Obamacare and Criminal Justice-- New York

DevelopmentsTracie M. GardnerOctober 22, 2013

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Country’s only public interest law and policy org focused on with addiction, criminal records, and HIV/AIDS

Co-Chair national Coalition for Whole Health, over 100 national, state and local members advocating for strong ACA implementation for MH/SUD.

Focus on expanding access to care for people with SUD, HIV/AIDS and people in the criminal justice system; promoting health care not criminal justice responses to addiction

Legal Action Center -- who we are:

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"It is of compelling public importance that the State conduct a fundamental restructuring of its Medicaid program to achieve measurable improvement in health outcomes, sustainable cost control and a more efficient administrative structure."- Governor Andrew M. Cuomo, January 5, 2011

Governor Cuomo Announces Closure of Seven State Prison Facilities-- Action fulfills Governor's pledge to make appropriate changes based on declining inmate population and provides $184 million in savings to state taxpayers over next two years. June 30, 2011

Executive Changes on Public Safety and Health

Major opportunities for the CJ Population Significantly close the insurance and treatment

gaps Better ensure that our constituencies have all of

their complex health needs met Shift to new payers, less reliance on unstable

funding streams Foster a paradigm shift in the criminal justice

system for people with SUD--opportunities at each intercept

Maximizing the ACA for criminal justice-involved individuals

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It’s prison, stupid.

New research shows precisely how the prison-to-poverty cycle does its damage.

Unlike men, the highest concentration of women living with HIV/AIDS falls almost entirely within the highest poverty neighborhoods in the City.

Medicaid suspension vs. termination Early efforts in NY to facilitate Medicaid

applications for people who are about to leave prison.

LAC provided information about provision of Medicaid law that allows federal reimbursement for certain institutional care provided in the community for people in prison.

LAC role in bringing Health and CJ together

Overarching goal: improve health care access and health outcomes for individuals at all stages of involvement in New York State’s criminal justice system utilizing opportunity of recent and ongoing federal and state health care reform efforts.

New York Work

Improve Health and Reduce Recidivism and Incarceration of Criminal Justice Population by:

(1) Enrolling Them in Medicaid and (2) Linking them to and providing them

the health and other care Link Individuals in the Criminal Justice System

to Health Homes: front and back end Inclusion of criminal justice services in the MA

waiver

Opportunities for the Criminal Justice System--NYS

Sequential Intercept Model: A teaching tool.

Health homes are meant to build on other care coordination models to create linkages to community and social supports, enhance coordination of physical health, mental health and substance use care, and to improve health outcomes for high-cost patients.

Health Homes

Chronic Episode Diagnostic Categories Health Home Eligibles Adults 21+ YearsWith a Predictive Risk Score 75% or Higher (n=27,752)                                     Percent of Adult Recipients with Co-Occurring Condition

