Justice Involved Services

Justice Involved Services

Opportunities for local and regional managed care organizations with justice-involved services

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Previously, HMA developed a comprehensive series of webinars reviewing the potential for using 1115 waivers to expand and improve health care services for the justice-involved population. With California becoming the first state earlier in 2023 to receive approval for the authority to provide a specific set of Medicaid services for up to 90 days in advance of release to youth and adults in state prisons, county jails, and youth correctional facilities, and many other states with pending waivers of a similar type, this blog post considers the implications of this emerging policy trend for local and regional managed care organizations (MCOs) in 2024.

The Opportunity

Delivering Medicaid services through MCOs has become the dominant strategy employed by states with 41 states (including the District of Columbia) using managed care for at least certain Medicaid populations. Local and regional MCOs represent a key component in this landscape across the country and often are deeply rooted in the states and communities they serve because of their specific focus on a single or limited number of markets.

With the precedent now in place for federal authority (and federal financial participation) to provide services such as reentry case management, behavioral health and physical health consultation services (in-person or via telehealth), laboratory and radiology services, medications as well as medication administration, medication assisted therapy inclusive of counseling, and community health worker services, states have a clear pathway toward pursuing the ability to provide services for the justice-involved population prior to release. Among the many important implementation questions states will need to consider as they continue to pursue the authority to provide these services is how the specific services will be delivered and financed. Given the dominance of Medicaid managed care, states will have to grapple with how MCOs can be leveraged to support a successful implementation of the delivery of services to the justice-involved population. The strong community presence of local and regional MCOs within the Medicaid managed care ecosystem makes these MCOs important entities for states to consider. Local and regional MCOs should consider what role they believe they can play as partners to states in these initiatives to serve justice-involved populations as successfully as they have served other Medicaid populations.

While the opportunities for local and regional MCOs will evolve over time, initial opportunities to contemplate are as follows:

  1. Serving as a Thought Partner: There is already significant interest across states in pursuing the ability to deliver services in advance of release but local and regional MCOs can support state officials looking to develop in greater detail the most viable path forward to do so. Local and regional MCOs can be well positioned serve as thought partners to states by educating themselves about California’s 1115 waiver approval and engaging state officials in their markets as partners to think through how the approach taken by California can be adapted to a given state’s goals and environment.
  2. Serving as the Lead Case Manager: Providing reentry case management to coordinate the reentry process for the justice-involved population is likely to be a key service in any service array from this population. To ensure the complex coordination related to this process occurs successfully across multiple organizations, local and regional MCOs can explore working with states to serve as the lead entity for case management as individuals are enrolled (or reenrolled) in managed care.
  3. Facilitating Enrollment Continuity and Continuity of Care: The process for transitioning to Medicaid coverage and care after these have been interrupted as a result of incarceration can be daunting for both the justice-involved population and well as state administrators and providers. Local and regional MCOs can play an intervening role here to provide support to all parties involved to produce a result where the enrollment process is as seamless as possible and critical care delivery is maintained specific to an individual’s health and social needs.
  4. Providing Infrastructure Funding: In partnership with states, local and regional MCOs can infrastructure funding to build capacity to support many of these entities who will be involved with the reentry process. Such entities can include, for example, behavioral health providers, community-based organizations, primary care providers, and social service providers. The type of capacity needed will likely include data sharing, technology changes, and workforce development.
  5. Providing Technical Assistance: In addition to supporting capacity-building, local and regional MCOs can provide technical assistance to entities involved with the reentry process. Complex operational, policy, and technology issues will arise during the reentry process that are specific to a given entity. Local and regional MCOs, because of their focused knowledge and experience in specific markets, are well positioned to provide expertise and guidance on issues ranging from care management to claims submission.

What’s Next?

As more states with pending 1115 waivers for reentry services for the justice-involved population gain approval, local and regional MCOs should anticipate engagement from states on planning and implementation in in 2024. Given this, taking action early to engage state partners and prepare your organization to serve this population is a prudent step to consider now.

For More Information

If you have questions about how HMA can support your efforts related to the Medicaid services for justice-involved populations and local and regional MCOs, please contact Michael Engelhard, managing director, Linda Follenweider, managing director, or Patrick Tigue, managing director.

