Technical Assistance Partnership for Child and Family Mental Health MEDICAID AND JUVENILE JUSTICE Mary B. Tierney, MD May 27, 2004 Mary B. Tierney, MD May 27, 2004

Technical Assistance Partnership for Child and Family Mental Health OVERVIEW OF THE ISSUE More than 16% of jail inmates have a mental illness Youth in the juvenile justice system have higher rates of mental health disorders than the general population One in five has a serious mental health problem More than 16% of jail inmates have a mental illness Youth in the juvenile justice system have higher rates of mental health disorders than the general population One in five has a serious mental health problem

Technical Assistance Partnership for Child and Family Mental Health OVERVIEW OF THE ISSUE A study of States with the highest mental health utilization rate had the lowest incarceration rate Interruptions of Medicaid coverage are associated with higher rates of psychiatric hospitalization A study of States with the highest mental health utilization rate had the lowest incarceration rate Interruptions of Medicaid coverage are associated with higher rates of psychiatric hospitalization

Technical Assistance Partnership for Child and Family Mental Health OVERVIEW OF MEDICAID

Technical Assistance Partnership for Child and Family Mental Health MEDICAID Federal/State Partnerships State Agency Requirements Eligibility Services Payment for Services Federal/State Partnerships State Agency Requirements Eligibility Services Payment for Services

Technical Assistance Partnership for Child and Family Mental Health MEDICAID FEDERAL/STATE PARTNERSHIP Federal Statute and Regulations Govern Overall Program State Plan Requirements State Plan Flexibility Federal Match Federal Financial Participation (FFP) Federal Medical Assistance Percentage (FMAP) Federal Statute and Regulations Govern Overall Program State Plan Requirements State Plan Flexibility Federal Match Federal Financial Participation (FFP) Federal Medical Assistance Percentage (FMAP)

Technical Assistance Partnership for Child and Family Mental Health STATUTORY, REGULATORY REQUIREMENTS There are stringent Federal requirements on Medicaid State agencies with regard to: Administration of the program, i.e., State Plan Hiring and subcontracting Submitting correct and valid reports [Sections 1902 (a) (4) – 1902 (a) (6)] There are stringent Federal requirements on Medicaid State agencies with regard to: Administration of the program, i.e., State Plan Hiring and subcontracting Submitting correct and valid reports [Sections 1902 (a) (4) – 1902 (a) (6)]

Technical Assistance Partnership for Child and Family Mental Health STATE PLAN REQUIREMENTS AND FLEXIBILITY States must meet all Federal mandates with regard to eligibility, services, administration States have flexibility to design their programs in those areas where the Federal statute and regulations gives them latitude in eligibility and services States must meet all Federal mandates with regard to eligibility, services, administration States have flexibility to design their programs in those areas where the Federal statute and regulations gives them latitude in eligibility and services

Technical Assistance Partnership for Child and Family Mental Health FEDERAL MATCH FFP FMAP FFP FMAP Generally at 50% 75% for Case Management, Maintenance of MIS Ranges from 50 – 83%

Technical Assistance Partnership for Child and Family Mental Health FINANCIAL STANDARDS Income Standard – maximum amount of income a person can have and be eligible for Medicaid including wages, salary and unearned income such as social security Resource Standard – anything a person owns that can be converted into cash including automobiles, real estate Income Standard – maximum amount of income a person can have and be eligible for Medicaid including wages, salary and unearned income such as social security Resource Standard – anything a person owns that can be converted into cash including automobiles, real estate

Technical Assistance Partnership for Child and Family Mental Health CATEGORIES OF ELIGIBILITY Mandatory Coverage Optional Groups with FFP Mandatory Coverage Optional Groups with FFP

Technical Assistance Partnership for Child and Family Mental Health MANDATORY COVERAGE Categorically Needy Families and Children Aged, Blind and Disabled Categorically Needy Families and Children Aged, Blind and Disabled

Technical Assistance Partnership for Child and Family Mental Health FAMILIES AND CHILDREN HIGHLIGHTS Low Income Families with Children TANF/AFDC Recipients Families that Lost TANF/AFDC because of Employment Qualified Pregnant Women and Children Low Income Families with Children TANF/AFDC Recipients Families that Lost TANF/AFDC because of Employment Qualified Pregnant Women and Children Newborn Children of Medicaid Eligible Children Low Income Children under Age Six Low Income Children under Age Nineteen Foster Care and Adoption Assistance

Technical Assistance Partnership for Child and Family Mental Health AGED, BLIND & DISABLED SSI Recipients Disabled Adult Children Zebley v. Sullivan Decision SSI Recipients Disabled Adult Children Zebley v. Sullivan Decision

Technical Assistance Partnership for Child and Family Mental Health OPTIONAL GROUPS HIGHLIGHTS Infants to age 1 year and Pregnant Women below 185% FPL Individuals Eligible for assistance who are in institutions Individuals Receiving Home and Community Based Services Infants to age 1 year and Pregnant Women below 185% FPL Individuals Eligible for assistance who are in institutions Individuals Receiving Home and Community Based Services Noninstitutionalized Disabled Children (Katie Beckett) Children under 21 years who meet income requirements but not eligible for TANF Ribicoff Kids

