policy brief- mco - final - calhps€¦ · the model outlined in this policy brief suggests a...

CaliforniaHealthPolicyStrategies,L.L.C.www.calhps.com916.842.0715d.panush@calhps.com

PolicyBrief

TowardaComprehensiveModelofIntegrationforJustice-InvolvedIndividualsUsingMedi-CalManagedCareOrganizations(MCOs)

February2019

ExecutiveSummaryThereisgrowingrecognitionoftheuniquehealthandbehavioralhealthneedsofjustice-involvedindividualsandtheurgencyofcreatingamoreeffectivedeliverysystemtoprovidethoseservices.Thispolicybriefdescribesacomprehensivemodelforintegratingcareforthejustice-involvedpopulation.ThemodelrecognizesthecentralroleofMedi-CalManagedOrganizations(MCOs)tocoordinatehealthcareservicesforitsmembers–includingthejustice-involvedpopulation.Buttheseplanscan’tdothejobontheirown.Themodelalsoreliesonacollaborationwithcommunityhealthcenters,stateandlocaljusticesystemagencies,andcounties.Thecoreelementsofthemodelinclude:

• ExpandedRoleofMedi-CalMCOs.Thesehealthplanshaveresponsibilityandfiscalincentivesformanagingandcoordinatingthecareofcomplex,highutilizingandcostlyMedi-Calbeneficiaries.OtherstatesarealreadycontractingwiththeirMedicaidplanstoundertakein-reachforprisonandjailinmateswhoaremedicallyfragileorSMI.Thehealthplancouldalsocoordinatethetransferofhealthrecordsfromprisonandjailtothecommunityproviderandclinician.

• SeamlessTransitionfromPrison/Jail.Theprocessoftransitioninghealthandbehavioralhealthcareforinmatesshouldbeginwhiletheyarestillincarcerated.Pre-releaseplanningshouldassistinmatesinobtainingeligibilityforhealthandsocialserviceentitlementprograms,helpobtainvalididentification,assistMedi-Caleligibleindividualswithhealthplanselection,setupappointmentswithcommunityproviders,coordinatetransferofmedicalrecords,obtainappropriatereleaseofinformationauthorization,andfacilitatecommunicationbetweeninstitutionandcommunityclinicians.AproposaltocreateatransitionshubformedicallyfragileCDCRinmatesisdiscussed.

• SpecializedProviderNetwork.Ahealthplancouldestablishaprovidernetworkthatofferedamedicalhomeoptionforpreparedtoservejusticeinvolved

individuals.TheseproviderswouldhavemorefamiliaritywiththecriminaljusticesystemandcouldbebetterequippedtoeitherprovidementalhealthandSUDservicesthemselvesorcoordinatetreatmentwiththecountybehavioralhealthdepartments.

• CommunityHealthWorkers(CHWs).Providingjustice-involvedindividualsthehelpofapersonwithanunderstandingofthecriminaljusticesystemandthelocalhealthandbehavioralhealthsystemscanincreasethechancesthattransitiontothecommunitywithbesuccessful.CHWswhothemselveshaveahistoryofincarcerationwillhavesharedlifeexperiencesthatcanbuildrapportandtrustwiththerecentlyreleasedindividual.Ideally,theseCHWswouldsupportthetransitionprocessbythatbeginningwhiletheinmateisstillincarcerated.Inthecommunity,theCHWswouldalsobeembeddedwiththeclinicalteam.

• Probation/ParoleEngagement.Probationofficersandparoleagentshaveacompellinginterestinbeingpartoftheteamthatiscoordinatingtreatmentandcareofthejustice-involvedindividualswhomtheyaresupervising.Bothcliniciansandpublicsafetystaffneedtounderstandeachother’srolesandfindabalanceofappropriateinformationsharingabouttheircommonclient.

• SupplementalCountyIncentiveFunding.Countieshavestrongincentivestosupporteffectiveprogramsthatimprovepublicsafety,reducerecidivismandhomelessness,andreducejailcostsassociatedwiththecareandtreatmentofseriouslymentallyillandmedicallyfragileinmates.Acountymightbewillingtoinvestinaprogramthatcanreducehealthandbehavioralhealthjailcosts.

• DataSharingandPerformanceMetrics.Themodelalsorequiresarobustdatasharingsystemtoallowforthehealthplantofacilitateacontinuityofcarewheninmatesleavetheprisonorjailbyallowingthesharingofhealthrecordsbetweentheprisonorjailandthecommunityprovider.Thedatasystemshouldalsoallowforthecollectionofperformancemeasuresthatcanprovideevaluationandthefeedbackthatcanleadtoimprovements.

Aspartofthestate’sMedi-Cal2020waiver,ninecountieshavetargetedformerlyincarceratedindividualsfortheirWholePersonCare(WPC)pilots.Thesepilotsnowoperateundertheauspicesofthestate’sfive-yearwaiverandaredesignedtocoordinatehealth,behavioralhealthandsocialservicestoimprovehealthoutcomesofMedi-Calbeneficiarieswhoarehighutilizersofthehealthcaresystem.Asthewaiver’s2020expirationdateapproaches,policy-makersareconsideringhowtoinstitutionalizethebestpracticesthatareemergingfromWholePersonCarepilotsandotherinnovativeeffortstocoordinatecareforcomplexneedindividuals.Theapproachdescribedinthispolicybriefsuggestsapotentiallysustainablepathwaytoaddressthisneed.

