ACCIPP State and Federal Health Care Reform in Alameda County: Impact on Children of Incarcerated Parents - Data on the Uninsured -Place Matters -Who has MediCal? -Who Gets What Under Health Reform? -The Culture of Coverage --HCSA CJ/JJ Initiatives

Who Are the Uninsured?

The Burden of the Uninsured Cost are Rising at 5x the rate of wages Premiums doubling for all employers every decade EMS System Projections Market forces and MediCaid Program Compromised access to Primary and Specialty Care

Emergency Department Payer Source: Alameda County Acute Care Facilities, 2010

Who Goes Where? The Affordable Care Act Will Add More Than 200,000 Covered Individuals in Alameda County 0% FPL 133% FPL400% FPL MediCaid Expansion The Exchange Employer and Individual Mandate 56,000 newly eligible 107,000 eligible for subsidy 35,000 required to purchase or their employer will be required to purchase Approximately 60,000 Alameda County Residents will not be insured, even under the most optimistic implementation scenario

The Achilles Health of Health Reform..  Eligibility Doesn’t Mean Enrollment  Enrollment Doesn’t Mean Access  In order to attract providers, we must raise rates. To raise rates, we have to get those eligible enrolled—viability of managed care approach to MediCal depends on the effective eligibility and enrollment models.  CHK is a pilot for us to innovate and collaborate more effectively and prepare for Implementation of the ACA. 9

Policy Drivers  Healthy Families to MediCal  1115 Waiver  BMOC  The Inmate Exception  Tax Initiative

Criminal Justice and Health Reform  AB 109  MediCaid Expansion and the Inmate Exception  The Exchange 11

HCSA and CJ/JJ Initiatives  JJ Reform: Transition Center, Guidance Clinic, SBHCs, EPSDT  Youth Development: Youth Centers, BMOC, YFOH, Youth Alive, Youth Radio, EMS Corps  FACT, CJ Mental Health, CIT, UMHI, Healthy Oakland  Pipeline Project, Prosperity Project, Place Matters 12