Preventing Type 2 Diabetes in correctional settings

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Today is World Diabetes Day, a day created to keep the importance of diabetes prevention and management in the public and political spotlight. One in every four U.S. healthcare dollars is spent on individuals diagnosed with diabetes, and more than half of that expenditure is directly attributable to diabetes. An estimated 37 million people in the U.S. have type 2 diabetes, and another 96 million (more than one out of every three people) have prediabetes, meaning they are at risk of developing type 2 diabetes.[i]

The urgency of preventing and managing type 2 diabetes is as applicable in correctional facilities as it is in populations in the community. Especially as there is an overrepresentation of populations that have a higher burden of prediabetes and type 2 diabetes in correctional facilities including individuals who:

  • are older,
  • have serious mental illness,
  • have poorer physical and mental health than counterparts in the community,
  • are above recommended body weight,
  • have reduced access to health insurance, and
  • are from racial and ethnic minority groups. 

Administrators of correctional facilities are responsible for the healthcare costs for individuals in their custody who have type 2 diabetes, and the cost of managing this condition in these settings is particularly high.

Fortunately, type 2 diabetes is preventable. One evidence-based and effective strategy for preventing type 2 diabetes is the National Diabetes Prevention Program (National DPP) lifestyle change program. This program is a year-long evidence-based program delivered over 22 sessions using a CDC-approved curriculum. Program participants are expected to lose 5−7 percent of their weight and engage in physical activity for 150 minutes each week.[ii] The National DPP lifestyle change program can be offered in person, online, through distance learning, or a combined approach and is led by a trained lifestyle coach.[iii] The program has been proven to reduce the risk of individuals with prediabetes developing type 2 diabetes by 58 percent (71 percent for people older than age 60).[iv] Projections in other settings that compare the cost of the National DPP lifestyle change program to the costs of treating type 2 diabetes show that the program is cost-effective.[v]

HMA recently published a white paper, “Implementing the National Diabetes Prevention Program Lifestyle Change Program in Correctional Settings,” describing how the National DPP lifestyle change program can be used to achieve cost savings and better health for people at risk of developing type 2 diabetes in correctional settings. There have been two successful implementations of the National DPP lifestyle change program to date. The first is described in the study “Prevention in Prison: The Diabetes Prevention Program in a Correctional Setting,” where 47 people from a federal correctional facility participated in a modified version of the National DPP lifestyle change program. Participants who completed the program demonstrated significant reductions in their body mass index and A1C levels. Weight loss in the study was similar to what participants of the National DPP lifestyle change program in the community typically achieve.[vi]

The second successful implementation is with the Wisconsin Department of Corrections (DOC), which has successfully offered the National DPP lifestyle change program in three correctional facilities. To date, 19 Wisconsin DOC staff have trained as lifestyle coaches and 131 individuals across the three facilities have participated in the program. The Wisconsin National DPP state quality specialist shared the following cohort data in 2018−2019:

  • 16 percent of the participants were Black and 84 percent were White
  • 100 percent of participants were male, with an average age of 45.6 years
  • 58 percent of participants were eligible for the program based on a blood test
  • 100 percent of participants attended 14 or more sessions in months one through six (typically, 16 sessions take place in the first six months)
  • 71 percent of participants attended six or more sessions in months 7−12 (typically, six sessions take place in the second six months)

Overall average weight loss was 8.3 percent during the year-long cohort, well above the National DPP lifestyle change program goal of 5−7 percent weight loss. The response from program participants was positive. Wisconsin DOC plans to scale the National DPP lifestyle change program to all appropriate facilities in the future.

For additional information, consult the white paper “Implementing the National Diabetes Prevention Program Lifestyle Change Program in Correctional Settings.”

If you would like to learn more about how HMA can help your organization implement a DPP program, contact:

Angela Bowen, Consultant

Chris Wilks, PhD, Senior Consultant

[i] Centers for Disease Control and Prevention. The Facts, Stats, and Impacts of Diabetes. Available at: https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed April 18, 2023.

[ii] Centers for Disease Control and Prevention. Research Behind the National DPP. Available at: https://www.cdc.gov/diabetes/prevention/research-behind-ndpp.htm. Accessed on June 15, 2023. 

[iii] National DPP Coverage Toolkit. National DPP Coverage Toolkit: Delivery Options. Available at: https://coveragetoolkit.org/medicaid-agencies/medicaid-agencies-delivery/program-delivery-options/.  Accessed January 18, 2023.

[iv]Centers for Disease Control and Prevention. National Diabetes Prevention Program. Available at: https://www.cdc.gov/diabetes/prevention/index.html.  Accessed December 19, 2022.

[v]National DPP Coverage Toolkit. Cost & Value. Available at: https://coveragetoolkit.org/cost-value-elements/. Accessed June 15, 2023.

[vi]Fine A, Gallaway SM, Dukate A. Prevention in Prison: The Diabetes Prevention Program in a Correctional Setting. Diabetes Spectrum. 2019;32(4):331-337.