Overview:Asstateandcountygovernmentsembracegreatereffortstoimprovethetransitionofindividualsfromincarcerationtothecommunity,andcoordinatecareforjustice-involvedindividuals,thereisneedforexploringnewmodelsthataresustainableandcanbeintegratedintothecurrenthealthcaredeliverysystem'sstructureandcultureofcoverage.Thechallengeaheadishowtodevelopacomprehensivesystemofcarethatfacilitatesacollaborationwithstateandlocalcriminaljusticeagencies,MCOs,countybehavioralhealthagencies,communityhealthworkers,communityhealthcenters,and,importantly,theformerlyincarceratedindividualsthemselves.Manycountiesincludedthejustice-involvedpopulationintheirWholePersonCare(WPC)pilotproposalsaspartofthestate’s1115MedicaidWaiverprocess.Countiesrecognizedthereentrypopulation’sexceptionallyhighratesofmedicalandbehavioralhealthproblems,andtheneedforimprovingthispopulation’sconnectionswithmedical,behavioralhealth,andotherservicesupondischargefromjailandprisonTherearecurrentlynineapprovedWPCpilots(ContraCosta,Kern,LosAngeles,Mendocino,Placer,Riverside,SanMateo,SantaCruz,andSmallCountyCollaborative)thathavespecificallytargetedtheformerlyincarceratedindividuals.Therearefourcountiesthathaveprogramdesignswhichdirectlyengagelocaljailsand/orprobationdepartmentsintheircollaborativeeffortstoservethereentrypopulation.(AdetaileddiscussionofthesepilotscanbefoundinourJune2018PolicyBrief,OverviewofReentryFocusedWholePersonCarePilots.1)Thestate’s1115Medi-CalWaiverWholePersonCare(WPC)pilotsarescheduledtoendin2020.CitingnewCMSrulesforfuturewaiversrelatingtofiscalneutrality,DHCSstaffarepessimisticthatthestate’scurrentwaiverwouldbeextended.ForcountieswithWPCpilotsthattargetthejustice-involvedpopulation,thechallengeaheadistosustaininitiativesthataredeemedtobesuccessful.Thepolicyframework,infrastructureandrelationshipbuildingthathasoccurredintheseWPCpilotsshouldnotbelost.Moreover,thelessonsfromWPCcountiesshouldbedisseminatedthroughoutthestatesothatothercountiescanbenefitfromwhathasbeenlearned.Themodeloutlinedinthispolicybriefsuggestsacomprehensiveapproachformeetingtheuniqueneedsofthejustice-involvedpopulation.Asmoreattentionisfocusedonfindingbetterwaystoreducerecidivismandimprovehealthandbehavioralhealthoutcomes,thecoreelementsofthismodelareemergingandevolving.Progressisbeingmade.

1http://calhps.com/reports/WPCBrief-6102018.pdf

CoreElementsofaComprehensiveModelofCareforJustice-involvedIndividuals

• ExpandedRoleofMedi-CalMCOs.PriortothepassageoftheAffordableCareAct,mostjustice-involvedindividualswereeitherineligibleforMedi-Caluponreleaseorcouldnotaffordprivatehealthinsurance.A2008surveyofSanFranciscocountyjailsfoundthat90%ofthepeopleenteringcountyjailhadnohealthinsurance.2TheAffordableCareAct’sMedicaidexpansiontolow-income,nondisabledadultsunderage65withincomesbelow138%ofthefederalpovertylevelopenedthedoortohealthcoverageformillionsofAmericans–includingthepreviouslyuninsuredwhoareinvolvedwiththecriminaljusticesystem.Thefederalgovernmentinitiallyprovided100%ofthecostofcoverageforthenewlyeligibleindividuals,steppingdowntoa90%matchduring2020andbeyond.Over80%oftheMedi-Calpopulationisnowservedbymanagedcareplansthatreceiveacapitatedpaymentfororganizingandprovidingcare.Particularlyformedicallyfragileinmateswithcostlyandcomplexmedicalneeds,thecapitatedpaymentprovidesafiscalincentiveforplanstoadoptstrategiesthatkeepformerinmatesoutofemergencyroomsandhospitals.Thiscouldincludeassistanceinfindingamedicalhome,schedulinginitialappointments,pharmacyservicesandcarecoordination.CaliforniacouldinstitutionalizetherelationshipbetweenMCOsandthereentrypopulationthroughitscontractswiththeplans.OtherstatesarealreadycontractingwiththeirMedicaidplanstoundertakein-reachforprisonandjailinmateswhoareplanmembersandaremedicallyfragileorSMI.Thehealthplancouldcoordinatethetransferofhealthrecordsfromprisonandjailtothecommunityprovider.Appendix1summarizestheeffortsinotherstates.(AfulldiscussionandanalysisiscontainedinourpolicybriefonMedicaidManagedCareOrganizationandReentry.3)

• SeamlessTransitionfromPrison/Jail.Theprocessoftransitioninghealthandbehavioralhealthcareforinmatesshouldbeginwhiletheyarestillincarcerated.Inourmodel,pre-releaseplanningshouldassistinmatesinobtainingeligibilityforhealthandsocialserviceentitlementprograms,helpobtainvalididentification,assistMedi-Caleligibleindividualswithhealthplanselection,setupappointmentswithcommunityproviders,coordinatetransferofmedicalrecords,obtainappropriatereleaseofinformationauthorization,andfacilitatecommunicationbetweeninstitutionandcommunityclinicians.Inmostcases,CaliforniaDepartmentofCorrectionsandRehabilitation(CDCR)doesnothaveaprotocolorprocedurestoensurecontinuityofcareandaneffective

2Wang,Emilyetal.2008“DischargePlanningandContinuityofHealthCare:FindingsfromtheSanFranciscoJail.”AmericanJournalPublicHealth,98(12).3http://calhps.com/wp-content/uploads/2019/01/Policy-Brief-MC-Managed-Care-model-Final.pdf

transitiontocommunity-basedhealthcareservices.About3,000inmatesor6.5%ofallreleasesareclassifiedbyCDCRas“highrisk”becauseoftheirseriousmedicalneeds.Thispopulationischaracterizedbycomplex,costlyhealthconditionsthatrequireextensivecarecoordinationandcarecontinuityfollowingreleaseintothecommunity.ThevastmajorityareeligibleforMedi-CalandwillbecomeMedi-Calmanagedcareplanenrollees.Toaddresstheneed,theCalHPSReentryHealthProjectfacilitatedaseriesofdiscussionsthatincludedCDCR’sHealthCareServices,L.A.CareandPartnershipHealthPlan,theTransitionsClinicNetwork,andseveralcommunityhealthcenters.AproposaltoestablishaCDCRTransitionHubemergedfromthesediscussions.(SeeAppendix2)TheTransitionsHubproposaladdressestheneedforaprocessforcoordinationandpre-releaseplanningofcomplex,chronicallyillstateprisoninmateswhoarereturningtotheircommunitiesfromstateprison.Itproposestheestablishmentofafive-yeardemonstrationprojecttodeterminetheeffectivenessofacarecoordinatormodelthatwouldprovidepre-releaseplanningandcoordinationtofacilitatethetransitionofmedicallyfragileinmatestothecommunity.Administeredthroughahubthatwouldservemultipleprisons,themodelwouldrelyonspeciallytrainedcommunityhealthworkerswithhistoriesofincarcerationaswellasclinicalstafftoengageinmatespriortotheirrelease.ThehubstaffwouldassistCDCR’sTransitionalCaseManagementProgram(TCMP)inMedi-Caleligibilitywhereneeded,helpinmateswithhealthplanselection,setupappointmentswithcommunityproviders,coordinatetransferofmedicalrecords,andserveasaliaisonbetweenCDCRHealthCareServicesandcommunitybasedclinicalservices.Theprojectwouldincludeanevaluationcomponenttodetermineeffectivenessandpotentialsavings.Thecostofthefive-yearproject,includingevaluation,isestimatedat$5million.LosAngelesCounty’sWholePersonCare(WPC)pilotisundertakingasimilareffortforinmateswhoaretransitioningfromjail.Theprogramaimstoenrollroughly1,000LACountyjailinmatespermonthwhoareeligibleforMedi-Cal,arehighutilizersofhealthorbehavioralhealthservices,andareathighriskduetochronicmedicalconditions,mentalillness,substanceusedisorders,homelessness,orpregnancy.Anadditional400individualspermonthrecentlyreleasedfromcustodywillbeenrolledfromthecommunity,viareferralsfromProbation,CDCR,andcommunity-basedreentryservicesagencies.Thepilotprovidesbothpre-andpost-releaseservices.Thefollowingservicesareprovidedpre-release(injail):

