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State Medicaid Eligibility Policies for Individuals Moving Into and Out of Incarceration

Executive Summary
  1. As noted in the methodology section, supra, our review did not assess whether and how states are enforcing their Medicaid managed care contracts.

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  2. E. Ann Carson, U.S. Dep’t of Justice, Office of Justice Programs, Bureau of Justice Statistics, Prisoners in 2013 at 1-2 (revised Sept. 30, 2014), available at http://www.bjs.gov/content/pub/pdf/p13.pdf; Todd D. Minton and Daniela Golinelli, U.S. Dep’t of Justice, Office of Justice Programs, Bureau of Justice Statistics, Jail Inmates and Midyear 2013: Statistical Tables (revised Aug. 14, 2014), available at http://www.bjs.gov/content/pub/pdf/jim13st.pdf.

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  3. See, e.g., Nat’l Comm’n on Correctional Health Care, The Health Status of Soon-To-Be-Released Inmates: A Report to Congress (2002).

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  4. David Cloud, Vera Institute of Justice, On Life Support: Public Health in the Age of Mass Incarceration 10 (2014) (citing Anne C. Spaulding, HIV/AIDS among Inmates of and Releasees from US Correctional Facilities, 2006: Declining Share of Epidemic but Persistent Public Health Opportunity, 4 PLOS One e7558 (2009)).

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  5. Id. at 9 (citing Seth J. Prins, Prevalence of Mental Illnesses in US State Prisons: A Systematic Review, 65 Psychiatric Services 862 (2014)).

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  6. Id. at 10 (citing Jennifer C. Karberg & Doris J. James, U.S. Dep’t of Justice, Office of Justice Programs, Bureau of Justice Statistics, Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002 (2005); Seena Fazel et al., Substance abuse and dependence in prisoners: a systematic review, 101 Addiction 181 (2006); Bridget F. Grant et al., Prevalence and Co-occurrence of Substance Use Disorders and Independent Mood and Anxiety Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions, 61 Archives of General Psychiatry 807 (2004)).

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  7. Andrew P. Wilper et al., The Health and Health Care of US Prisoners: Results of a Nationwide Survey, 99 Am. J. Pub. Health 666, 668-69 (2009).

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  8. See, e.g., Emily A. Wang et al., Discharge Planning and Continuity of Health Care; Findings from the San Francisco County Jail, 98 Am. J. Pub. Health 2182 (2008) (finding approximately 90% of individuals who enter county jails have no health insurance); Kamala Mallik-Kane & Christy A. Visher, Urban Inst., Justice Policy Ctr., Health and Prisoner Reentry: How Physical, Mental, and Substance Abuse Conditions Shape the Process of Reintegration 13 (2008) (finding that 78% of men and 66% of women have no health insurance two to three months after release from prison).

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  9. 42 U.S.C. § 1396a(a)(10)(A). In addition, individuals must be residents of the state in which they apply and be citizens or have qualifying immigration status.

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  10. 42 U.S.C. § 1396d(a)(29)(A); 42 C.F.R. §§ 435.1009, 435.1010.

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  11. The Kaiser Family Foundation State Health Facts. Data Source: Current status for each state is based on KCMU tracking and analysis of state executive activity. Available at http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/

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  12. See Letter from Robert A. Streimer, Dir., Disabled and Elderly Health Programs Grp., Ctr. for Medicaid and State Operations, Dep’t of Health & Human Servs., to All Associate Regional Adm’rs., Div. for Medicaid and State Operations 1 (Dec. 12, 1997); see also Health Care Finance Agency Program Issuance Transmittal Notice Region IV (Mar. 6, 1998) (transmitting policies set forth in the December 1997 policy letter to Medicaid agencies in AL, FL, GA, KY, MS, NC, SC, and TN).

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  13. Letter from Glenn Stanton, Acting Dir., Disabled and Elderly Health Programs Grp., Ctr. for Medicaid and State Operations, Dep’t of Health & Human Servs., to State Medicaid Directors 2 (May 25, 2004) (discussing strategies for ending chronic homelessness).