Child and family wellbeing

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Child welfare services face challenges every day to prevent, treat, and reduce risk of maltreatment, neglect, trauma, housing instability, and violence in communities. These issues need to be seen as a priority for public health and community wellbeing and not just the jurisdiction and responsibility of child welfare agencies.

There are many opportunities for improvement in this area, including:

Integrating prevention services within the human services system to help support families and youth experiencing child welfare interventions

Providing technical assistance and supports to systems serving child welfare and justice-involved youth, including: policy and practice reviews, workforce and workload analyses, process re-engineering

Increasing Medicaid providers who offer more community based Evidenced Based and Informed Practices (EBP) among Community Based Organizations (CBO), Providers, and Local Government entities

Developing the workforce to enable prevention programs and building competencies to engage in meaningful interactions with children, youth, and families

Addressing disparities in both experiences and outcomes for children, youth and families, rather than focusing on responding through merely a transactional and compliance driven approach

If your organization works to help meet the needs of children, youth and families impacted by issues like mental health and substance abuse, domestic violence, child abuse and neglect, food insecurity, housing instability, incarceration, and other traumas, Health Management Associates (HMA) can help make your efforts more effective.

Together we can help you move programs upstream with strong prevention and family strengthening approaches and integrate payment models with the human services delivery system to streamline and improve resources. 

HMA can help in the following ways:

Developing system integration models

Strategies to improve school-based mental health support implementation

Provide technical assistance and consulting support regarding service access and expansion of Medicaid utilization for implementation of evidence-informed programs

Workforce planning and strategy

Assist states, counties, hospitals, providers, and MCO’s address the challenges of hospital overstays and behavioral health placements

Provide technical assistance to state and local governments regarding limiting exposure to class action lawsuits or providing expert witness services

Strategic planning

Program evaluation, research and analysis including cost/benefit analysis of programs

Leadership development

Stakeholder engagement

A longtime leader in health and human services, HMA experts have front line and executive level experience providing direction to child welfare programs.

We consult with public and private sector entities who serve children and families to improve, streamline and integrate essential services. We ground our work in human-centered design, lived expertise, and change management and leadership principles in state and county program development.

Contact our experts:

Uma Ahluwalia

Uma Ahluwalia

Managing Principal

Uma Ahluwalia is a respected healthcare and human services professional with extensive experience leading key growth initiatives in demanding political … Read more
John Eller

John Eller

Managing Principal

John Eller is a seasoned executive with more than 23 years of service in public administration and health and human … Read more
Jon Rubin

Jon Rubin

Principal

Jon Rubin is a human services leader with over 20 years of experience in strategic planning, identifying and analyzing problems, … Read more
Doris Tolliver

Doris Tolliver

Principal

Doris Tolliver is a strategic thinker specializing in racial and ethnic equity, organizational effectiveness, change management, and business strategy development. She … Read more

Child and family wellbeing: family resilience

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This is part of an ongoing series highlighting efforts in human services and family wellbeing. 

For decades, practitioners have recognized that child neglect was often interconnected in some families with stressors associated with familial poverty. Poverty is often a stressor in cases of child neglect, poor health, and even youth incarceration. Food insecurity, housing instability, and family stressors often related to unemployment, incarceration, and domestic violence can in some circumstances, result in parental burnout and lead to poor parenting decisions. There is also a perverse disincentive for families to experience career and wage progression which often results in steep fiscal cliffs with benefits that are needed to stabilize families and guide them towards economic self-sufficiency[1]. There is advocacy and increasing recognition through efforts such as Universal Basic Income Pilot programs and experiments with expanding Earned Income Tax Credits and Child Tax Credits attempting to mitigate catastrophic benefits cliffs that impact child and family wellbeing and economic self-sufficiency.

Public Safety Net programs such as Temporary Assistance to Needy Families, Supplemental Nutrition Assistance Program, WIC, Free and Reduced School Meals, Child Care Subsidies, Earned Income Tax Credit, Eviction Prevention Grants, and a host of other federal, state, and local programs are intended to support and strengthen families and increase protective factors for children[2].   

Recent investments in the safety net including the childcare tax credit and the Pandemic Electronic Benefit Card (P-EBT) have shown that when concrete supports are provided to families, child maltreatment rates significantly decrease.[3]  

During the height of the COVID-19 pandemic, the federal government implemented a One-Year Expansion of the Child Tax Credit which extended the eligibility to families with little to no income. It helped increase the credit amount families received from $3,600 per qualifying child younger than six years old and $3,000 for qualifying child between the ages of 6 and 17. It also provided monthly payments of $250 to $300 per qualifying child as opposed to an annual payment which aligned with monthly living expenses. According to the US Census Bureau, 2021 saw a historic decline in child poverty which lifted one million children under the age of six out of poverty, and 1.9 million for children between the ages of six and 17.  