o In-personmeetingswithinthefirst3daysofcustody,toconductacomprehensivepsychosocialassessmentanddevelopare-entrycareplan;

o IncreasedMedi-Calenrollmentefforts(enrollmentstartingatjailintakeforactivationafterrelease);

o ReferralstolocalHomelessInitiativeprograms(e.g.,SSIadvocacyprogram);

o Provisionofadischargemedicalorbehavioralhealthvisit;o Provisionofa30-daysupplyofprescriptionmedicationatreleasefor

participantswithchronichealthormentalhealthconditions;o Generationofa“ContinuityofCareDocument”fortransmittaltothe

participant’shealthcareproviderinthecommunity;o EstablishmentofaWholePersonCarereleasedesktoarrange

transportation,shelterorotherservicesforthosebeingreleasedwithlittlenotice;and

o Anin-personorvideo-conferencevisitwiththeCommunityHealthWorker(CHW)tobeassignedtotheparticipantinthecommunity,toestablishapointofcontactuponrelease.

TheWPCReentrypost-releaseprogramconnectsparticipantstoCHWswithapriorpersonalhistoryofincarceration.CHWsassistparticipantstoeffectivelyengagewithcommunity-basedhealth,behavioralhealth,andsocialserviceprovidersastheyreturntothecommunity.Thefollowingservicesareprovidedpost-release:

o Mentorshipandsocialsupport;o Healthandsocialservicenavigation;o Linkagetohousing,employment,education,legalassistanceandsocial

supports;o Accompanimenttokeyhealthandbehavioralhealthappointmentso Assistancewithadherencetotreatmentandmedicationregiments;ando Connectiontotransportation.

• SpecializedProviderNetwork.Ahealthplanshouldestablishaprovidernetworktospecificallyprovideamedicalhomeoptionforjusticeinvolvedindividuals.TheseproviderswouldhavemorefamiliaritywiththecriminaljusticesystemandcouldbebetterequippedtoeitherprovideorcoordinatetreatmentwiththecountybehavioralhealthdepartmentformentalhealthandSUDservices.Ideally,FQHCsorothercommunityclinicsthatbothprovidecomprehensivehealthservicesandbehavioralhealthcarecouldofferatrusted,one-stopshopforthejustice-involvedpopulation.Clinicalandadministrativestaffatthesehealthcenterscouldbereceivetrainingtobetterunderstandtheuniqueneedsofthejustice-involvedpopulation,reducestigma,addresstrauma,andestablishprotocolsforcoordinatingwithcriminaljusticeagencies.Providersinthespecializednetworkwouldprovidepatientcenterservices(i.e.,accesstoprimarycareserviceswithintwo-weeksofreleasefromcustody;behavioralhealth;medicationassistedtreatmentforSUDs;andaccesstohousing,socialservices,education&employmentsupportandothercommunityprogramsforthereentrypopulation).Theconceptofaspecializedprovidernetworkisnotunique.Forexample,theInlandEmpireHealthPlaninRiversideandSanBernardinocountieshasaspecializednetworkofproviderstoserveitsbeneficiariesinthefostercaresystem.However,untilrecently,therehavebeenalimitednumberofprovidersthat

nowprovidespecializedhealthcareservicestomeettheuniqueneedsofthejustice-involvedpopulation.AnewinitiativetocreateaspecializedprovidernetworkisbeingledbytheTransitionClinicNetwork(TCN).TCNhasdevelopedamodelofcarethatisspecificallytailoredtomeettheneedsofthejustice-involvedpopulationtransitioningfromcustody.Startingin2006withapilotprojectinaSanFranciscocommunityhealthcenter,themodelhasspreadandnowlinkstogether29clinicsintwelvestates,includingeightinCalifornia.Theuseofcommunityhealthworkerswithahistoryofincarcerationisacomponentofthemodel.AnevaluationpublishedinHealthAffairsfoundthattheTCNmodelreducedemergencyroomvisitsandhospitalizationsinhalf.4TheCaliforniaHealthCareFoundation(CHCF)isnowsupportingtheexpansionoftheTCNmodeltouptotwenty-fivenewsitesinCalifornia.Theinitialcohortofclinicsincludesthirteensites.EachsitewasresponsibleforfundingtheCHWsthatwillbeembeddedintheclinicteamthatservesthejustice-involvedpopulation.ApolicybriefpublishedbyCHCFidentifiesfundingstrategiestopayforCHWsintheseclinics.5

• CommunityHealthWorkers(CHWs).Providingjustice-involvedindividualsthehelpofapersonwithanunderstandingofthecriminaljusticesystemandthelocalhealthandbehavioralhealthsystemscanincreasethechancesthattransitiontothecommunitywithbesuccessful.CHWswhothemselveshaveahistoryofincarcerationwillhavesharedlifeexperiencesthatcanbuildrapportandtrustwiththerecentlyreleasedindividual.Ideally,theseCHWswouldbeembeddedintheclinicalteam.Theymaybethe“secretsauce”foreffectiveengagementwiththejustice-involvedpopulationandifengagedwiththeindividualbeforereleasetheycanprovidea“warmhand-off”fromjailorprisonandhelpnavigatethecomplex,andattimesconfusinglocalhealthcaredeliverysystem.

CHWsplayacentralroleintheLosAngelesWPCpilotprogram.Theseworkersarestationedincountyjailfacilitiesandthecommunity.Todate,theLosAngelesWPChashiredabout50CHWs.FiveCHWsarefullcountyemployeesandhavepassedLASheriffbackgroundchecks.TheseworkersaresituatedinsidethreeoftheLosAngelescountyjails.FiveotherCHWshavepassedtheirLASheriffbackgroundchecksandareintheprocessofonboardingandtraining.Thereareapproximately35-40CHWsthataredeployedincommunitycontractedsites.Atotalof19agencieshavecontractedwiththeLosAngelesWPCpilotprogram.

