-cost public

health insurance program

• Administered jointly by the state & federal government

• Colorado Department of Health Care Policy & Financing (HCPF)

Connect for Health Colorado

(Marketplace)

• Marketplace to purchase health insurance & apply for federal financial assistance to help cover the cost of purchasing health insurance

• Can choose from a variety of health plans

12

New Coverage Options

MedicaidExpanded to cover all

Coloradans up to 133% FPL (about $1300/month), including single adults.

Estimated 2/3 of justice involved population will be eligible for Medicaid.

Connect for Health Colorado

(Marketplace)

Private insurance, including tax subsidies to those up to 400% FPL (about $3800/month).

Estimated 1/3 of justice involved population will be eligible for premium subsidies.

13

2014 Federal Poverty Guidelines

Size of Family

133% 138% 185% 200% 300% 400%

1 $15,521 $16,105 $21,590 $23,340 $35,010 $46,680

2 $20,921 $21,707 $29,101 $31,460 $47,190 $62,920

3 $26,321 $27,310 $36,612 $39,580 $59,370 $79,160

4 $31,721 $32,913 $44,123 $47,700 $71,550 $95,400

5 $37,120 $38,516 $51,634 $55,820 $83,730 $111,640

6 $42,520 $44,119 $59,145 $63,940 $95,910 $127,880

14

Comprehensive Coverage

Under the ACA, both Medicaid and private health plans offered through the Marketplace must provide 10 essential health benefits.

10 Essential Health Benefits

Free preventative coverage

Mental health and substance abuse coverage parity

o Ambulatory patient serviceso Emergency Services o Hospitalization o Maternity/newborn care o Mental health/substance abuse o Prescription drugs o Rehabilitative and habilitative

services and devices o Laboratory services o Preventive and wellness

care/chronic disease management

o Pediatric services, including oral and vision care

15

Eligibility and Enrollment of Justice Involved Populations

16

Eligibility Depends on CJ Status

Eligibility to enroll in health coverage through Connect for Health Colorado or Medicaid differs & depends on the person’s involvement in the criminal justice system.

Most are eligible for coverage, some are not.Clients are NOT eligible for coverage if

BOTH:

• they are an inmate of a public institution (i.e., under the control of state, county, federal government or municipality), AND

• they can be charged criminally with escape if they leave the institution without authorization.

17

Eligibility during Pretrial Phase

 Pretrial Status

 

Eligible for

Medicaid?

Marketplace

Eligible for Coverage?

Eligible for Tax

Credits?

- On bond or diversion pending

disposition

Yes Yes Yes

- In jail pending disposition No* Yes** Yes

* The jail or prison facility is responsible for all health care services provided in-house. Medicaid can reimburse for medical care provided to an incarcerated person admitted as an inpatient in a hospital for at least 24 hours. Medicaid enrollment for this purpose can occur at any point during the hospitalization up to 90 days after release from the hospital. ** Private insurance may pay for inpatient or outpatient services received while someone is in jail pretrial as long as the person continues to pay premiums and receives treatment in-network.

18

Eligibility while serving a sentence

 Serving Sentence

 Eligible for Medicaid?

Marketplace**Eligible for Coverage?

Eligible for Tax

Credits?

In Jail No* No No

In Prison No* No No

Probation Yes Yes Yes

Parole Yes Yes Yes* The jail or prison facility is responsible for all health care services provided in-house. Medicaid can reimburse for medical care provided to an incarcerated person admitted as an inpatient in a hospital for at least 24 hours, including individuals residing in a Community Corrections facility.

**Marketplace enrollment must be discontinued within 30 days of being sentenced to a period of incarceration.

19

Eligibility in Community Corrections/Half-Way Houses

 Community Corrections

 Eligible

for Medicaid

?

Marketplace

Eligible for Coverage?

Eligible for Tax

Credits?

- - Residential diversion clients No ? ?

- - Residential transition clients No ? ?

- - Non-residential diversion clients Yes Yes Yes

- - Non-residential transition clients Yes Yes Yes

- - Condition of probation* Yes Yes Yes

- - Condition of parole No ? ?