More recently States are experimenting with Universal Basic Income projects aimed at reducing child poverty, improving protective factors in families and reducing child maltreatment.[4] These experiments are currently being evaluated, but early research is showing promising signs of reduced child poverty in jurisdictions where these projects have gone live. 

There is considerable literature that shows that changes in income alone, holding all other factors constant, have a major impact on the numbers of children being maltreated. Conversely, reduction in income or other economic shocks to the family increase incidents of child maltreatment. 

A study performed by the Nuffield Foundation noted that internationally, evidence has shown a much stronger relationship between poverty and child abuse and neglect. Research has shown that without government and service providers responding to increased pressures on family life will lead to the risk of more children suffering harm, abuse and neglect.[5]

 Another study by Casey Family Programs on predicting chronic neglect, found that the strongest predictors of chronic neglect were parent cognitive impairment, history of substitute care, parent mental health problems, and a higher number of substantiated allegations in the first CPS report[6]. This suggests that families at risk for chronic neglect face multiple challenges and significant financial insecurity that require significant support.

  • Other significant predictors include:
    • Younger parents
    • Families with a higher number of children
    • Families with a child under age 1

Recognizing these challenges to strengthening the protective factors for young moms, there have been several successful efforts around the country to focus on pregnant and parenting teen and young adult moms. From Health Families America, Nurse Home Visiting Programs, there has been a body of evidence created that shows the strengths of providing wrap around services and home-based interventions for moms and babies. These supports strengthen the mom-baby nurturing relationship and reduce risk of maltreatment and increase protective factors. 

One such organization that has demonstrated significant success in disrupting the cycle of generational poverty is The Jeremiah Program. This is a national organization that aids single mothers and their children to provide coaching and assistance in navigating barriers to education, college access and career support, safe and affordable housing, early childhood education and childcare, and empowerment, leadership, and career training. This supportive program helps build up single mothers to achieve their educational and career goals and gain long-term economic prosperity. 

As child welfare and poverty policies intersect, the current thought leadership is focused on recognizing that economic and concrete supports reduce involvement in child welfare.[7] As the science and voices of children and families with lived experience intersect and rise up, the federal and state policy landscape around alleviating poverty to improve child wellbeing will continue to gain momentum. Family and Child Well-Being indicators significantly reflect racial and ethnic inequalities both in child welfare and across the poverty landscape. Economic stability is also a key strategy to address racial and ethnic inequalities and closing the opportunity gap for all. Over the next 3-5 years we believe there will be a fundamental shift in policy, financing, and outcomes tracking that reflect our commitment to our society’s most vulnerable children and families. That is why it is crucial for States and Local governments to enact policies that would support programming to alleviate poverty and improve child and family resilience and protective factors.

HMA consultants have decades of experience working hand-in-hand with public health, social services, behavioral health, Medicaid, and human services agencies. We help strengthen relationships surrounding policy, practice and revenue maximization in the human services space. Our experts work to help support programs in areas of Nutrition: Women, Infants & Children (WIC), Supplemental Nutrition Assistance Program (SNAP); Financial Support: Child Support, Temporary Assistance for Needy Families (TANF); Child and Adult Welfare Services; Medicaid; Housing and Weatherization; Early Education: Childcare Subsidy, Child Care and Development Block Grant (CCBDG) programs; and Workforce Development and Workforce Innovation and Opportunity Act (WIOA) programs.

If you have questions on how HMA can support your efforts in Child and Family Wellbeing, please contact Uma Ahluwalia, MSW, MHA, Managing Principal or Kathryn Ngo, MPH, BSN, Project Manager.

[1] What Are Benefits Cliffs? – Federal Reserve Bank of Atlanta (atlantafed.org)

[2] Economic Supports Chapin Anderson Nov 2020b (chapinhall.org)

[3] Research Reinforces: Providing Cash to Families in Poverty Reduces Risk of Family Involvement in Child Welfare | Center on Budget and Policy Priorities (cbpp.org)

[4] Understanding The Difference Between Guaranteed Basic Income Vs Universal Basic Income – Orange and Blue Press

[5] https://www.nuffieldfoundation.org/news/relationship-between-poverty-and-child-abuse-and-neglect

[6] Predicting Chronic Neglect – Casey Family Programs

[7] Economic Supports Chapin Anderson Nov 2020b (chapinhall.org)

Resources for Medicaid 1115 Waivers: creating new programs for justice-involved individuals

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HMA created a comprehensive series of webinars discussing the potential for using 1115 demonstrations to expand and improve healthcare services for the justice-involved population. Replays of the webinars and other justice-involved healthcare resources are now available.

