Housekeeping
• Please silence all mobile devices.
• This session is being recorded. To view the recording please visit www.naco.org/educational-recordings.
• Questions will be answered at the end of the session.
Workshop Evaluations
Workshop evaluations forms can be found in the NACo conference app and online at
www.naco.org/workshopevals.
Please visit iTunes or Google Play to download the 2015 NACo Annual Conference App!
Chief Deputy Glen Matayabas
Buncombe County Sheriff’s Office
60 Court Plaza, Asheville, NC 28801
Email: [email protected]
Office: 828-250-4578 Mobile: 828-450-5098 Fax: 828-250-4471
HEALTH COVERAGE IN JAILS:
IMPORTANT PROVISIONS AND STRATEGIES
BUNCOMBE COUNTY DETENTION FACILITY
The Buncombe County Detention Facility is a
604-bed, adult local confinement facility utilizing a
direct supervision style of inmate management.
The facility confines pre-trial and sentenced local,
state and federal inmates. In 2014, the facility
booked 13,825 inmates and had an average daily
population of 438 inmates.
JAIL SYSTEM AND POPULATION 5
POPULATION SNAPSHOT
• Total Inmate Population 455
Male Inmates 403
Female Inmates 52
• Pre-Trial Inmates 339
• Sentenced Inmates 116
• Federal Inmates 38
• Statewide Misdemeanant Confinement Program 45
JAIL SYSTEM AND POPULATION 6
ACCESS TO MEDICAL CARE
“From the moment an inmate enters a county jail, whether awaiting trial or
convicted, they gain access to complete medical care including prescriptions,
dental and mental health.”
Sheriff Ed McMahon of the New Hanover County Sheriff’s Office.
(5/14/14 Web Article from WECT TV6)
JAIL SYSTEM AND POPULATION 7
LEGAL DUTY OF THE SHERIFF
• Deliberate Indifference…A jail official is deliberately indifferent
to an inmate’s serious medical needs only if the official actually
knows that the inmate has a serious medical need and fails to
take reasonable steps to deal with it. (Farmer v. Brennan, 511
U.S. 825, 1970)
• Federal courts have held that a serious medical need is “one
that has been diagnosed by a physician as mandating
treatment or one that is so obvious that even a lay person
would easily recognize the necessity for a doctor’s attention.”
Estelle v. Gamble, 429 U.S. 97 (1976)
JAIL SYSTEM AND POPULATION 8
OUR JAIL MEDICAL PHILOSOPHY
• Contracted medical services with 24/7 medical staff coverage
• Contract for medical services only – cost pool for outside services not
included and focused on cost saving strategies
• Medical services based on National Commission on Correctional Health
Care Standards
• The Sheriff’s Office and County takes a proactive approach to address
the medical needs of the inmates at the point of intake/booking
• Collaborative effort utilizing all available county services with EMS, HHS,
Jail, LME and case management through RHA
JAIL SYSTEM AND POPULATION 9
DETENTION OFFICER
MEDICAL PROCESS
Jail Nurse
Jail
Intake
Medical
Screener
Brief Jail Mental
Health Screener
JAIL SYSTEM AND POPULATION 10
NURSE MEDICAL PROCESS
Referral FNP
Triage Nurse in Booking
Immediate H & P
Private Interview
JAIL SYSTEM AND POPULATION 11
NURSE MEDICAL PROCESS
• Immediate review of inmates history and medical needs no fourteen day waiting period or
having to sign up for sick call – proactive approach
• Address internal medical needs early to reduce outpatient costs
• Assess insurance along with determination for qualifications for disability or medicaid
• Inmates with high risk health concerns are seen early to prevent any inmates that are
contagious don’t put other inmates or staff at risk
• Inmates with drug and alcohol abuse are seen early placed on withdrawal protocols in order not
to experience a catastrophic event because of appropriate detoxification procedures
• Stabilize patients, catch contagions diseases quicker, know how to house inmates, reduced ER
visits and outpatient sourcing
• Early detection, early recognition, early advanced life support and early distribution of services
JAIL SYSTEM AND POPULATION 12
MEDICAID ENROLLMENT
• Population of Buncombe County is 247,912 of which 44,000 have been
determined eligible and approved for Medicaid.
• Almost eighteen percent of the county residents qualifies for Medicaid under
the NC Fast Track System.
• Jail Triage Nurse immediately reviews availability of insurance and eligibility
for Medicaid under NC Fast.
