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HomeMy WebLinkAboutMINUTES - 08122014 - D.11RECOMMENDATION(S): ACCEPT the report regarding Inmate Health Insurance Enrollment Program and DESIGNATE the Employment and Human Services as the department responsible for coordinating the provisions of AB720. (Kathy Gallagher, Employment and Human Services Director) FISCAL IMPACT: Not applicable. BACKGROUND: Assembly Bill 720 ((Statutes of 2013) authorizes the Board of Supervisors in each county, in consultation with the county Sheriff, to designate an entity to assist county jail inmates to apply for a health care insurance affordability program and authorizes the entity to act on behalf of a county jail inmate for the purpose of applying for, or determining, MediCal eligibility for acute inpatient hospital services. County jail inmates who are currently enrolled in the MediCal program shall remain eligible for, and shall not be terminated from, the program due to their detention, unless they become otherwise ineligible, or suspension of their benefits has ended. The law further states that the fact that an applicant is an inmate shall not, in and of itself, preclude a county human services agency from processing an application for the MediCal program submitted to it by, or on behalf of, the inmate. CONSEQUENCE OF NEGATIVE ACTION: Not applicable APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 08/12/2014 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:John Gioia, District I Supervisor Candace Andersen, District II Supervisor Mary N. Piepho, District III Supervisor Karen Mitchoff, District IV Supervisor Federal D. Glover, District V Supervisor Contact: Kathy Gallagher, 313-1579 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: August 12, 2014 David Twa, County Administrator and Clerk of the Board of Supervisors By: June McHuen, Deputy cc: D.11 To:Board of Supervisors From:Kathy Gallagher, Employment & Human Services Director Date:August 12, 2014 Contra Costa County Subject:Assembly Bill (AB) 720 Inmate Health Insurance Enrollment Programs CHILDREN'S IMPACT STATEMENT: Not applicable. CLERK'S ADDENDUM Speakers: Bob Brewer,Goodwill Industries of the Greater East Bay ATTACHMENTS AB 720 Final report AB 720 Attachments 1 I. Overview of AB 720 (Statutes of 2013) Assembly Bill (AB) 720 (Statutes 2013) authorizes the Board of Supervisors in each county, in consultation with the Office of the Sheriff, to designate an entity to assist county jail inmates to apply for health care coverage, and authorizes that entity to act on behalf of a county jail inmate for the purpose of applying for and determining Medi-Cal eligibility for acute inpatient hospital services. Medi-Cal will not always reimburse costs for inmates in county jails; however, county jail inmates who are currently enrolled in the Medi-Cal program shall remain eligible for benefits but not in receipt of those benefits while incarcerated. Benefits will not be terminated but suspended for a period up to one year while in detention unless the inmate becomes ineligible or the suspension ends. AB 720 further states that the fact an applicant is an inmate shall not preclude a County Human Services agency from processing an application for the Medi-Cal program submitted to if by, or on behalf of, the inmate. With the implementation of the Affordable Care Act (ACA) on January 1, 2014; all individuals regardless of age may be eligible to no cost Medi-Cal offered through the Employment and Human Services Department (EHSD), or may be eligible to other affordable health care coverage plans offered through our State’s health care coverage exchange, Covered California. The expansion of Medi-Cal under ACA to single, childless adult individuals ages 18-64 facilitates the Medi-Cal eligibility of many of the County’s inmate population. Inmates assigned to home detention are not considered as incarcerated or inmates of a public institution; however, efforts to outreach to potential customers either on home detention or probation are in development with the County’s Probation Department, AB 109 partners, and other Community-Based Organizations (CBOs). Approximately 1,600 individuals are incarcerated at the various detention facilities located in Contra Costa County. Approximately 65 to 90 individuals go through the detention intake process on a daily basis. Of those, about 25 to 30 are released within hours of their booking. The Office of the Sheriff estimates the following for inmates between the ages of 18 and 64 (who are eligible for expanded Medi-Cal): o Projected Annual Jail Admissions: 21,215 o Projected Eligibility for Medi-Cal: 14,542 It is anticipated that 100% of those inmates who do not have health care coverage will be eligible to enroll into some type of health coverage. Options include Medi-Cal and