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  14. 42 U.S.C. § 1396a(a)(8).

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  15. 42 U.S.C. § 1396d(a)(29)(A); 42 C.F.R. § 435.1009. Medicaid regulations define inmate[s] of a public institution as individuals who are living in a public institution, unless they are: (1) “in a public educational or vocational training institution for purposes of securing educational or vocational training;” or (2) in a public institution for “a temporary period pending other arrangements appropriate to [their] needs.” 42 C.F.R. § 435.1010. A public institution is one that “is the responsibility of a governmental unit or over which a governmental unit exercises administrative control.” Id. CMS has further explained that the definition includes individuals “serving time for a criminal offense or confined involuntarily in State of Federal prisons, jails, detention facilities, or other penal facilities.” Letter from Robert A. Streimer, supra note 12, at 1. It also includes individuals held involuntarily in detention centers awaiting trial, people required to reside in wilderness camps that are under governmental control, and involuntary residents of halfway houses under governmental control. Letter from Robert A. Streimer, supra note 12, at 4.

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  16. 42 U.S.C. § 1396d(a)(29)(A); 42 C.F.R. §§ 435.1009, 435.1010.

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  17. Letter from Robert A. Streimer, supra note 12, at 3.

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  18. Ingrid A. Binswanger et al., Release from Prison – A High Risk of Death for Former Inmates, 356 N Eng. J. Med. 157, 160 (2007).

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  19. Id. at 165. See also Joseph P. Morrissey et al., Medicaid Enrollment and Mental Health Service Use Following Release of Jail Detainees with Severe Mental Illness, 57 Psychiatric Services 809 (2006) (finding that among individuals with severe mental illness, those enrolled in Medicaid at the time of their release from jail were more likely to use services, accessed the services more quickly, and received more days of services than those who were not enrolled in Medicaid).

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  20. Joseph P. Morrissey et al., The Role of Medicaid Enrollment and Outpatient Service Use in Jail Recidivism Among Persons With Serious Mental Illness, 58 Psychiatric Services 794 (2007).

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Issue Brief
  1. See Letter from Glenn Stanton, supra note 13, at 1-2.

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  2. Id.

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  3. See 2015 N.M. Laws 127 (to be codified at N.M. Stat. Ann. § 27-2-4).

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  4. See, e.g., Unicameral Leg., LB12 (Neb. 2015).

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  5. See Colo Rev. Stat. Ann. § 25.5-4-205.5; Colo. Dep’t of Health Care Policy and Fin., HCPF 14-006, Medicaid Policy for Incarcerated or Inmates in a Correctional Facility 2 (2014), available at https://www.colorado.gov/pacific/sites/default/files/2014 Agency Letters Number 14-006.pdf.  See also Ct. Gen. Assembly, Office of Legislative Research, 2013-R-0288, The Affordable Care Act and Prisoners (2013), available at http://www.cga.ct.gov/2013/rpt/2013-R-0288.htm.

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  6. Fla. Stat. Ann. § 409.9025.

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  7. N.C. Dep’t of Health & Human Servs., Div. of Medical Assistance, Family And Children’s Medicaid Manual §3360 (updated 2015), available at http://info.dhhs.state.nc.us/olm/manuals/dma/fcm/man/. Moreover, individuals in certain eligibility categories cannot have their eligibility suspended. The Medicaid agency must evaluate these individuals for eligibility in other categories and transfer or terminate their eligibility as appropriate. Id.

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  8. Ariz Health Care Cost Containment Sys., Eligibility Policy Manual § 1502 (updated 2014), available at. https://www.healthearizonaplus.gov/PolicyManual/eligibilitypolicymanual/MA/MA1500/MA1502.V_Incarcerated.html

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  9. Id. Oregon also only suspends eligibility for Medicaid enrollees expected to remain incarcerated for no more than 12 months. Or. Rev. Stat. Ann. § 411.447.

