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Technical Assistance Partnership for Child and Family Mental Health
MEDICAID AND JUVENILE JUSTICE
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 ISSUEOVERVIEW 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 ISSUEOVERVIEW 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 MEDICAIDOVERVIEW OF MEDICAID
Technical Assistance Partnership for Child and Family Mental Health
MEDICAIDMEDICAID
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
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
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
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 MATCHFEDERAL MATCH
FFP
FMAP
FFP
FMAP
Generally at 50% 75% for Case
Management, Maintenance of MIS
Ranges from 50 – 83%
Generally at 50% 75% for Case
Management, Maintenance of MIS
Ranges from 50 – 83%
Technical Assistance Partnership for Child and Family Mental Health
FINANCIAL STANDARDSFINANCIAL 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 ELIGIBILITYCATEGORIES OF ELIGIBILITY
Mandatory Coverage
Optional Groups with FFP
Mandatory Coverage
Optional Groups with FFP
Technical Assistance Partnership for Child and Family Mental Health
MANDATORY COVERAGEMANDATORY 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 CHILDRENHIGHLIGHTS
FAMILIES AND CHILDRENHIGHLIGHTS
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
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 & DISABLEDAGED, 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 HIGHLIGHTSOPTIONAL 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
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 ELIGIBILITYFFP VERSUS ELIGIBILITY
FFP
Medicaid eligibility
FFP
Medicaid eligibility
Technical Assistance Partnership for Child and Family Mental Health
FFP FOR PERSONS IN PUBLIC INSTITUTIONS
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
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 RULEEXCEPTIONS 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
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
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 AFFECTEDELIGIBILITY 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 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 MESSAGETAKE AWAY MESSAGEINDIVIDUALS WHO RESIDE IN CORRECTIONAL FACILITIES
SHOULD NOT BE DISENROLLED ONLY BECAUSE THEY ARE IN A
FACILITY
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
TANFTANF
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
SSISSI
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
SSISSI
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 MESSAGESFINAL 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 CONTACT INFORMATION
Mary B. Tierney, MD
202-403-5620
Mary B. Tierney, MD
202-403-5620