subsidized or unsubsidized coverage through Covered California. Undocumented individuals may be eligible for restricted Medi-Cal coverage. II. Roles of County Departments under AB 720 A. Employment and Human Services Department (EHSD) 2 EHSD will serve as the lead agency partner in Contra Costa County’s AB 720 implementation efforts by: 1. Establishing a Memorandum of Understanding (MOU) between the partner agencies (see attached final MOU as Attachment I); 2. Arranging for periodic reviews of the MOU, the AB 720 program, and desired outcomes; 3. Engaging in re-entry efforts with partner agencies for to continued health care coverage of the re-entry population; 4. Working with the Health Services Department and the Office of the S heriff to ensure those incarcerated individuals in hospital facilities receive a health care coverage application 5. Managing ongoing Medi-Cal eligibility services including: i. Suspension of Medi-Cal coverage for up to one year for any inmate that is determined to have Medi-Cal coverage upon incarceration; ii. Identification of specific eligibility workers to process Health Care Coverage applications received from inmates of detention facilities in Contra Costa County; iii. Processing of applications with all necessary verifications within seven (7) days of receipt; iv. Forwarding of Notices of Actions (NOAs) to inmates and the Health Services Department’s Behavioral Health liaison; v. Releasing the Medi-Cal suspend status for any previously suspended inmate when notified of the inmate’s release from custody; vi. Collecting and sharing data with the Health Services Department and the Office of the Sheriff; vii. Maintaining confidentiality of inmate information received from any source; viii. Working with the Health Services Department and the Office of the Sheriff to ensure those incarcerated and in a hospital facility receive an application of health care coverage B. Office of the Sheriff The Office of the Sheriff will serve as a partner agency by: 1. Providing data regarding incarcerated individuals to EHSD including, but not limited to, incarceration date, identifying information, demographic information, and release dates; 2. Allowing the placement of application packets and a drop box to collect applications in detention facilities (out of concern for the safety and well-being of other County staff not currently placed and providing services in detention facilities, it was agreed that no EHSD staff will be worksited in the facilities); 3. Providing inmates release information to EHSD 30 days prior to the inmates’ release to facilitate the removal of suspended Medi-Cal benefits; 4. Providing a Medi-Cal flyer to inmates incarcerated less than 30 days in the release packet. (See attached front/back Medi-Cal flyer as Attachment II.) 3 C. Health Services Department The Health Services Department, Behavioral Health Services will serve as a partner agency by: 1. Serving as a liaison between the inmate and EHSD in order to facilitate successful completion of the Health Care Insurance (HCI) application process; 2. Serving as a liaison between the inmate and EHSD in order to facilitate suspension of Medi-Cal benefits; 3. Distributing the application for HCI to inmates who are determined to have no health care coverage; 4. Reviewing the HCI application for completeness, ensuring that all questions are answered, and that appropriate signatures and dates are included; 5. Providing assistance to the inmate for completion of the HCI application if needed; 6. Transferring the completed HCI application to EHSD; 7. Acting as the Authorized Representative (AR) on behalf of the inmates and receiving Notices of Action (NOAs) issued on inmates’ cases by EHSD. (See attached Health Services “Medi-Cal Outreach and Enrollment Consent” form as Attachment III.) III. Program Accessibility EHSD in partnership with the Health Services Department and the Office of the Sheriff will implement a process designed to facilitate Medi-Cal eligibility for inmates by creating a streamlined process to expedite applications and program accessibility. This will in clude the suspension rather than the discontinuance of benefits to inmates who are Medi-Cal eligible upon arrest as well as the establishment of a process to apply for benefits during incarceration, thus making Medi-Cal coverage more accessible upon release. (See attached front/back AB 720 Workflow and Narrative as Attachment IV.) A. Inmate Currently Active to Medi-Cal 1. EHSD will be notified of an individual’s incarceration who is a Medi-Cal recipient, will suspend the inmate’s Medi-Cal coverage, and will advise the inmate of the suspension of Medi-Cal benefits while incarcerated. 2. During the inmate’s incarceration, the Behavioral Health Liaison will act as the Authorized Representative (AR) for the inmate. The role of the liaison includes facilitating any Medi-Cal program requirements to secure ongoing eligibility. 