4ShiraShavit,etal.“TransitionsClinicNetwork:ChallengesandLessonsinPrimaryCareforPeopleReleasedfromPrison,”HealthAffairs,June2017.https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.00895“HowToPayforIt-FinancingCommunityHealthCareWorkers,CHCF,November2018. https://www.chcf.org/wp-content/uploads/2018/11/HowToPayForCommunityHealthWorker.pdf

Boththejailandcommunity-basedCHWsareintegraltoLosAngelescounty’sWPCpilotsuccess.Theworkersstationedinthejailsareespeciallyusefulforimprovingtheaveragerateofprogramfollow-throughamongreentryparticipants.Additionally,ongoingtrainingisanecessarycomponentoftheCHWprogramtoprovideinstitutionalsupportandreduceburn-out.

• Probation/ParoleEngagement.Probationofficersandparoleagentshaveacompellinginterestinbeingpartoftheteamthatiscoordinatingtreatmentandcareofthejustice-involvedindividualswhomtheyaresupervising.Bothcliniciansandpublicsafetystaffneedtounderstandeachother’srolesandfindabalanceofappropriateinformationsharingabouttheircommonclient.PlacerandRiversidecountyhavedevelopedWPCpilotsthatdirectlyengagetheirprobationdepartmentstomeetthebehavioralandphysicalhealthneedsofhigh-riskindividualsreenteringthecommunity.ThePlacerCountyProbationDepartmenthasdedicatedprobationofficerstoworkcloselywiththePlacerWPCteam.Thesededicatedofficersidentifyindividualswhoarewithin90daysofscheduledreleasefromjailandwhoalsomeetoneormoreoftheWPCtargetpopulationcriteria.TheProbationOfficeralsoidentifythoseindividualswhoareinterestedinworkingwiththeWPCTeamtoreceivethesupportneededtotransitionbacktothecommunity.TheseofficersconnectthePlacerWPCteamwiththeindividualandfacilitatecontactatthetimeofreleasefromjail.TheRiversideCountyWPChasembeddedspecializednursesateachprobationreportingcenter.NewprobationersandindividualsonPost-ReleaseCommunityRelease(PRCS)mustreporttotheirlocalProbationDepartmentOfficewithin48hours.AnurseishousedateachProbationDepartmentOffice.ThenurseenrollstheprobationerintothescreeningpartoftheWPCpilotandevaluatestheindividualforpiloteligibility.Theprobationerisscreenedforthefollowing:lengthoftimeonprobation(minimum12months),at-riskoforexperiencinghomelessness,socialneeds,Medi-Caleligibility,behavioralhealthneeds,andphysicalhealthneeds.Thenursethenactsasadirectliaisontofacilitatetheconnectionofthatindividualwiththeprimarycareresourcestheyrequire.Basedonscreeningresults,thenursewillcoordinatefollow-upappointments.

• SupplementalCountyIncentiveFunding.Countieshavestrongincentivestosupporteffectiveprogramsthatimprovepublicsafety,reducerecidivismandhomelessness,andcontroljailcostsassociatedwiththecareandtreatmentofseriouslymentallyillandmedicallyfragileinmates.Asjailsfaceincreasingscrutinyforhealthandbehavioralhealthcareprovidedtoincarceratedinmates,thesecostsarerapidlyescalating.Further,upto90%ofthetreatmentandmedicationcostscouldbereimbursedbythefederalgovernment,iftheservicesareprovidedinthe

community.Acountymightbewillingtoinvestinaspecializednetworkofprovidersforthejustice-involvedpopulationiftrue,off-settingsavingscouldbedemonstratedthroughlowerjailcosts.Additionallocalfundingcouldbeusedtoprovideincentivepaymentstoprovidersinthespecializednetworktopayfortheextracostsofthepopulationandforservicesthatarenototherwisematchableforfederalfinancialparticipation(FFP).

• DataSharingandPerformanceMetrics.Themodelalsorequiresarobustdatasharingsystemtoallowforthehealthplantofacilitatethetransferofmedicalrecordswheninmatesleavetheprisonorjail.Thedatasystemshouldalsoallowforthecollectionofperformancemeasuresthataretiedtoevaluatetheapproachandprovidefeedbackthatcanleadtoimprovement.

Appendix

1. MedicaidManagedCare&Reentry:StateInitiatives-Overview

MultiplestateshaveleveragedMedicaidmanagedcareplansandcorrectionsfacilities’medicalvendorstoconnectpeopletomedicalcareduringincarcerationanduponreentry.Mostcommonly,theseeffortsfirsttargetedhigh-needindividuals.Detailsofstates’effortsarebelow.State Initiative

Arizona Arizona’sMedicaidagency,managedcareplans,andcorrections

facilitiesworktogethertohelpmedically-vulnerable,incarceratedindividuals(1)applyforMedicaidand(2)connectwithmedicalcareuponrelease.ThisworkisdescribedinArizona’scontractwithMCOs,whichstipulatesthatplansmust“conductreach-incarecoordinationformemberswhohavebeenincarceratedintheadultcorrectionalsystemfor30daysorlongerandhaveananticipatedreleasedate.”MCOsreach-ineffortsincludehelpingincarceratedpeopleapplyforMedicaidandschedulingmedicalappointmentstooccurwithinsevendaysofrelease.Todate,8,977“pre-release”Medicaidapplicationshavebeenapproved.(812havebeendeniedand2,962applicationsarestillpending.)

Colorado Colorado’scontractswithcounty-levelmanagedcareplansrequirethemtocollaboratewithjailsandprisonstocoordinatemembers’transitionsfromincarceration.MCOsprovidecasemanagementforincarceratedpeople,includingconnectingthemtoMedicaid.ColoradousesMedicaidfundingtopayforcasemanagementforincarceratedpeoplewithbehavioralhealthneeds.Duringincarceration,casemanagementinvolvessupportfromnursingstaff,mentalhealthstaff,andpre-releasespecialists.Afterincarceration,casemanagementincludessupportfromparoleofficers,reentryspecialists,andmentalhealthclinicians.MCOsconductproactivein-reach,includingsettingupmedicalappointments,buildingdatasystemswithjailstofacilitatecarecoordination,memberengagement,andotherformsofcaretransitionsupport.

Connecticut ConnecticutDepartmentofCorrections’contractwithitsmedicalcarevendorrequiresthevendortocoordinatereentrycareforincarceratedpeoplewithidentifiedphysicalandmentalhealthneeds.