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  10. See Iowa Code Ann. § 249A.38; Iowa Admin. Code R. § 75.12(1); Indiana Health Coverage Program Policy Manual § 2237.05.00 (undated), available at http://in.gov/fssa/files/Medicaid_Combined_PM.pdf.

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  11. Fl. Stat. Ann. § 409.9025(1)-(2).

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  12. N.C. Dep’t of Health & Human Servs., Div. of Medical Assistance, Family And Children’s Medicaid Manual §3360 (updated 2015), available at http://info.dhhs.state.nc.us/olm/manuals/dma/fcm/man/

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  13. Indiana Health Coverage Program Policy Manual § 2237.05.00 (undated), available at http://in.gov/fssa/files/Medicaid_Combined_PM.pdf.

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  14. Deborah Bachrach, Patricia Boozang, & Dori Glanz, State Health Reform Assistance Network, The Report Wood Johnson Fdtn., States Expanding Medicaid see Significant Budget Savings and Revenue Gains, (2015), http://www.rwjf.org/en/library/research/2015/04/states-expanding-medicaid-see-significant-budget-savings-and-rev.html

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  15. Ibid.

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  16. Deloitte commissioned by Kentucky, Report on Medicaid Expansion in 2014, (2015), http://governor.ky.gov/healthierky/Documents/medicaid/Kentucky_Medicaid_Expansion_One-Year_Study_FINAL.pdf

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  17. Cf. Colo. Dep’t of Health Care Policy and Fin., HCPF 14-006, Medicaid Policy for Incarcerated or Inmates in a Correctional Facility 2 (2014), available at https://www.colorado.gov/pacific/sites/default/files/2014%20Agency%20Letters%20Number%2014-006.pdf (indicating that applications can be filed 24 hours after admission) with Kan. Dep’t of Health & Environment, Div. of Health Care Finance, Policy No: 2012-09-01, Inpatient Hospital Coverage for Inmates of State Correctional Institutions (2012), available at https://khap.kdhe.state.ks.us/kfmam/policydocs/Inmate%20Memo.pdf (indicating that applications should be filed after discharge).

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  18. Ariz. Health Care Cost Containment Sys., Eligibility Policy Manual § 1312 (updated 2014), available at https://www.healthearizonaplus.gov/PolicyManual/EPMPlus/index.html#page/MA/MA1300/MA1312.html.

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  19. Colo. Dep’t of Health Care Policy and Fin., HCPF 14-006, Medicaid Policy for Incarcerated or Inmates in a Correctional Facility 2 (2014), available at https://www.colorado.gov/pacific/sites/default/files/2014%20Agency%20Letters%20Number%2014-006.pdf. Similarly, in Oregon, the county jail must notify the Medicaid agency when an individual returns from the hospital so that the Medicaid agency can suspend eligibility. See Or. Health Authority, Div. of Medical Assistance Programs, Medicaid Eligibility for Inmates of Jails and Prisons 11, 23 (updated Sept. 2014), available at http://www.orpca.org/Oregon_Medicaid_Eligibility_Determinations_for_Inmates-UPDATED_9-14.pdf.

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  20. See, e.g., Kan. Dep’t of Health & Environment, Div. of Health Care Finance, Policy No: 2012-09-01, Inpatient Hospital Coverage for Inmates of State Correctional Institutions (2012), available at https://khap.kdhe.state.ks.us/kfmam/policydocs/Inmate%20Memo.pdf (outlining process for individuals in state custody);  N.H. Dep’t of Health & Human Servs., Div. of Family Assistance, Medical Assistance Manual (updated 2014), available at http://www.dhhs.nh.gov/MAM_HTM/newmam.htm (outlining process for individuals in state custody).

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  21. 42 U.S.C. § 1396a(a)(8).

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  22. See Letter from Robert Streimer, supra note 12, at 1; Letter from Glenn Stanton, supra note 13, at 2.

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  23. See 42 U.S.C. § 1396b(a)(7).