• Those inmates that generally qualify under NC Fast:
• Single adults ages 18 to 64 declared disabled by Disability
Determination Services
• Pregnant females
• Low income families
• Suicide attempts with wrap-around services for mental health
MEDICAID ENROLLMENT 13
MEDICAID ENROLLMENT
• Under the Affordable Care Act, North Carolina is a non-expansion state
under Medicaid
• It is important to be able to quickly qualify and enroll inmates in
Medicaid, when these inmates receive outside medical services which
can be costly to the county
• Process for enrolling Medicaid-eligible individual can start in jail allowing
continuity of care
• Sheriff’s Office, Social Services, Probation, Certified Navigators and
Hospitals need to work together to get clients enrolled
MEDICAID ENROLLMENT 14
MEDICAID ENROLLMENT
• Age and Gender which are most eligible – Low income childless adults
likely to be males and to be under age 35
• Benefits for inmates under Medicaid:
• Emergency Services
• Hospitalization
• Maternity and Newborn Care
• Mental Health and Substance Abuse Services
• Prescription Drugs
• Laboratory Services
MEDICAID ENROLLMENT 15
INMATE INPATIENT EXCEPTION
• Because of the Affordable Care Act, Medicaid now covers more individuals under the Patient Protection and Affordable Care Act (PPACA). Some that are eligible qualify as low-income adults and includes inmates from local jails such as Buncombe County.
• Federal law prohibits states from obtaining federal Medicaid matching funds for health care services provided to inmates with the exception of when inmates are patients in medical institutions.
• Under this exception, inmates who are eligible for Medicaid are admitted to hospitals for at least 24 hours, qualify for inpatient services under federal Medicaid. The intent of the federal prohibition is to ensure that federal Medicaid funds are not used to finance care that is the responsibility of state and local authorities.
INPATIENT EXCEPTION 16
BUNCOMBE COUNTY MEDICAL COSTS
• Medical Staff Contract $962,652
• Outside Medical Services $366,664
• Medical Supplies $9,648
• Total Cost $1,338,964
• Average Cost Per Inmate $8.37
• Average Daily Population 438
MEDICAL COST SAVINGS 17
NORTH CAROLINA STATUTES
• § 153A-225. Medical care of prisoners.
• May utilize Medicaid coverage for inpatient hospitalization or
for any other Medicaid services allowable for eligible prisoners,
provided that the plan includes a reimbursement process which
pays to the State the State portion of the costs.
• Each unit may establish fees of not more than twenty dollars
($20.00) per incident for the provision of nonemergency
medical care to prisoners and a fee of not more than ten dollars
($10.00) for a 30-day supply or less of a prescription drug. In
establishing fees pursuant to this section, each unit shall
establish a procedure for waiving fees for indigent prisoners.
MEDICAL COST SAVINGS 19
NORTH CAROLINA STATUTES
• § 153A-225.2. Payment of medical care of prisoners.
• Counties shall reimburse those providers and facilities providing
requested or emergency medical care outside of the local
confinement facility the lesser amount of either a rate of seventy
percent (70%) of the provider's then-current prevailing charge or
two times the then-current Medicaid rate for any given service.
Each county shall have the right to audit any provider from whom
the county has received a bill for services under this section but
only to the extent necessary to determine the actual prevailing
charge to ensure compliance with this section.
MEDICAL COST SAVINGS 20
NORTH CAROLINA STATUTES
• § 153A-224, the facility shall pay the cost for emergency
services unless the inmate has third party insurance. The
county is only responsible for costs not reimbursed by third
party insurance such as Medicaid.
• For all medical claims for inmates which are active or eligible
for Medicaid under NC Fast are denied for this reason and
returned.
STRATEGIES TO REDUCE COSTS
• Employ telemedicine technology to reduce outpatient costs
• Initiate outsourcing agreements with discounts
• Coordinate with County Health and Human Services for
inmates admitted to the hospital for eligibility under NC Fast
• Review health and/or hospital contracts annually
• Use performance benchmarks and statistics to review
adequate cost savings
• Ensure all medical bills are scrubbed for accuracy and
pricing
• Review Inmate Catastrophic Insurance
QUESTIONS
Chief Deputy Glen Matayabas
Buncombe County Sheriff’s Office
60 Court Plaza, Asheville, NC 28801
Email: [email protected]
Office: 828-250-4578 Mobile: 828-450-5098 Fax: 828-250-4471
COOK COUNTY HEALTH & HOSPITALS SYSTEM
Health Coverage Enrollment in Jails
NACo Annual Conference July 12, 2015
System Overview
The Cook County Health & Hospitals System (CCHHS) served more than 300,000 unique individuals this past year. CCHHS at a Glance: • 2 hospitals, • 16 outpatient facilities, • four regional centers with specialty services and advanced
diagnostics, • correctional health services, • a specialty center for persons with infectious disease, • a nationally-certified public health department, • CountyCare, one of the largest Medicaid managed care health
plans in the region with more than 170,000 members.