What’s next for 1115 Waivers in your organization?

If your organization or state agency is ready to create new initiatives to improve carceral healthcare delivery and facilitate smoother transitions back into communities, HMA can help. Our consultants bring unparalleled expertise in Medicaid policy and correctional health as well as a deep understanding of the unique needs of this population. We have the operational knowledge and experience with technology and digital health solutions – and the ability to collect and analyze the right data to drive meaningful improvements in equity and access to care.

If you have questions or want to discuss options, please contact any of the speakers from the series:

Register today for HMA’s 6th annual conference on Trends in Publicly Sponsored Healthcare, Oct. 30-31 in Chicago. The event will feature the session, Medicaid and Individuals in Carceral Settings: Improving Coordination, Managing Transitions. Register now: https://conference.healthmanagement.com/

HMA annual conference on innovations in publicly sponsored healthcare

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Innovations in Publicly Sponsored Healthcare: How Medicaid, Medicare, and Marketplaces Are Driving Value, Equity, and Growth

Pre-Conference Workshop: October 29, 2023
Conference: October 30−31, 2023
Location: Fairmont Chicago, Millennium Park

Health Management Associates has announced the preliminary lineup of speakers for its sixth annual conference, Innovations in Publicly Sponsored Healthcare: How Medicaid, Medicare, and Marketplaces Are Driving Value, Equity, and Growth.

Hundreds of executives from health plans, providers, state and federal government, investment firms, and community-based organizations will convene to enjoy top-notch content, make new connections, and garner fresh ideas and best practices.

A pre-conference workshop, Behavioral Health at the Intersection of General Health and Human Services, will take place Sunday, October 29.

Confirmed speakers to date include (in alphabetical order):

  • Jacey Cooper, State Medicaid Director, Chief Deputy Director, California Department of Health Care Services
  • Kelly Cunningham, Administrator, Division of Medical Programs, Illinois Department of Healthcare and Family Services
  • Karen Dale, Chief Diversity, Equity, and Inclusion Officer, AmeriHealth Caritas
  • Mitchell Evans, Market Vice-President, Policy & Strategy, Medicaid & Dual Eligibles, Humana
  • Peter Lee, Health Care Policy Catalyst and former Executive Director, Covered California
  • John Lovelace, President, Government Programs, Individual Advantage, UPMC Health Plan
  • Julie Morita, MD, Executive Vice President, Robert Wood Johnson Foundation
  • Anne Rote, President, Medicaid, Health Care Service Corp.
  • Drew Snyder, Executive Director, Mississippi Division of Medicaid
  • Tim Spilker, CEO, UnitedHealthcare Community & State
  • Stacie Weeks, Administrator/Medicaid Director, Division of Health Care Financing and Policy, Nevada Department of Health and Human Services
  • Lisa Wright, President and CEO, Community Health Choice

Publicly sponsored programs like Medicare, Medicaid, and the Marketplaces are leading the charge in driving value, equity, and growth in the U.S. healthcare system. This year’s event will highlight the innovations, initiatives, emerging models, and growth strategies designed to drive improved patient outcomes, increased affordability, and expanded access.

Conference Agenda

Early bird registration ends July 31. Questions may be directed to Carl Mercurio at [email protected]. Group rates, government discounts, and sponsorships are available.

Register Now

New experts join HMA in April 2023

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HMA is pleased to welcome new experts to our family of companies in April 2023.

Jed Abell – Consulting Actuary
Wakely

Jed Abell is a professional health insurance actuary with over 20 years of experience focusing on Medicare Advantage, Part D, and commercial employer group plans.

Surah Alsawaf – Senior Consultant
HMA

Surah Alsawaf is a senior consultant with experience in creating and implementing regulatory strategies and workflows, conducting reviews and audits, and leading cross-functional teams to complete complex deliverables.

Elrycc Berkman – Consulting Actuary
Edrington

Elrycc Berkman is experienced in Medicaid managed care rate development including managed long-term services and supports (MLTSS) and program of all-inclusive care for the elderly (PACE) rate development.

Monica Bonds – Associate Principal
HMA

Monica Bonds is an experienced managed care professional with over 15 years of experience working in large and diverse organizations.