Thevendorprovides“dischargeplanners”whoworkwithindividualsbeginning60-90dayspriortotheirreleasetocoordinateappointments,identifyandconnectindividualstocommunityproviders,andprovideshort-termprescriptionsandprescriptionvoucherstobeuseduponrelease.KaiserFamilyFoundationsuggeststhatthisworkhasbeensuccessful:“about60%oftheincarceratedpopulationisenrolledinMedicaiduponrelease,eitherthroughreinstatementofsuspendedcoverageorthroughthepre-releaseenrollmentprocess.”Thissuccessispartiallyattributedtointer-agencycoordination,includingcleardocumentationofroles,responsibilities,andfunding.

Florida Florida’s2017ManagedCarePlanContractstipulatesthatMCOsmustreachouttoMedicaidenrolleeswhoareinvolvedinthejusticesystem,withafocuson“preventativemeasurestoassessbehavioralhealthneeds.”Intheirproviderhandbooks,Medicaidmanagedcareplansdiscusstheservicestheyoffertoreentrypopulations.BetterHealthFlorida’s2016providerhandbook,forexample,guaranteesthat“memberscanreceivepsychiatryserviceswithin24hoursofreleasefromjail,juveniledetentionorotherjusticefacility”bycalling“PsychCareat1-800-221-5487.”Inaddition,BetterHealthFloridaandMolinaHealthcarereportthattheyofferpreventative-orientedbehavioralhealthcareoutreachtomembersatriskofjusticesysteminvolvement.

Louisiana LouisianarequiresMCOstoconductpre-releasecareplanningtoensurethathigh-need,incarceratedindividualscanaccessmedicationuponrelease.TheStateidentifiesthesehigh-need,incarceratedindividualsninemonthspriortorelease,usingdata-sharingbetweentheDepartmentofCorrectionsandtheLouisianaMedicaidagency.Inaddition,LouisianaworkstoenrollincarceratedindividualsinMedicaidpriortorelease,includingconnectingthemtoahealthplan.Thisisfacilitated,inpart,byautomationoftheMedicaidapplicationandplanselectionprocess.

Massachusetts

Massachusetts’sMedicaidagencyworkswiththeMassachusetts’sDepartmentofCorrectionstoenrollprisonersintoMedicaidpriortotheirrelease.MassachusettsDepartmentofCorrections,forexample,usesitsmedicalvendortoofferincarceratedpeoplepatienteducationandcontinuityofcarepriortotheirrelease.Massachusettshasbeenrelativelysuccessfulinitsefforts.AccordingtotheKaiserFamilyFoundation,“over70%ofindividualsreleasedfromprisoninfiscalyear2015hadaMassHealth[Medicaid]applicationsubmitted,andoverthree-quartersofsubmittedapplicationswereapproved.”

Moreover,mostindividualswhodidnothaveanapplicationsubmittedwerealreadyenrolled.Massachusetts’ssuccessisinpartduetoextensivecollaborationandtheeffortsofmultipletaskforces.

Ohioincludeslanguageinits2018MCOcontractsrequiringthemto“participateinthedevelopment,implementation,andoperationofinitiativesforearlymanagedcareenrollmentandcarecoordinationforinmatestobereleasedfromstateprisonsorstatepsychiatrichospitalsandyouthsinDepartmentofYouthServicescustody.”Ohiohasapre-releaseMedicaidenrollmentprogramwhichinvolvespeerMedicaideducators,selectionofamanagedcareplanbeforerelease,andrequirementsforMCOstoprovidemedically-fragilepeoplewithtransitionplans,pre-releaseconferences,andfollow-upafterreleasetoconnectthemtohealthcareproviders.ANationalAssociationofMedicaidDirectorsofficialsuggestedthatmanagedcareplans’casemanagementeffortshavebeeneffective.TheUrbanInstituteconfirmsthis;itreportsthatasofMay2016,Ohio’spre-releaseenrollmentprogram“included21prisonfacilitiesthathadenrolledmorethan4,100peopleinMedicaidbeforetheywerereleasedintothecommunity.”

RhodeIsland TheMedicaidLeadershipInstituteworkedwiththestateMedicaidagency,correctionsofficials,andadvocacyorganizationstodeterminehowtofacilitateMedicaidapplicationsfromcorrectionsfacilities.ThestateconductedapilotprograminMedically-AssistedTreatment(MAT),whichrequiredmanagedcareproviderstoamendtheircontractstoallowpilotparticipantsaccesstoVivitroljustpriortoandshortlyafterrelease.USDepartmentofHealthandHumanServices,NationalInstitutesofHealth,andthemanufacturerofVivitrolsubsidizedthispilotprogram.Theresultsarenotyetavailable.

Appendix2.CDCRHealthTransitionHubProposal

CDCRHealthTransitionsHubFacilitatingCommunityHealthCareofComplex,ChronicallyIllPrison

Inmates

I. ExecutiveSummary:

Thisproposaladdressestheneedforaprocessforcoordinationandpre-releaseplanningofcomplex,chronicallyillstateprisoninmateswhoarereturningtotheircommunitiesfromstateprison.Inmostcases,theCaliforniaDepartmentofCorrectionsandRehabilitation(CDCR)doesnothaveaprotocolorprocedurestoensurecontinuityofcareandaeffectivetransitiontocommunity-basedhealthcareservices.About3,000inmatesor6.5%ofallreleasesareclassifiedbyCDCRas“highrisk”becauseoftheirseriousmedicalneeds.Thispopulationischaracterizedbycomplex,costlyhealthconditionsthatrequireextensivecarecoordinationandcarecontinuityfollowingreleaseintothecommunity.ThevastmajorityareeligibleforMedi-CalandwillbecomeMedi-Calmanagedcareplanenrollees.Thisproposalrecommendstheestablishmentofafive-yeardemonstrationprojecttodeterminetheeffectivenessofacarecoordinatormodelthatwouldprovidepre-releaseplanningandcoordinationtofacilitatethetransitionofmedicallyfragileinmatestothecommunity.Administeredthroughahubthatwouldservemultipleprisons,themodelwouldrelyonspeciallytrainedcommunityhealthworkerswithhistoriesofincarcerationaswellasclinicalstafftoengageinmatespriortotheirrelease.ThehubstaffwouldassistTransitionalCaseManagementProgram(TCMP)inMedi-Caleligibilitywhereneeded,helpinmateswithhealthplanselection,setupappointmentswithcommunityproviders,coordinatetransferofmedicalrecords,andserveasaliaisonbetweenCDCRHealthCareServicesandcommunitybasedclinicalservices.Theprojectwouldincludeanevaluationcomponenttodetermineeffectivenessandpotentialsavings.Thecostofthefive-yearproject,includingevaluation,isestimatedat$5million.Thisproposalincludesthefollowing:

• Background• ProposedTargetPopulation• DescriptionoftheClearinghouseModel• Budget• EvaluationandPotentialforSustainability.