3. The Office of the Sheriff will notify EHSD of the inmate’s release allowing for the removal of the suspension of coverage and issuance of a NOA. B. Inmate With No Active Medi-Cal 1. Applications for Health Insurance coverage (form CCFRM 604) will be readily available to inmates at a designated area within the detention facility. Inmates may complete the application at any time during their incarceration. EHSD, in 4 partnership with the Behavioral Health Liaison will process the applications prior to the inmates’ release. 2. When inmates meet with the Behavioral Health Liaison, the Liaison acting as an Authorized Representative (AR) will discuss Medi-Cal eligibility and will assist in the completion of the Health Care Insurance applications which will be forwarded to EHSD for processing. IV. Next Steps The partners involved in the AB 720 implementation and operational efforts will further explore program and funding crossovers, and tracking and follow-up with stakeholders of the AB 109 re- entry efforts and services. The primary purpose will be to coordinate services and to track previously incarcerated individuals in the community for continued health care coverage. Attachments: Attachment I: Final AB 720 MOU Attachment II: Medi-Cal flyer (front/back) Attachment III: Health Services’ Medi-Cal Outreach and Enrollment Consent form Attachment IV: AB 720 Workflow and Narrative (front/back) ATTACHMENT I Non-financial Memorandum of Understanding Contra Costa County Employment and Human Services Department, Health Services Department and the Office of the Sheriff Health Care Coverage Screening for Inmates of Detention Facilities in Contra Costa County The Contra Costa Employment and Human Services Department (“EHSD”), the Contra Costa Health Services Department (“HSD”) and the Contra Costa County Office of the Sheriff (“Office of the Sheriff”) enter into this Memorandum of Understanding (“MOU”) pursuant to Assembly Bill No. 720 (“AB 720”), which pertains to the health care enrollment of county jail inmates. RECITALS: 1. In 2013, the California Legislature enacted AB 720. 2. The purpose of AB 720 is to enroll inmates in a county jail in the Medi-Cal program or to facilitate application for private health insurance coverage through Covered California. 3. In addition, AB 720 provides that county jail inmates who are currently enrolled in the Medi-Cal program shall remain eligible for, and shall not be terminated from, the program due to their detention, unless otherwise required by federal law. 4. Under AB 720, the Contra Costa County Board of Supervisors, in consultation with the Office of the Sheriff, is authorized to designate an agency to enroll inmates in these health coverage programs. EHSD is the designated agency. NOW, THEREFORE, THE PARTIES AGREE: I. Term: The initial term of this MOU is from August 1, 2014 to July 31, 2015. This MOU shall automatically renew for successive one-year terms unless any party notifies the other parties of a request for revision or termination of the MOU as provided in paragraph V., below. II. HSD will be responsible for and agrees to the following: A. The HSD Behavioral Health Liaison (“BHL”) will screen the inmates for health care coverage. The BHL will notify EHSD of those inmates who have current Medi-Cal coverage. EHSD HSD SO AB 720 MOU 8/1/14 ATTACHMENT I B. With the assistance of the Office of the Sheriff, the HSD BHL will distribute the Medi-Cal Inmate Application packet to inmates screened with no health care coverage. The Medi-Cal Inmate Application packet will include, at a minimum: • Cover Letter • CCFRM 604 - Application for Health Insurance • Behavioral Health Release • Return Postage Paid Envelope C. The HSD BHL will review the Application for Health Insurance for completeness, provide assistance to the inmates for completion, and will submit the completed Application for Health Insurance to EHSD. D. The BHL shall also ensure that the inmate signs and dates any other required forms, and provides appropriate verifications. E. The BHL will submit to the Office of the Sheriff’s professional visitor jail clearance process. III. EHSD will be responsible for and agrees to the following: A. EHSD will identify eligibility workers to process the Applications for Health Insurance. B. The eligibility workers will review all Applications for Health Insurance completed and submitted by HSD Behavioral Health staff and, if necessary, will follow up with Behavioral Health staff to obtain clarification and/or further information. C. If the “Authorized Representative” section of the Application for Health Insurance is signed by the patient to designate the HSD BHL as their Authorized Representative, the eligibility