Yucheng Feng – Senior Consulting Actuary
Wakely

Yucheng Feng has over 15 years of experience providing actuarial support for Medicare Advantage clients, including bid preparation, reserve, actuarial analytics and providing strategic recommendations. Read more about Yucheng.

Melanie Hobbs – Associate Principal
HMA

Melanie Hobbs is an accomplished healthcare executive, consultant, and thought leader specializing in Medicare, Medicaid, and Special Needs Plans (SNPs).

Daniel Katzman – Consulting Actuary
Wakely

Daniel Katzman is experienced in Medicare Advantage bid pricing and modeling as well as claims trend analytics and affordability/cost-savings analysis. Read more about Daniel.

Supriya Laknidhi – Principal
HMA

Supriya Laknidhi has over 20 years of experience in the healthcare industry and a proven track record in driving growth and innovation for companies.

Donald Larsen – Principal
HMA

Dr. Donald Larsen is a C-suite physician executive with over 30 years of experience spanning complex academic medical centers, community health systems, acute care hospitals, and research institutes.

Ryan McEntee – Senior Consultant
Wakely

Ryan McEntee is an experienced managed care executive specializing in strategic leadership within Medicare Advantage plans. Read more about Ryan.

Nicole Oishi – Principal
HMA

Nicole Oishi has over 30 years of experience in senior leadership roles as a healthcare clinician and executive.

Read more about our new HMA colleagues

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Surah Alsawaf

Senior Consultant

Elrycc Berkman

Elrycc Berkman

Consulting Actuary II

Monica Bonds

Monica Bonds

Associate Principal

Melanie Hobbs

Associate Principal

Don Larsen

Donald Larsen

Principal

Child and family wellbeing: May is National Foster Care Month

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This is part of an ongoing series highlighting efforts in Human Services and Family Wellbeing. 

During the month of May, National Foster Care Month provides an opportunity to raise awareness on issues related to foster care and to celebrate those who are dedicated to serving our children, youth, and families. Yet it is important to note that unfortunately issues surrounding children and youth experiencing foster care are not limited to one month a year. As noted in our recent child well-being blog, Child welfare services face challenges every day to prevent, treat, and reduce risk of maltreatment, neglect, trauma, housing instability, and violence in communities. All these issues contribute to the significant number of children and youth who enter or remain in the foster care system. These issues are year-round and decades in the making. They need to be seen as a priority for public health and community wellbeing and not just the jurisdiction and responsibility of child welfare agencies.

To positively impact the number of children and youth experiencing foster care, there are some strategies that can be implemented now to promote change:

  • We must meaningfully elevate the voices of those with lived experience to help us design systems that meet their needs. For foster care, working to hear and understand the voices of youth based on how they have experienced foster care will help create opportunities to improve the system from those most impacted. Further, the meaningful elevation of these voices helps to ensure their input is not contributing towards tokenism and re-traumatization.
  • Multi-system involvement is important. We can work together to enhance access, increase prevention-oriented services, improve community health, and well-being, and achieve better outcomes using an equity lens, but proposed system reforms cannot be successful without shared ownership within the community and across government agencies. This requires building a responsive and integrated system of care approach to allow communities to seek solutions with the necessary support of the highest leadership within their organizations.   
  • Continue to find ways to assure that mandated reporters and staff who work within child welfare understand that poverty is not neglect, and poverty alone should not be a reason children and youth are removed from their home(s).
  • System redesign is needed. From front end reporting and assessment, to working with court systems, to building up networks of caring service providers, each component of the current child welfare system and human services partners can strive to find areas needing improvement and collectively change the experiences for children and youth engaged in the child welfare system.
  • Focus on mental health. This year’s theme from the Children’s Bureau for national foster care month is “Strengthening Minds, Uplifting Families” and is dedicated to supporting children and youth mental and behavioral health as the largest unmet need related to foster care. According to the Children’s Bureau, Up to 80 percent of children experiencing foster care have significant mental health issues, compared with approximately 18 to 22 percent of the general population.[1]

HMA can help public sector and community partners align themselves to improve and develop new delivery systems that will work to address inequalities and disparities as communities strive to meet the needs of children, youth and families impacted by issues like mental health and substance use disorder, domestic violence, child abuse and neglect, food insecurity, housing instability, incarceration and other traumas that impact them greatly.