Condition Total

Severe Mental Illness

Mental Illness

Subst-ance

AbuseHyper-tension

Hyper-lipidemia Diabetes Asthma

Congest-ive Heart

Failure

Angina & Ische-

mic Heart

Disease HIV ObesityOsteo-

arthritis

COPD & Bronch-iectasis Epilepsy CVD

Kidney Disease

Severe Mental Illness 43.5 100.0 74.7 77.2 33.8 28.1 23.2 34.1 6.8 8.5 9.6 14.8 23.2 13.9 20.1 31.9 10.9Mental Illness 46.2 70.4 100.0 70.9 42.0 33.7 28.0 35.8 11.0 12.6 8.7 16.9 29.9 17.8 19.4 41.0 16.4Substance Abuse 54.4 61.9 60.3 100.0 35.4 25.9 21.4 32.8 7.5 9.4 11.2 10.7 23.1 14.5 16.4 34.4 11.2Hypertension 37.6 39.1 51.6 51.1 100.0 47.4 41.4 30.7 28.2 22.1 5.6 17.8 29.3 22.6 13.9 62.2 30.8Hyperlipidemia 29.8 41.0 52.2 47.1 59.8 100.0 54.9 37.7 27.8 33.4 5.6 23.6 30.9 25.1 15.0 70.4 31.5Diabetes 27.8 36.3 46.5 41.8 56.0 58.8 100.0 35.4 25.7 25.3 5.4 24.3 28.1 22.8 13.2 64.9 34.3Asthma 28.3 52.4 58.5 62.9 40.8 39.7 34.8 100.0 15.3 17.4 12.3 22.0 34.3 33.0 16.7 47.7 18.4Congestive Heart Failure 13.4 22.1 37.9 30.6 79.5 61.9 53.5 32.3 100.0 41.2 4.1 21.1 26.1 33.9 8.9 100.0 50.3Angina & Ischemic HD 12.2 30.5 47.8 41.8 68.2 81.5 57.6 40.3 45.1 100.0 4.6 24.1 33.8 31.5 11.7 100.0 41.9HIV 8.3 50.2 48.4 73.5 25.2 20.0 18.1 41.9 6.7 6.8 100.0 4.9 26.6 16.4 13.2 31.1 17.9Obesity 12.7 50.5 61.4 45.8 52.6 55.4 53.1 49.0 22.2 23.1 3.2 100.0 39.3 25.7 16.5 60.1 27.2Osteoarthritis 22.1 45.7 62.7 56.8 49.9 41.8 35.5 44.0 15.8 18.7 10.0 22.7 100.0 25.5 15.1 52.0 24.9COPD & Bronchiectasis 15.5 38.8 53.0 50.6 54.7 48.1 40.7 60.1 29.2 24.8 8.7 21.0 36.1 100.0 14.0 67.2 27.0Epilepsy 13.5 65.1 66.6 66.3 38.8 33.2 27.2 35.1 8.9 10.6 8.1 15.6 24.8 16.2 100.0 41.1 16.3CVD 41.9 33.2 45.3 44.6 55.9 50.2 43.1 32.3 32.0 29.2 6.2 18.3 27.4 25.0 13.2 100.0 35.4Kidney Disease 18.8 25.2 40.4 32.4 61.5 49.9 50.6 27.6 35.8 27.2 7.9 18.3 29.1 22.3 11.7 78.6 100.0

Total 100.0 43.5 46.2 54.4 37.6 29.8 27.8 28.3 13.4 12.2 8.3 12.7 22.1 15.5 13.5 41.9 18.8Note: Diagnosis History During Period of July 1, 2010 through June 30, 2011.

Health Home Highest Risk Population – Multiple Co-occurring Complex Disease

so Care MUST Be Integrated

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Sample of 2,055 unique Medicaid IDs from NYC CJ data; 1,121 members matched to HHs

Medicaid IDs matched to the calendar year 2011 Health Home eligible population.

Preliminary 2011 NYC CJ Data

• 1) Developmental Disabilities

• 47,760 Recipients $9,919 PMPM

• 2) Long Term Care

• 197,549 Recipients

• $5,163 PMPM

• 4) All Other Chronic

Conditions• 386,399 Recipients

$841 PMPM

• 3) Mental Health & or Substance Abuse

• 418,677 Recipients $1,540 PMPM

$5.6 Billion44% Dual11% MMC

$11.6 Billion

83% Dual18% MMC

$3.7 Billion23% Dual67% MMC

$7.3 Billion13% Dual66% MMC

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Health Home Eligibles in NYS(1M Medicaid Members out of 5M)

$28.2 Billion

Total ComplexN=1,050,385

$2,366 PMPM32% Dual55% MMC

Time Period: July 1, 2010 – June 30, 2011

Goals: Engage the criminal justice population in

health homes by creating 6 health home pilots that will pioneer effective engagement of people in state prisons, local jails and probation and alternative to incarceration/reentry programs.

Identify models for successful collaborations between the health care and criminal justice systems to engage and serve this population most effectively.

Workgroup on CJ and Health Homes