II. Background

TheCaliforniaDepartmentofCorrectionsandRehabilitation(CDCR)spendsover$3billiontoprovidehealthandmentalhealthservicesforits120,000inmates.Thisrepresentsabout25%ofCDCR’s2018-19budget.Criminaljusticepopulationshavedisproportionateratesofchronicphysicalandmentalhealthproblemsrelativetothegeneralpopulation.6Asthestate’sprisoninmatepopulationcontinuestoage,thesecostsarelikelytoincrease.Forexample,theportionofpeopleage50yearsorolderinCaliforniastateprisonsgrewfrom4%to21%between1990and2013,whilethepercentageofpeopleage25yearsoryoungerdecreasedfrom20%to13%.7Asthequalityofinstitutionalizedcarehasimprovedalongwithhighercosts,greaterattentionisbeingfocusedontheneedsofinmateswhoarereturningfromprisontotheircommunities.A2007studyofover30,000peoplereleasedinWashingtonStatefoundthattheadjustedriskofdeathwas12.7timeshigherforpeopleinthetwoweeksfollowingreleasecomparedtothegeneralpopulation.Theleadingcausesofdeathwasdrugoverdose,cardiovasculardisease,homicide,andsuicide.8AnotherstudythatlookedathospitalizationratesofMedicareeligibleformerlyincarceratedpersonsfoundthataboutonein70arehospitalizedforanacuteconditionwithinsevendaysofrelease,andoneintwelveby90days,aratemuchhigherthaninthegeneralpopulation.9PriortothepassageoftheAffordableCareAct,mostindividualsreturningfromincarcerationwereuninsuredandmainlyreliedoncommunitysafetynetclinicsandhospitalsfortheircare.TheexpansionofMedi-CaleligibilitytoincludelowincomechildlessadultshasdramaticallyincreasedthepercentageofformerlyincarceratedindividualswhocanaccessMedi-Calservices,whichareprovidedinmostcasesthroughmanagedcareplans.

AspartofCDCR’spre-releaseplanningprocess,inmatesreceiveassistanceforaccessinghealthcoverage,SSIandotherbenefitsuponreleasefromprison.Thisprocessgenerallybeginsapproximately90-120dayspriortorelease.AccordingtothelatestCaliforniaRehabilitationOversightBoard(C-ROB)report,asof2017,100%ofstatewideinmatereleasesarescreenedforbenefiteligibility.10However,inmatesaregenerallyunabletopicktheirMedi-Calmanagedcareplanuntiltheyreturntothecommunity.

6SeeMassoglia,MichaelandWilliamPridemore.2015.“IncarcerationandHealth.”AnnualReviewofSociology,41(4) [Link]; and Schnittker, Jason, Michael Massoglia, and Christopher Uggen. 2012. “Out and Down:IncarcerationandPsychiatricDisorders.”JournalofHealthandSocialBehavior,53(4).[Link]7Grattet,RykenandJosephHayes.2015.“California’sChangingPrisonPopulation.”PPIC.[PDF]8Binswanger,Ingridetal.2007.“ReleasefromPrison—AHighRiskofDeathforFormerInmates.”NewEnglandJournalofMedicine,356(2).[PDF]9Wang,Emilyetal.,2013.“AHighRiskofHospitalizationFollowingReleaseFromCorrectionalFacilitiesinMedicareBeneficiaries.”JAMAInternalMedicine,173(17).[Link]10CaliforniaRehabilitationOversightBoard.2017.“AnnualReport.”

WiththeexceptionofcountiesthatareservedbyaCountyOrganizedHealthSystem(COHS),Medi-Calbeneficiarieshaveachoiceofhealthplanofferedintheircounty.InCOHScountiesthereisonlyoneplan.11EnrollmentisaMedi-CalplanismandatoryformostMedi-Calbeneficiariesandifnoplanischosen,thereisadefaultprocessthatplacesthebeneficiaryinaplanbasedonanalgorithmicformula.

Forindividualsreturningtothecommunity,itmaytake30-60daysfollowingreleasebeforetheyareenrolledinaplan.TheMedi-Calbeneficiaryreceivesfee-for-serviceMedi-Calduringthisinterimperiodbutdoesnothaveaccesstothebenefitsofbeinginmanagedcaresuchasaccesstoamedicalhome,andspecialists.Thisdelaycanbehighlyproblematicforindividualswithseriousorchronicmedicalconditions.

Inmostcases,CDCRdoesnothaveaprotocolorprocedurestoensurecontinuityofcareandaneffectivetransitiontocommunity-basedhealthcareservices.Thislackofcoordinatedcareimpactspatients’healthoutcomesandutilizationinthecommunity.Directreferraltoprimarycare-basedhealthservicesisassociatedwithloweremergencydepartmentandhospitalizationratesinchronicallyillpatientspostreleasefromincarceration.12Successfultransitionalpre-releaseplanningrequiresaaclearideaofwheretodirecttheindividualtoensurecontinuityofcare.Butatpresent,thereisnoonetorefertheinmatetountiltheinmateknowswhereheorsheselectsahealthplanandidentifiesaprimarycareprovider.Attheproviderlevel,avarietyofapproachesarebeingutilizedtoaddresstheuniqueneedsofjustice-involvedindividualswhoaretransitioningfromprisonandjails.Keyelementsincludeestablishingamedicalhomethatprovidespatient-centeredcareandusesCommunityHealthWorkers(CHWs)whohelpfacilitateacontinuityofcareastheindividualleavescustody.CHWsalsohelpformerlyincarceratedindividualsnavigatethecomplexhealthandsocialservicedeliverysystemsinthecommunity.TheTransitionsClinicNetwork(TCN)workswithhealthsystemstoimplementtheTransitionsClinic(TC)modelofcare,acost-savings,evidence-basedprogramthatimproveshealthandreentryoutcomesamongchronicallyillindividualsreturningfromincarceration.FirststartedinSanFrancisco,TCN,anaffiliateofUniversityofCalifornia,SanFrancisco,supportshealthsystemsincaringforchronicallyillindividualsreturningfromincarceration.TheTCNmodelofcarehasbeensuccessfullyimplementedincommunity-basedclinicsin11statesandPuertoRico.AllTCNprogramsemployCHWs,whohaveapersonalhistoryofincarceration.TheCHWsplayanintegralroleaspartoftheirclinicalteamthatprovideshealthandbehavioralhealthcareservices.Theyalsoaddressthesocialdeterminantsofhealth(housing,employment,foodsecurity,etc.).Inthismodel,theCHWsconnectwithinmateswhilestillincarceratedandhelpwith