HMA can help support foster care prevention or reunification program efforts in the following ways:

  • Creating additional human service system integration of prevention services to help support families and youth experiencing child welfare interventions or foster care.
  • Increasing Medicaid providers who offer more Evidenced Based and Informed Practices (EBP) among Community Based Organizations (CBO), Providers, and Local Government. 
  • Supporting Managed Care Organizations to develop programs specifically designed to support the wellbeing of children and youth in the foster care system and their families.
  • Connecting the Family First Prevention Services Act (FFPSA) & Medicaid funding together to ensure that funding supports the need and enhance service implementation.
  • Working to implement School Based Mental Health programs in communities.  We can help convene stakeholders, create process flows, and support the development of sustainable funding for such programs.
  • Increasing the meaningful use of youth voice for true collaboration in system redesign.
  • Enhancing judicial engagement with the child welfare system in a way that supports meaningful youth and family voice and representation in court while maintaining the child welfare system’s responsibilities around assuring child safety.  Making the court process less traumatic for children and youth and more part of a solution for them will support better outcomes.
  • Recognizing longstanding racial inequities in foster care experiences that can and should be addressed holistically in communities and supporting efforts to understand the root causes for the disparities in foster care placement.

Read other parts of this blog series:

If you have questions on how HMA can support your efforts in Child and Family Wellbeing, please contact: Uma Ahluwalia, MSW, MHA, Managing Principal, John Eller, Principal, Jon Rubin, Principal, or Nicole Lehman, Senior Consultant.

[1] Data:  https://www.childwelfare.gov/fostercaremonth/awareness/facts/

Illinois requests Section 1115 waiver extension to respond to HRSNs and eliminate inequities

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This week our In Focus section reviews the Illinois Healthcare Transformation 1115 Waiver Extension request, posted for review on May 12, 2023.

In pursuing this waiver extension, Illinois joins a growing list of states taking advantage of new Centers for Medicare & Medicaid Services (CMS) policy flexibilities to address health-related social needs (HRSNs) through Medicaid and test community-driven initiatives that are focused on improving health equity, improving access to care, and promoting whole-person care.

The Illinois waiver incorporates two of the most significant new opportunities in the CMS demonstration waiver flexibilities by proposing to incorporate housing supports for people who are experiencing or at risk of homelessness. The waiver also would extend community reintegration services for justice-involved adults and youths for up to 90 days before their release from incarceration. For a full list of proposed benefits and demonstrations, see Table 1.

Table 1. Summary of Illinois Medicaid 1115 Waiver Extension 

Source: Illinois Department of Health and Family Services. Illinois Healthcare Transformation Section 1115 Demonstration Extension Overview. Available at: https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/1115demonstrationoverview05122023.pdf.

The Illinois waiver represents an unprecedented opportunity to demonstrate the long-term, positive impact of providing HRSN services to achieve health equity and create a sustainable, community-driven system for delivering those services. The demonstration proposes to offer a range of HRSN services that are focused on the unmet needs of people who are homeless and housing insecure, are justice-involved, have behavioral health conditions, are pregnant, are unemployed, are food insecure, and/or have been exposed to violence or are at risk of violence with the goal of eliminating health disparities.

The waiver projects a five-year total of $4.4 billion in HRSN services expenditures and another $800 million in HRSN-related infrastructure, indicating Illinois’ long-term commitment to healthcare transformation and to building an equitable, accessible, and high-quality delivery system.

For additional information, please email [email protected].

Biden administration encourages states to apply for Medicaid Reentry 1115 Demonstration for individuals in carceral settings

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This week our In Focus section reviews guidance from the Centers for Medicare & Medicaid Services (CMS), released on April 17, 2023, encouraging states to apply for the new Medicaid Reentry Section 1115 Demonstration Opportunity. The demonstration is aimed at helping improve care for individuals in carceral settings prior to their release.

Background

The United States has approximately 1.9 million individuals incarcerated nationwide. Studies have shown higher rates of mental illness and physical health care needs in incarcerated populations compared to the general population, as well as associations between jail incarceration and increases in premature death rates from infectious diseases, chronic lower respiratory disease, drug use, and suicide.

CMS states that formerly incarcerated individuals with physical and mental health conditions and substance-use disorders (SUDs) typically have difficulty succeeding upon reentry due to obstacles present immediately at release, such as high rates of poverty and high risk of poor health outcomes. These individuals tend to face barriers in obtaining housing, education, employment, and health care access upon release. They often do not seek outpatient medical care and are at significantly increased risk for emergency department (ED) use and hospitalization.

Purpose and Goals

After collecting feedback from stakeholders, including managed care organizations, Medicaid beneficiaries, health care providers, the National Association of Medicaid Directors, and other representatives from local, state, and federal jail and prison systems, CMS designed the Reentry Section 1115 Demonstration Opportunity. The services covered under this demonstration opportunity should aim to improve access to community resources that address the health care and health-related social needs of the carceral population, with the aims of improving health outcomes, reducing emergency department visits, and inpatient hospital admissions for both physical and behavioral health issues once they are released and return to the community.