Technical Assistance Partnership for Child and Family Mental Health FFP VERSUS ELIGIBILITY FFP Medicaid eligibility FFP Medicaid eligibility

Technical Assistance Partnership for Child and Family Mental Health FFP FOR PERSONS IN PUBLIC INSTITUTIONS FFP prohibited for persons in correctional facilities No distinction made with respect to whether adult or child No distinction made with respect to size or type of facility- juvenile detention, half-way house FFP prohibited for persons in correctional facilities No distinction made with respect to whether adult or child No distinction made with respect to size or type of facility- juvenile detention, half-way house

Technical Assistance Partnership for Child and Family Mental Health FFP FOR PERSONS IN PUBLIC INSTITUTIONS No distinction made as to whether the facility is run through the public or private sector Individuals on probation or parole are not considered residents of a correctional facility and are eligible for FFP for health services No distinction made as to whether the facility is run through the public or private sector Individuals on probation or parole are not considered residents of a correctional facility and are eligible for FFP for health services

Technical Assistance Partnership for Child and Family Mental Health EXCEPTIONS TO FFP RULE Persons in public institutions “for a temporary period of time pending other arrangements appropriate to his needs” Persons who are transferred from jail into an inpatient medical facility such as a nursing facility, intermediate care facility for the mentally retarded (ICF/MR) Persons in public institutions “for a temporary period of time pending other arrangements appropriate to his needs” Persons who are transferred from jail into an inpatient medical facility such as a nursing facility, intermediate care facility for the mentally retarded (ICF/MR)

Technical Assistance Partnership for Child and Family Mental Health MEDICAID ELIGIBILITY CATEGORIES Not enrolled but eligible upon release Enrolled in Medicaid when incarcerated and eligibility is NOT affected Enrolled in Medicaid and eligibility is affected Not enrolled but eligible upon release Enrolled in Medicaid when incarcerated and eligibility is NOT affected Enrolled in Medicaid and eligibility is affected

Technical Assistance Partnership for Child and Family Mental Health NOT ENROLLED BUT ELIGIBLE UPON RELEASE Under 1902 (a) (8), may apply for Medicaid at any time during incarceration Will become eligible upon release from the correctional facility 90-day filing rule for SSI versus 45-day rule for all other categories Under 1902 (a) (8), may apply for Medicaid at any time during incarceration Will become eligible upon release from the correctional facility 90-day filing rule for SSI versus 45-day rule for all other categories

Technical Assistance Partnership for Child and Family Mental Health ELIGIBILITY NOT AFFECTED Mandatory and optional categories for low-income pregnant women and youth “Spendowners” Optional eligibility categories including those enrolled or eligible for a home and community-based program Mandatory and optional categories for low-income pregnant women and youth “Spendowners” Optional eligibility categories including those enrolled or eligible for a home and community-based program

Technical Assistance Partnership for Child and Family Mental Health ELIGIBILITY IS AFFECTED Those qualified through the Supplemental Security Income (SSI) program Those qualified through Temporary Assistance to Needy Families (TANF) Those qualified through the Supplemental Security Income (SSI) program Those qualified through Temporary Assistance to Needy Families (TANF)

Technical Assistance Partnership for Child and Family Mental Health TAKE AWAY MESSAGE INDIVIDUALS WHO RESIDE IN CORRECTIONAL FACILITIES SHOULD NOT BE DISENROLLED ONLY BECAUSE THEY ARE IN A FACILITY

Technical Assistance Partnership for Child and Family Mental Health TANF Eligibility is suspended but should be reinstated prior to release provided they fit into the State Plan’s eligibility requirements and TANF regulations Custodial parents Eligibility is suspended but should be reinstated prior to release provided they fit into the State Plan’s eligibility requirements and TANF regulations Custodial parents

Technical Assistance Partnership for Child and Family Mental Health SSI Individuals living in “209 (b)” States can continue eligibility and receive services upon release Individuals on SSI in non- 209 (b) States continue SSI cash payments and are Medicaid eligible for a period of up to 1 month following incarceration Individuals living in “209 (b)” States can continue eligibility and receive services upon release Individuals on SSI in non- 209 (b) States continue SSI cash payments and are Medicaid eligible for a period of up to 1 month following incarceration

Technical Assistance Partnership for Child and Family Mental Health SSI 12- Month suspension of eligibility and re- determination of continued disability When SSI and therefore are activated, cash payments and Medicaid eligibility are reinstated from the time of release or the time of initial application/re-application 12- Month suspension of eligibility and re- determination of continued disability When SSI and therefore are activated, cash payments and Medicaid eligibility are reinstated from the time of release or the time of initial application/re-application

Technical Assistance Partnership for Child and Family Mental Health FINAL TAKE HOME MESSAGES Do not disenroll individuals who are Medicaid eligible, eligibility is only suspended FFP is affected, not eligibility Initial application for Medicaid can begin at any time during incarceration Re-application should begin well in advance of discharge Do not disenroll individuals who are Medicaid eligible, eligibility is only suspended FFP is affected, not eligibility Initial application for Medicaid can begin at any time during incarceration Re-application should begin well in advance of discharge

Technical Assistance Partnership for Child and Family Mental Health CONTACT INFORMATION Mary B. Tierney, MD Mary B. Tierney, MD