Prisoner Medicaid Eligibility Incarcerated Populations, the Affordable Care Act, and the Challenge of 2014 Brad Brockmann, JD, MDiv, Executive Director, Center for Prisoner Health and Human Rights, Providence, RI Jody Rich, MD, MPH, Professor of Medicine, Brown University Medical School, Co-founder and Director, Center for Prisoner Health and Human Rights

Session Outline Brief introduction and gauging audience experience and expectations Review of current continuity of care and discharge planning challenges for soon-to-be-released prisoners Key Medicaid expansion features Presentation of structural and other practical issues that need to be addressed in connection with Medicaid expansion in 2014 as informed by the RI experience Summary of ongoing challenges that need to be addressed prior to 2014 Open discussion of audience experiences with preparing for Medicaid expansion in 2014

Key Medicaid Expansion/ACA Features Coverage for populations most likely to be involved with the criminal justice system Parity Emphasis on need for effective prevention services (90% Federal payment for expansion population so long as they do not become disabled) Navigators Health homes One stop shopping Technology upgrades, improved interface among different healthcare systems Reimbursement of healthcare expenditures by correctional facilities for medical and mental health services incurred by non-adjudicated detainees who have Health Exchange issued health plans

Key Lessons from RI Experience Be at the table Beware silos- both between agencies and, within agencies, between departments Always bring IT to the table Bring people who have an excellent comprehension of how different inter- and intra- agency systems interface, exchange and utilize information, etc. Get a really big table so everyone will fit

Ongoing Challenges and Opportunities Role of Navigators Be at the table Health homes Opportunity for continued healthcare coverage for non- adjudicated detainees with exchange-issued insurance plans after incarceration: what does this mean for prisons/jails? New electronic/computer systems, new interfaces between agencies: integrating correctional institutions into new health information technology infrastructure Capacity Differential treatment of non-adjudicated detainees with Medicaid coverage post-incarceration

Thank you!! Thank you!