worker is permitted to discuss the status of these pending applications with the BHL, as needed. D. The eligibility workers will process each Application for Health Insurance within seven (7) business days following receipt of a completed application and appropriate verification. E. EHSD will forward case disposition notices to the inmate and the HSD BHL. F. EHSD will suspend Medi-Cal coverage for up to one (1) year for any inmate that is determined by HSD Behavioral Health to have Medi-Cal and is 2 ATTACHMENT I approved for Medi-Cal coverage while incarcerated. EHSD will immediately notify the Office of the Sheriff of an inmate’s Medi-Cal coverage suspension. G. If EHSD imposes a Medi-Cal coverage suspension pursuant to paragraph III.F. above, EHSD will lift the Medi-Cal suspension after one (1) year or upon the inmate’s release from the detention facility, whichever is sooner. The Office of the Sheriff must provide necessary information to EHSD as provided in paragraph IV.B. below. H. EHSD agrees to advise the HSD BHL and the Office of the Sheriff of any change in the process used by the eligibility workers that may negatively impact this application process. I. EHSD agrees to maintain confidentiality of inmate personal identifying information received from any source. J. EHSD agrees to collect and share with the HSD Behavioral Health Department and Office of the Sheriff data showing the total number of applications received, demographic categories, and application disposition trends. The reports will be compiled and shared monthly, quarterly and annually. IV. The Office of the Sheriff will be responsible for and agrees to the following: A. Provide a daily list of individuals who are arrested to EHSD, including the inmate’s name, social security number and date of birth so that EHSD can determine if the inmate is a current receipt of Medi-Cal benefits. B. Provide advance notice to EHSD as soon as possible, but no less than thirty (30) days, of the release date of each inmate whose Medi-Cal coverage was suspended pursuant paragraph III.F. of this MOU so that Medi-Cal benefits can be made available to the inmate upon his or her release. C. Allow the placement of application packets and the installation of drop boxes at County detention facilities. D. Provide a Medi-Cal informational flyer to inmates incarcerated for less than thirty (30) days at the time of their release. The flyer will be provided to the Office of the Sheriff by EHSD. V. Joint Obligations: A. The parties will review this MOU, and the processes outlined therein, six (6) months from the effective date. Any party may also request a review of the 3 ATTACHMENT I terms of the MOU at any time. If the parties agree to revise any term of this MOU, those revisions will be formalized in writing and executed as an amendment to the MOU. B. In the case of an unresolved dispute, each department will elevate the issue to its appropriate administrative or executive representative. The administrative or executive representative from each department will consult one another on the issue and reach a joint resolution. C. This MOU by and between EHSD, HSD and the Office of the Sheriff will remain in effect until and unless one of the parties opts to terminate its participation. Such termination must be exercised in writing to the parties to this MOU at least sixty (60) days in advance. ____________________________________ Date: _________________________ Employment & Human Services Department (Department Head or Designee) __________________________________ Date: _________________________ Contra Costa Health Services Department (Department Head or Designee) __________________________________ Date: _________________________ Contra Costa Office of the Sheriff (Department Head or Designee) 4 ATTACHMENT III Medi-Cal Outreach and Enrollment Consent By applying for health care coverage through the Medi-Cal Outreach and Enrollment program, I give my consent to permit program representatives to gather the personally identifiable information required to complete my online application for Medi-Cal benefits. I confirm that all information given to program representatives is true and accurate to the best of my knowledge. I also understand that this information will be used to apply for Medi-Cal coverage, as well as for monitoring my application status and retention of benefits through the Medi-Cal Outreach and Enrollment Program sponsored by the Department of Health Care Services for the State of California. Medi-Cal Outreach and Enrollment personnel will safeguard all information to ensure its confidentiality and integrity, and to prevent unauthorized or inappropriate access, use or disclosure. _____________________________________ ______________________________________ (Printed Name) (Signature) _____/_____/_____ (Date)