25 NACo Annual Conference I July 2015
CountyCare Medicaid Health Plan
As the result of the Patient Protection and Affordable Care Act (ACA), for the first time in the CCHHS’ history, a majority of our patients have health insurance coverage.
26 NACo Annual Conference I July 2015
5%
32%
21%
16%
26% COMMERCIAL
MEDICAID
MEDICAID MANAGED CARE
MEDICARE
OTHERS
UNINSURED
CountyCare Network
More than 130 primary care access sites • all CCHHS facilities • all Federally Qualified Health Centers (FQHCs) in Cook County • American Indian Health Service • 30+ hospitals including every major academic medical center in
Cook County
Access to a comprehensive range of health care services • primary & specialty visits • prescription medications • laboratory, x-ray and other diagnostic services • mental health and substance use treatment services • dental care, vision care, and transportation
27 NACo Annual Conference I July 2015
CCHHS Payor Mix
28
NACo Annual Conference I July 2015
54.4
36.5 32.3
45.6
63.5 67.7
0
10
20
30
40
50
60
70
80
90
100
2013 2014 2015
Insurance Status of CCHHS Patients
Uninsured/ self pay Insured
54
.4
32
.2
10
.9
2.5
36
.5
47
.7
12
.1
3.7
32
.3
50
13
.5
4.2
S E L F - P A Y M E D I C A I D M E D I C A R E C O M M E R C I A L
CCHHS PAYOR MIX 2013-2015
2013 2014 2015
Correctional Health Services CCHHS operates one of the largest correctional health services in the country. CCHHS provides a comprehensive range of onsite services to detainees at the Cook County Jail. • Primary Care • 11 Specialty Care Clinics • Dental and Mental Health Services • Laboratory Work • Pharmacy • Rehabilitative Care • Dialysis • 129-bed infirmary
29 NACo Annual Conference I July 2015
Correctional Health Costs
Each year, CCHHS spends upwards of $70 million in providing correctional health services. • 75,000+ intake screenings for new detainees, • 83,000+ primary care, urgent care & specialty care visits for those
in custody, • 6 million doses of medication, • 20-30% of the jail population are monitored for behavioral health
on any given day.
30 NACo Annual Conference I July 2015
Medicaid Enrollment at the Jail
In keeping with its mission to serve all in need, CCHHS has an obligation to care for detainees not only while incarcerated, but after they are released as well. Enrolling detainees during the intake process ensures that eligible detainees have health coverage upon or soon after release. This promotes continuity of care for these individuals, especially those with chronic conditions, once they are back in their communities.
31 NACo Annual Conference I July 2015
Medicaid Enrollment at the Jail
Inmates upon intake meet with an ‘Application Assistor’ to screen for Medicaid eligibility and assist with completing an online application. Individuals not able to complete an application at the time of intake are identified for follow-up within 72 hours, often post-discharge. Applications are tracked and monitored for successful processing by the State.
32 NACo Annual Conference I July 2015
Medicaid Enrollment at the Jail
In partnership with Treatment Alternatives for Safe Communities (TASC), CCHHS has helped more than 12,000 detainees at the jail enroll in Medicaid. Once enrolled in Medicaid, an individual can choose to join or is otherwise auto-enrolled into one of approximately 15 managed care plans, including CountyCare. Currently, over 4,000 of CountyCare’s members originated from the jail application initiative.
33 NACo Annual Conference I July 2015
Post-Release Linkage
CCHHS recently enhanced its collaboration with TASC to provide linkage programs to help connect individuals being released from the Cook County Jail with vital services, including: • community based health and behavioral health care providers
and services, • transportation, • shelters and housing resources, • food pantries, • workforce development programs.
34 NACo Annual Conference I July 2015
What’s Next
• National Health Service Corps Legislation
• Community-based Crisis Intervention/Triage Centers
• Polk Bros. Initiative
35 NACo Annual Conference I July 2015
Evaluations
NACo values all feedback.
Evaluation forms can be found in the NACo Conference app and online at
www.naco.org/workshopevals.
Please visit iTunes or Google Play to download the 2015 NACo Annual Conference App!
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