1. Tracie M. Gardner October 22, 2013

2.  Country’s only public interest law and policy org focused on with addiction, criminal records, and HIV/AIDS  Co-Chair national Coalition for Whole Health, over 100 national, state and local members advocating for strong ACA implementation for MH/SUD.  Focus on expanding access to care for people with SUD, HIV/AIDS and people in the criminal justice system; promoting health care not criminal justice responses to addiction 2

3.  "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, 2011 3

4. Major opportunities for the CJ Population  Significantly close the insurance and treatment gaps  Better ensure that our constituencies have all of their complex health needs met  Shift to new payers, less reliance on unstable funding streams  Foster a paradigm shift in the criminal justice system for people with SUD--opportunities at each intercept

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9. Unlike men, the highest concentration of women living with HIV/AIDS falls almost entirely within the highest poverty neighborhoods in the City.

10.  Medicaid suspension vs. termination  Early efforts in NY to facilitate Medicaid applications for people who are about to leave prison.  LAC provided information about provision of Medicaid law that allows federal reimbursement for certain institutional care provided in the community for people in prison.

11.  Overarching goal: improve health care access and health outcomes for individuals at all stages of involvement in New York State’s criminal justice system utilizing opportunity of recent and ongoing federal and state health care reform efforts.

12.  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 and other care  Link Individuals in the Criminal Justice System to Health Homes: front and back end  Inclusion of criminal justice services in the MA waiver

14.  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.

15. Chronic Episode Diagnostic Categories Health Home Eligibles Adults 21+ Years With a Predictive Risk Score 75% or Higher (n=27,752) Percent of Adult Recipients with Co-Occurring Condition ConditionTotal Severe Mental Illness Mental Illness Subst- ance Abuse Hyper- tension Hyper- lipidemiaDiabetesAsthma Congest- ive Heart Failure Angina & Ische- mic Heart DiseaseHIVObesity Osteo- arthritis COPD & Bronch- iectasisEpilepsyCVD Kidney Disease Severe Mental Illness 43.5100.074.777.233.828.123.234.16.88.59.614.823.213.920.131.910.9 Mental Illness 46.270.4100.070.942.033.728.035.811.012.68.716.929.917.819.441.016.4 Substance Abuse 54.461.960.3100.035.425.921.432.87.59.411.210.723.114.516.434.411.2 Hypertension 37.639.151.651.1100.047.441.430.728.222.15.617.829.322.613.962.230.8 Hyperlipidemia 29.841.052.247.159.8100.054.937.727.833.45.623.630.925.115.070.431.5 Diabetes 27.836.346.541.856.058.8100.035.425.725.35.424.328.122.813.264.934.3 Asthma 28.352.458.562.940.839.734.8100.015.317.412.322.034.333.016.747.718.4 Congestive Heart Failure 13.422.137.930.679.561.953.532.3100.041.24.121.126.133.98.9100.050.3 Angina & Ischemic HD 12.230.547.841.868.281.557.640.345.1100.04.624.133.831.511.7100.041.9 HIV 8.350.248.473.525.220.018.141.96.76.8100.04.926.616.413.231.117.9 Obesity 12.750.561.445.852.655.453.149.022.223.13.2100.039.325.716.560.127.2 Osteoarthritis 22.145.762.756.849.941.835.544.015.818.710.022.7100.025.515.152.024.9 COPD & Bronchiectasis 15.538.853.050.654.748.140.760.129.224.88.721.036.1100.014.067.227.0 Epilepsy 13.565.166.666.338.833.227.235.18.910.68.115.624.816.2100.041.116.3 CVD 41.933.245.344.655.950.243.132.332.029.26.218.327.425.013.2100.035.4 Kidney Disease 18.825.240.432.461.549.950.627.635.827.27.918.329.122.311.778.6100.0 Total 100.043.546.254.437.629.827.828.313.412.28.312.722.115.513.541.918.8 Note: Diagnosis History During Period of July 1, 2010 through June 30, 2011.

16.  Sample of 2,055 unique Medicaid IDs from NYC CJ data; 1,121 members matched to HHs  Medicaid IDs matched to the calendar year 2011 Health Home eligible population. 16

17. 4) All Other Chronic Conditions 386,399 Recipients $841 PMPM 3) Mental Health & or Substance Abuse 418,677 Recipients $1,540 PMPM 2) Long Term Care 197,549 Recipients $5,163 PMPM 1) Developmental Disabilities 47,760 Recipients $9,919 PMPM $5.6 Billion 44% Dual 11% MMC $11.6 Billion 83% Dual 18% MMC $3.7 Billion 23% Dual 67% MMC $7.3 Billion 13% Dual 66% MMC test $28.2 Billion Total Complex N=1,050,385 $2,366 PMPM 32% Dual 55% MMC Time Period: July 1, 2010 – June 30, 2011

18. Goals:  Engage the criminal justice population in health homes by creating 6 health home pilots that will pioneer effective engagement of people in state prisons, local jails and probation and 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.