- - SB 252 beds (parole revoked) No No No

* As a condition of probation, the court can order a defendant convicted of a drug offense to complete treatment in a residential treatment program provided in a community corrections facility (CRS 18-1.3-204(2.2)). These people are not subject to prosecution for escape if they leave the facility (CRS 18-8-208(11)). Therefore, they are Medicaid eligible while residing in the community corrections facility.

20

When Can I Begin the Enrollment Process?

• Medicaid • Can enroll at anytime throughout the year• Process may begin 41 days prior to

release

• Connect for Health Colorado • Open Enrollment: Nov. 15, 2014 – Feb. 15,

2015• Release from incarceration is considered a

“qualifying life event,” which allows someone to purchase health insurance from the Marketplace outside open enrollment timeframe within 60 days

21

Identification Needed to Enroll

• Identification and verification of citizenship is required for enrollment in Medicaid and Connect for Health Colorado Name Social Security Number or Legal

Permanent Resident Documentation Date of Birth Income information

22

Resources to help with Enrollment

Step 1Connect with enrollment specialists• County Department of Human

Services• Medical Assistance Sites• Health Coverage Guides• Mobile Van/Onsite Services

23

Applying for Coverage in Colorado

County Department of Human Services & Medical Assistance Sites• Call to schedule an appointment• Can help enroll in Medicaid and

other public benefits (food assistance, etc.)

• Online mapping tool to find the nearest location: http://www.colorado.gov/apps/maps/hcpf.map

24

Applying for Coverage in Colorado

Health Coverage Guides• Resource to help with enrollment for

both Medicaid & Connect for Health Colorado

• Will need appropriate documentation• On average, an hour for Medicaid

enrollment• Can take an additional hour to sign up

for a plan on Connect for Health Colorado if not eligible for Medicaidhttp://connectforhealthco.com

25

PEAK Mobile Enrollment

Health Access Express – Denver

HealthOutreach enrollment van that will come to your site to help with

enrollment Call or go online to schedule an appointment:

303-912-0263  |  303-503-1472  |  720-376-8535

26

Apply Online

You may also apply directly online: http://coloradopeak.force.com/

Each County also has a PEAK contact that can assist with

completing an application

27

How to Access Care through Medicaid

• Accountable Care Collaborative (ACC) is Medicaid’s primary health care program.

• It is comprised of Regional Care Collaborative Organizations (RCCOs) and Primary Care Medical Providers (PCMPs).

Physical Health Care

Coordination

• Behavioral Health Organizations (BHOs) are responsible for care coordination.

• BHOs contract with community mental health centers and other treatment providers.

Behavioral Health Managed

Care

Medicaid is administered by the Colorado Department of Health Care Policy and Financing (HCPF).

28

ACC – Regional Care Collaborative Organizations

29

RCCO Contact Information

RCCO 1: Rocky Mountain Health Plans• (970) 254-5771 or (800) 667-

6434

RCCO 2: Colorado Access• (303) 368-0035 or (855) 267-

2094

RCCO 3: Colorado Access• (303) 368-0037 or (855) 267-

2095

RCCO 4: Integrated Community Health Partners• (855) 959-7340

RCCO 5: Colorado Access• (303) 368-0038 or (855) 384-

7926

RCCO 6: Colorado Community Health Alliance• (303) 256-1717 or (855)

627-4685

RCCO 7: Community Care Central Colorado• (719) 314-2560 or (866)

938-5091

30

Behavioral Health Organizations (BHO)

31

Behavioral Health Organizations (BHO) Contact Information

• Access Behavioral Care Denver• (303) 751-9030 or (800) 984-9133

• Access Behavioral Care Northeast• (970) 221-8508 and (844) 880-8508

• Behavioral Health Inc.• (720) 490-4400 or (877) 349-7379

• Foothills Behavioral Health Partners• (303) 432-5950 or (866) 245-1959

• Colorado Health Partnerships• (800) 804-5008

32

Contacts

Colorado Criminal Justice Reform Coalition

Terri Hurst, Policy Coordinatorterri@ccjrc.org

Colorado Center on Law & PolicyElisabeth Arenales, Esq.-Director of Health

Program

earenales@cclponline.org, 303-573-5669 x 302

33

Questions