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  24. See, e.g., Va. Dep’t of Social Servs., Medicaid Manual § M0120.400F (updated 2013), available at https://www.dss.virginia.gov/files/division/bp/medical_assistance/manual_transmittals/manual/m01r.pdf;  Ariz. Health Care Cost Containment Sys., Eligibility Policy Manual §§ 1302, 1309, 1310 (updated 2014), available at https://www.healthearizonaplus.gov/PolicyManual/EPMPlus/index.html#page/MA/MA1300/MA1312.html.

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  25. See Mich. Comp. Laws Ann. § 400.106b; N.C. Dep’t of Health & Human Servs., Div. of Medical Assistance, Family And Children’s Medicaid Manual § 3360 (updated 2015), available at http://info.dhhs.state.nc.us/olm/manuals/dma/fcm/man/.

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  26. WA Health Care Authority, Apple Health (Medicaid) Manual Incarceration Overview (updated November 10, 2014), available at http://www.hca.wa.gov/medicaid/manual/Pages/90-110.aspx

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  27. AZ Health Care Cost Containment System (AHCCCS) Eligibility Policy Manual for Medical, Nutrition, and Cash Assistance §525, available at https://www.healthearizonaplus.gov/PolicyManual/eligibilitypolicymanual/index.html#page/MA/MA500/MA0525.html

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  28. Michigan Department of Community Health Modified Adjusted Gross Income (MAGI) Related Eligibility Manual, available at http://www.michigan.gov/documents/mdch/MAGI_Manual_457706_7.pdf

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  29. State or local corrections policies may also contain such requirements. Examining these corrections policies was beyond the scope of our review, which focused on Medicaid statutes, regulations, and policies.

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  30. Cohen, R., OLR Research Report, The Affordable Care Act and Prisoners, August 13, 2013, available at: http://www.cga.ct.gov/2013/rpt/2013-R-0288.htm

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  31. N.H. Dep’t of Health & Human Servs., Medical Assistance Manual § 175.01 (2014), available at http://www.dhhs.nh.gov/MAM_HTM/newmam.htm.

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  32. Va. Dep’t of Social Servs., Medicaid Manual § M0120.500F (updated 2013), available at https://www.dss.virginia.gov/files/division/bp/medical_assistance/manual_transmittals/manual/m01r.pdf

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  33. See generally 42 U.S.C. §§ 1396b(m), 1396d(t), 1396u-2.

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  34. See 42 U.S.C. §§ 1396u-2(a)(1)(B), 1396b(m)(1)(A) (managed care organizations), 1396d(a)(25), 1396d(t) (primary care case managers); 42 C.F.R. § 438.2 (prepaid health plans).

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  35. Ctrs. For Medicare & Medicaid Servs., Medicaid Managed Care Enrollment Report: Summary Statistics As Of July 1, 2011, at 4, available at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/2011-Medicaid-MC-Enrollment-Report.pdf.

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  36. As noted in the methodology section, supra, our review did not assess whether and how states are enforcing their Medicaid managed care contracts.

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  37. See, e.g., Ky. Dep’t for Medicaid Servs., Medicaid Managed Care Contract Between the Commonwealth of Kentucky on Behalf of Department for Medicaid Services and Anthem Health Plans of Kentucky, Inc. 86-88 (undated) (contract to expire June 30, 2015).

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  38. Wis. Dep’t of Health Servs., Contract for BadgerCare Plus and/or Medicaid SSI HMO Services for Jan. 1, 2014 – Dec. 31, 2015, at 144 (2014). The term “public institution” is not limited to penal institutions. See id. at 19; 42 C.F.R. § 435.1010.

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  39. See, e.g., Colo. Dep’t of Health Care Policy & Financing, Contract with Behavioral Healthcare, Inc. for Behavioral Health Services Program 17 (undated) (contract to expire June 30, 2015 unless sooner terminated or further extended).

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  40. Id. at 17-18.

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  41. Fla. Agency for Health Care Admin., 2012-2015 Health Plan Model Contract Attachment II – Core Contract Provisions 125 (undated).

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  42. Id.

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  43. Id.

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