6TherearesixCOHSoperatingintwenty-twocounties.https://healthconsumer.org/wp/wp-content/uploads/2016/10/County-Organized-Health-System-Medi-Cal-Plans.pdf12ShavitS,AminawungJA,BirnbaumN,etal.TransitionsClinicNetwork:ChallengesAndLessonsInPrimaryCareForPeopleReleasedFromPrison.HealthAff(Millwood)2017;36:1006–15

enrollmentinMedi-Calandcarecoordinationwhentheinmateisreleased.InCalifornia,inreachtoincarceratedpatientsviaCHWsisoccurringinSanQuentinStatePrison,SolanoandSantaClaraCountyjails,andintheLosAngelesjailaspartofthecounty’sWholePersonCarepilot.WhenSantaClaraCountyjailbeganallowingCHWstoconnecttopatientspriortoreleaseshowratesforpostreleaseprimarycareappointmentsincreasedfrom30%to70%.13Inadditiontoimprovingpatientengagement,thereiscompellingevidencethatimprovedcoordinationandtheuseofCHWscanimprovecareandreducecostsbykeepingpatientsoutofemergencyroomsandhospitals.ArandomizedcontrolledtrialconductedattheSoutheastHealthCenter,aTransitionsClinicinSanFrancisco,demonstrateda51%reductioninemergencydepartmentvisitsover12months,anaveragecostsavingsof$912perpatient.14Medi-Calmanagedcareplansalsohaveanincentivetoengagemedicallycomplexandpotentiallycostlyinmatesasearlyaspossible.Severalotherstates,includingArizona,Colorado,Florida,andOhio,havenegotiatedprovisionsinmanagedcarecontractstorequiretheirMedicaidhealthplanstoengagewitheligibleindividualswhiletheyarestillincarceratedandconnectthemtoamanagedcareplanandtoconductoutreachandcoordinationupontheirrelease.

Arizona,forexample,includedaspecificprovisioninitsMedicaidmanagedcareplancontractsrequiringtheplanstoprovidein-reachtoindividualsinjailandprisonwithcomplexmedicalneeds.StaffwithArizona’sMedicaidagencyadvisedthathealthplanswerepersuadedthattheinterventionwouldbecosteffectiveandwouldsavemoney.Noadditionalfundingwasprovided.Thecontractsrequireplanstodothefollowing:

• Implementreachincarecoordinationformemberswhohavebeenincarceratedin

theadultcorrectionalsystemfor30daysorlongerandhaveananticipatedreleasedate.

• Reachincarecoordinationactivitiesshallbeginuponknowledgeofamember’santicipatedreleasedate.

• Collaboratewithcriminaljusticepartnerstoidentifyjustice-involvedmembersintheadultcriminaljusticesystemwithphysicaland/orbehavioralhealthchronicand/orcomplexcareneedspriortothemember’srelease.

• Collaboratewiththemember’sbehavioralhealthcontractoriftheplanisnotthebehavioralhealthprovider.

13AdministrativedataasreportedbyDr.AriKriegsman,SantaClaraValleyMedicalCenter14Wang,Emilyetal.2012.“EngagingIndividualsRecentlyReleasedfromPrisonIntoPrimaryCare.”AmericanJournalofPublicHealth,109(2).[Link].Thereisalsopreliminarydata(Notpublishedyetunderpeerreview)showingthatTCNprogramsreduceambulatorycaresensitivehospitalizationsandshortenthelengthofstayofhospitalizations.

III. InitialTargetPopulation:Complex,ChronicallyIllPrisonInmates

Forthepurposesofthedemonstrationproject,themedicallyfragilepopulationwithinCDCRissuggestedasaninitialtargetpopulation.Thispopulationischaracterizedbycomplex,costlyhealthconditionsthatrequireextensivecarecoordinationandcontinuityfollowingreleaseintothecommunity.CDCR’sCorrectionalHealthCareServicesDivisionclassifiesthismedicallyfragilepopulationasbeing“HighRisk1sand2s.”In2016-17fiscalyear,CDCRreleased822HighRiskPriority1s(1.9%oftotalreleases),and2,006HighRiskPriority2s(4.6%oftotalreleases).Tobeclassifiedas“HighRisk,”aninmatemusthaveoneormoreriskfactorsasdescribedinthetable1.FortheinitialphaseoftheHealthTransitionsHubproject,werecommendprioritizingcoordinationeffortsontheambulatorypopulationofhighrisk,complexandchronicallyillinmates.Thereisacriticalneedforcoordinationinthetransitionofinmatesrequiringskillednursinghome(SNF)levelcare,butmostMedi-Calmanagedcareplansdonotincludelongtermcareservicesintheirbenefitstructure.Asacarved-outFee-For-Servicebenefit,thereareadditionalchallengesinfindinganappropriateplacementfortheseinmates.However,insomecases,thehubstaffmaybeabletoassist.

Ifthedemonstrationprojectissuccessful,thetargetpopulationcouldbeexpandedtoincludesinmateswithlessintensivemedicalconditions(e.g.,12,400inmatesclassifiedas“medium”healthcareriskor29%ofreleasesin2016-17).

Table1.CDCRDefinitionofHighRisk(Priority1andPriority2)Flag Description

HighRiskDiagnosis/Condition

PatientsidentifiedashavingadiagnosisclassifiedasHighRisk.Thesediagnosesorcombinationofconditionsaredeemedhighriskduetocurrentorfutureadversehealthevents.(Eachcondition“highRiskcriteriaisconsideredoneriskfactor.Thereare31conditionsthatareidentified,e.g.,HIV,Cardiomyopathy&CongestiveHeartFailure,Cancer,Asthma,COPD,Diabetes,Seizures,ChronicPain,etc.)

MultipleHigherLevelofCareEvents–Medical

Patientswithtwoormorecommunityhospitalinpatientadmissions(excludingadmissionsforacute/traumarelatedissues).

ProlongedMedicalBedStay

PatientsinCorrectionalTreatmentCenter(CTC),OutpatientHousingUnit(OHU)orSkilledNursingFacility(SNF)formorethan80daysofthelast180daysinprison.

MultipleHigherLevelofCareEvents–MentalHealth

PatientswiththreeormoreMentalHealthHigherLevelofCareAdmissions.

Polypharmacy Patientsprescribed13ormoremedications.