The purpose of this demonstration opportunity is to provide short-term Medicaid enrollment assistance and pre-release coverage for certain services to facilitate successful care transitions. The full goals, as quoted from CMS, are as follows:

  • “Increase coverage, continuity of coverage, and appropriate service uptake through assessment of eligibility and availability of coverage for benefits in carceral settings just prior to release
  • Improve access to services prior to release and improve transitions and continuity of care into the community upon release and during reentry
  • Improve coordination and communication between correctional systems, Medicaid systems, managed care plans, and community-based providers
  • Increase additional investments in health care and related services, aimed at improving the quality of care for beneficiaries in carceral settings and in the community to maximize successful reentry post-release
  • Improve connections between carceral settings and community services upon release to address physical health, behavioral health, and health-related social needs
  • Reduce all-cause deaths in the near-term post-release
  • Reduce number of ED visits and inpatient hospitalizations among recently incarcerated Medicaid beneficiaries through increased receipt of preventive and routine physical and behavioral health care”

CMS encourages states to engage with individuals who were formerly incarcerated when contemplating the design and implementation of their proposal. CMS also encourages states to design a broadly defined demonstration population that includes otherwise eligible, soon-to-be former incarcerated individuals. States have the flexibility to target population, such as individuals with specific conditions, but are encouraged to be mindful of undiagnosed conditions. States should have a plan to ensure incarcerated individuals will be enrolled in Medicaid upon their release, applying for Medicaid no later than 45 days before the day of release.

Reentry Section 1115 Demonstration Opportunity

To receive approval for the demonstration, the state proposal must include in the pre-release benefit backage:

  1. Case management to assess and address physical and behavioral health needs and health-related social needs;
  2. Medication-assisted treatment (MAT) services for all types of SUD as clinically appropriate, with accompanying counseling; and
  3. A 30-day supply of all prescription medications that have been prescribed for the beneficiary at the time of release, provided to the beneficiary immediately upon release from the correctional facility.

In addition to these three services states may include other important physical and behavioral health services to cover on a pre-release basis, such as family planning services and supplies, behavioral health or preventive services, including those provided by peer supporters/community health workers, or treatment for Hepatitis C. CMS is also open to states requesting Section 1115 expenditure authority to provide medical supplies, equipment, and appliances.

The Reentry Section 1115 Demonstration opportunity is not intended to shift current carceral health care costs to the Medicaid program. CMS will not approve state proposals to receive federal Medicaid matching funds for any existing carceral health care services funded with state or local dollars unless the state agrees to reinvest the total amount of new federal matching funds received into activities or initiatives that increase access to or improve the quality of health care services for individuals who are incarcerated.

CMS also expects states to refrain from including federal prisons as a setting in which demonstration-covered prerelease services are provided under the opportunity.

States with approved demonstrations will need to submit an implementation plan, a monitoring protocol, quarterly/annual monitoring reports, a mid-point assessment report, an evaluation design, and interim/summative evaluation reports.

California

California became the first state to receive approval for a Section 1115 waiver amendment earlier this year to provide limited Medicaid services to incarcerated individuals for up to 90 days immediately prior to release. The approval period runs through December 31, 2026, timed with the expiration of the CalAIM Medi-Cal waiver demonstration. California’s reentry demonstration initiative aims to provide health care interventions at earlier opportunities for incarcerated individuals to reduce acute services utilization and adverse health outcomes. The state anticipates it will increase coverage and continuity of coverage for eligible beneficiaries, improve care transitions for beneficiaries as they reenter the community, and reduce morbidity and mortality in the near-term post-release.

Pre-release services include comprehensive care management, physical and behavioral clinical consultation, lab and radiology, MAT, community health worker services, and medications and durable medical equipment. A care manager will be assigned to eligible individuals to establish a relationship, understand their health needs, coordinate vital services, and make a plan for community transition, including connecting the individual to a community-based care manager they can work with upon their release. Additionally, all counties implementing Medi-Cal application processes in jails and youth correctional facilities will “suspend” the Medicaid status while an individual is in jail or prison, so that it can be easily “turned on” when they enter the community.

On April 6, 2023, HMA held a webinar titled, “Medicaid authority and opportunity to build new programs for justice-involved individuals.” A replay can be watched here. HMA will announce additional webinars on the topic.

Link to Press Release and Letter