Overview of Federal Health Care Reform and NYS Medicaid Redesign

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1 Overview of Federal Health Care Reform and NYS Medicaid Redesign Issues and opportunities for Criminal Justice organizations and their clients Paul N. Samuels, Director and President, Legal Action Center New York City AIDS Fund Invitational Series on Health Care Reform 1/30/2014

2 Health care system: Not very effective addressing chronic illnesses, especially addiction (90% of 23 million Americans with SUDs receive no specialty care) and mental health (1/3 of those with SMI and ½ overall receive no care) Great disparities in providing care to people of color, poor and working poor Overuse of the most expensive and often least effective settings: ER s and hospitals BUT: ACA has created new landscape with lots of possibilities for reform

3 Criminal justice system (can be described in much the same ways): Not very effective addressing those with addictions: Decades of drug law and overly punitive policies caused mass incarceration and perpetual punishment through new Jim Crow of legal barriers to successful reentry Great disparities in treatment of people of color vast majority of drug arrests and incarceration despite whites using drugs at least as often and the poor Overuse of the most expensive and often least effective settings: prisons and jails BUT: widespread rejection of these failed policies and policy reforms in sentencing and reentry policies, plus, unlike health care reform, growing bi-partisan consensus for reform

4 Barriers Systems change is difficult Change in a large and sometime bureaucratic system is hard Need to devote resources to staff, training, etc. Need to have different state and local governments work together Need to get key stakeholders (including law enforcement, corrections, etc) invested in and working toward this shift

5 Barriers Fundamental problem: understanding each other s operations, culture and even language Need health/medicaid/cj and/or social services systems to work together, connect IT and data systems, etc. to make the enrollment happen Sometimes different and occasionally contradictory goals: most appropriate care vis-à-vis public safety; cj players favoring some approaches (e.g., long-term residential addiction treatment) and prohibiting others (e.g., methadone and other medication-assisted therapies) Even with bi-partisan support building, opposition to Obamacare and problems with roll-out increase the difficulties

6 Opportunities Triple Goal: Improve Public Health, Increase Public Safety, and Reap Substantial Cost Savings While Doing So Opportunity to enroll millions of Americans in criminal justice system in Medicaid (and sometimes in private insurance with subsidies through the Insurance Marketplaces) thereby providing huge infusion of federal funding to provide health coverage and link them to the care they need

7 Opportunities of ACA ACA creates major financial incentives to states and localities to enroll cj population in Medicaid since in expansion states federal Medicaid will for the first time pay for non-disabled single adults with no dependent children up to 138% FPL and pay 80% of the costs for first 3 years and increases to 90% Substance use disorders and mental health are an essential health benefit which must be covered at parity (Mental Health Parity and Addiction Equity Act) for the Medicaid expansion population and for coverage in the Marketplace

8 Opportunities of ACA Research shows treating addiction and MH effectively improves health and reduces crime. Thus, enrolling cj population in Medicaid and getting them care as early in the process as possible, beginning with arrest and pre-trial and for those in prisons/jails and under community supervision, not only will reduce health problems and crime and save taxpayer dollars, the federal government will pay most of the cost Plus, savings for all states as current Medicaid allows federal reimbursement at usual match even for people incarcerated who need community institutional care

9 Opportunities of ACA: Health Homes Section 2703 of the ACA created the new health home Medicaid option for beneficiaries with multiple chronic conditions. 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. 9

10 Executive Changes on NYS Public Safety and Health "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,

11 NYS Opportunities for the Criminal Justice System NYS response to CJ & Health opportunities--grown from ATI & Reentry Coalition advocacy! Meeting of the minds between Deputy Secretaries of Public Safety and Health led to recognition that much of the criminal justice population suffers from multiple chronic conditions, including HIV/AIDS, mental illness and addiction, and hence are exactly the patients that health homes have been designed to serve. Efforts are underway to capitalize on opportunities to improve the engagement of the criminal justice population into the healthcare system through the state Medicaid Redesign and federal ACA implementation. 11

12 Opportunities for the Criminal Justice System 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 Care They Need Enroll All Eligible Individuals in the Criminal Justice System onto Medicaid Link Individuals in the Criminal Justice System to Health Homes Ensure needs of CJ population addressed in HARPS Inclusion of criminal justice services in the waiver or through other mechanisms that would allow payment for these services with Medicaid funds. 12

13 NYS Criminal Justice and Health Home Workgroup Meeting since July 2011 via SDOH OHIP and LAC 40+State, local, provider, advocacy stakeholders and 6 health homes (2 Bronx/2 Brooklyn/2 Upstate) as CJ pilots Workgroup oversee and develop protocols in real time with the health home pilots effort to pioneer effective engagement of people in state prisons, local jails and probation and courts, 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. 13

14 MRT Waiver Overview The next step to implement the NYS Medicaid Redesign Action Plan relies on a 1115 waiver amendment agreement with the Centers for Medicare and Medicaid Services (CMS). In August 2012, New York submitted the MRT Waiver Amendment Proposal to CMS for approval that would allow reinvestment of $10 billion in MRT generated federal savings back into New York s health care delivery system over 5 years. State believes waiver is essential to fully implement the MRT action plan and Affordable Care Act. Redesigning Medicaid in New York 14

15 MRT Waiver Overview The waiver is designed to address the underlying challenges facing NYS health care delivery: Lack of primary care; Weak health care safety net; Imbalance in institutional versus community-based services Health disparities; and Transition challenges to managed care. Redesigning Medicaid in New York 15

16 MRT Waiver and DSRIP: New York is moving forward with a three-part approach requesting $10 billion to be distributed over five years: 1) Managed Care Contract Payments ($2.1bn/5yrs) 2) State Plan Amendment ($525mm/5yrs) 3) Delivery System Reform Incentive Payment (DSRIP) Plan ($7.375bn/5yrs) Redesigning Medicaid in New York 16

17 Safety Net Providers MRT Waiver and DSRIP Includes hospitals, nursing homes, clinics including FQHCs, behavioral health providers, home care agencies: Eligible providers will be defined by specific criteria that are currently under development and may vary across different regions of the state. Submitted DSRIP applications will be posted online, with the public invited to comment on which proposals should receive funding. DSRIP applications will be assessed by a review panel that includes experts outside state government. Providers sign up for Medicaid waiver updates at Additional information will be provided as federal approval is obtained and specifics are released.

18 Link to health care in a way we haven t been before More clients More resources In closing: What does this all mean for you? Lots to learn: Medicaid, linkage with health care, collaborating across systems

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