HighRiskSpecialtyConsultations

Patientswiththreeormoreappointmentswitha“highrisk”specialist(s)(e.g.,oncologists,vascularsurgeon).

AdvancedAge Patientswhoaresixty-fiveyearsofageorolder.

MultipleMediumRiskDiagnoses/Conditions

FourormoreMediumRiskchronicconditions.

Source:CDCR–CorrectionalHealthCareServices

IV. DescriptionofHealthTransitionsHubModel

Thedemonstrationprojectproposestoestablisha“HealthTransitionsHub”staffedbycommunityhealthworkersandhealthcareclinicianswhowouldprovideaninterfacebetweenthemedicallyhigh-riskinmates,CDCRmedicalstaffandcommunityprovidersandhealthplans.

TheHealthTransitionsHubwouldberesponsibleforpre-releasehealthcarecoordinationandplanningforaboutthreethousandhighrisk,medicallyhigh-riskinmatesreleasedannually–about250permonth.Approximately80%ofCDCR’shighrisk,medicallyhigh-riskinmatesarehousedinfourprisons:theCaliforniaMedicalFacility(CMF)atVacaville,theCaliforniaHealthCareFacility(CHCF)atStockton,R.J.DonovaninSanDiego,andtheCaliforniaInstitutionforMenatChino.TheHub’sadministrationwouldoperateinsideoneoftheseinstitutions,whichhasthegreatestvolumeofmedicallyhigh-riskinmates.TheHubwouldinitiallyfocusoninmatesbeingreleasedfromCMFandCHCFbutwouldhavethepotentialforexpansiontoservemedicallyhigh-riskinmatesbeingreleasedfromanystateprison.TheHub’sproposedstaffwouldinclude:asupervisingRN;aconsultingphysician;fiveCHW’swhohavelivedexperiencesandhaveapersonalunderstandingoftheincarceratedpopulation;andanadministrativepositiontoprovidesupportfortheteam.TheCHWsemployedbytheHubwouldhavesharedlifeexperiencesandahistoryofincarceration.Tofunctioneffectively,theHubwouldbenefitbyhavingadesignatedCDCRutilizationmanagementnursepositiontohelpfacilitatecoordinationwiththecorrectionalhealthservicesstaff.TheHubwoulddevelopaprotocolincollaborationwiththeCDCRHealthCareServicesstaff.Asuggestedtimelinecouldbegin120dayspriortoaninmate’sreleaseorsooner.TheCHWassignedtothatprisonbytheHubwouldreceiveapatientsummaryindicatingthepatient’shealthcareissues.

TheCHWs,withsupervisionfromtheclinicalstaff,woulddothefollowing:

• Meetwiththeinmateinpersonorviaateleconference;• Assistinhealthplanselection;• Facilitatereleaseofinformation;• Providepatienteducation;(i.e.overdosepreventioneducation,chronicdiseaseself-

management)• Facilitatemedicalrecordtransfer(withassistanceofaCDCRUtilization

ManagementNurse);• Assistincoordinatingcommunicationwithprison-basedcliniciansandcommunity

providers.• Patientactivationandengagement• Healthutilizationcounseling(healthsystemnavigation,educationabout

maximizinginteractionswithproviders)• CollaboratewithothercontractedproviderstoforSSIevaluation• CollaboratewithCDCRstaff,paroleandprobationtoaddresshousing,other

providedservicesrelatedtobehavioralhealthandsocialdeterminantsofhealth.

• Referralstorelevantcommunity-basedservicesrelatedtosocialdeterminantsofhealthwhenavailable.

V. ProposedBudgetThedemonstrationprojectwouldrequireatotalexpenditureof$5millionoverfiveyears.Thiswouldincludestaffingfortheclearinghouseandanevaluationoftheprojection.TheCDCRwouldbeauthorizedtoenterintoanInteragencyAgreementwithUCSFtocontractwiththeTransitionsClinicNetwork(TCN),whichwouldberesponsibleforimplementingandmanagingtheHub.TCNisanationallyrecognizedleaderintransformingthehealthcaresystemtobetterserveformerlyincarceratedindividuals.TCNhasrunamedicaldischargeclinicoutofSanQuentinforthepastdecade.

VI. EvaluationandPotentialforSustainabilityThedemonstrationprojectwouldincludeanevaluationtodeterminecosteffectivenessandimprovedhealthcareoutcomesfortheprogramparticipants.Specifically,theevaluationwouldprovideinformationonERvisits,hospitalizations,andoverallcoststoMedi-Cal.Theevaluationcouldalsoconsidertheimpactonrecidivism.Asnotedearlier,otherstateshavedirectedtheirMedicaidmanagedcareplanstoengageinmateswhoareformermembersoftheirrespectiveplansandarereturningtotheircommunities.Inthesestates,theMedicaidplanshaverecognizedthepotentialformaintainingcontinuityofcareforthehighrisk,medicallyfragilepopulationaswellaspotentialsavings.TheHubdemonstrationprojectwouldhelpdocumentthevalueofthisapproach.

AbouttheAuthors:

• DavidPanushisthePresidentofCalHPS.HepreviouslyservedastheExternalAffairsDirectorofCoveredCaliforniaandservedinaleadershippolicyroleasasenioradvisortofiveStateSenatePresidentsProTempore.

• KonradFrancoisaresearcherwithCalHPS.HeiscurrentlypursuingaPhDinSociologywithanemphasisinStatisticsattheUniversityofCalifornia,Davis.

• TaraSiegelisapolicyadvisorforCaliforniaHealthPolicyStrategiesandapolicyconsultantbasedinWashington,DC.SheholdsaM.P.P.fromGeorgetownUniversityandaB.A.fromWellesleyCollege.

AbouttheReentryHealthPolicyProject

• ThisbriefispartoftheReentryHealthPolicyProject,whichseekstoidentifystateandcountylevelpoliciesandpracticesthatimpedethedeliveryofeffectivehealthandbehavioralhealthcareservicesforformerlyincarceratedindividualswhoaremedicallyfragile(MF)andlivingwithseriousmentalillness(SMI),astheyreturntothecommunity.Thereportalsooffersspecificrecommendationsandbestpracticesforaddressingthesebarriers.TheReentryHealthPolicyProjectwasmanagedbyCaliforniaHealthPolicyStrategiesLLCwithsupportprovidedbytheCaliforniaHealthCareFoundation.

AboutCaliforniaHealthPolicyStrategies(CalHPS),LLC.

• CalHPSisamission-drivenhealthpolicyconsultinggroupbasedinSacramento.Formoreinformation,visitwww.calhps.com.

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