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Corrections and Medicaid Partnerships: Strategies to Enroll Justice-Involved Populations

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Date: November 17, 2015
Time: 3:00-4:00pm EST
View Webinar Here
Download Webinar Slides
Many individuals involved in the criminal justice system are now eligible for Medicaid in states that expanded the Medicaid program under the Affordable Care Act. Health coverage can provide individuals who are leaving incarceration with access to physical and behavioral health services critical to their successful reentry into the community. In some states, correctional agencies have partnered with Medicaid agencies to implement procedures to begin the Medicaid application process as individuals are nearing their incarceration release dates. This webinar features three states—Colorado, New Mexico and Wisconsin—that have initiated efforts to enroll justice-involved individuals in health coverage and explores some of the following questions:

  • How are states developing procedures to enroll justice-involved individuals in Medicaid, and what types of policy or process changes have they implemented?
  • What specific assistance is provided to incarcerated individuals who are enrolling in health coverage and how are applications processed?
  • What strategies have been most successful for states, and what are some of the operational challenges that states are in the process of addressing?
  • What types of interagency partnerships and coordination are needed to facilitate the enrollment of justice-involved individuals?
  • How are states promoting access to care for the justice-involved population upon their release from incarceration?

Wisconsin – Medical Homes

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Federal Support: On January 29, 2013, the Centers for Medicare & Medicaid Services (CMS) approved Wisconsin’s state plan amendment (SPA) to implement Section 2703 of the Affordable Care Act, creating health homes for Medicaid enrollees with an HIV diagnosis and at least one other diagnosed condition or a risk of developing a second condition. AIDS Service Organizations in four counties are eligible to serve as health homes under this SPA, serving large urban areas including Green Bay, Madison, and Milwaukee. The SPA became effective on October 1, 2012. Wisconsin was a recipient of a planning grant from CMS to develop its state plan amendment. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
Wisconsin has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”
Last updated: April 2014

Defining & Recognizing a Medical Home
Recognition: AIDS Service Organizations participating in Wisconsin’s ACA Section 2703 Health Homes program must integrate medical, behavioral, pharmacy, and oral health care. Wisconsin also expects health homes to either obtain national patient-centered medical home accreditation (e.g., NCQA) or provide written support that they meet the state’s health home standards, which include:
  • Adoption of written standards for patient access and communication;
  • Use electronic charting tools to organize clinical information;
  • Adopting evidence-based guidelines for treating HIV-related conditions;
  • Systematically tracking test results and identify abnormal results;
  • Electronically tracking patient referrals; and
  • Measuring and reporting health care quality, patient safety, and health outcome information.
Aligning Reimbursement & Purchasing
Wisconsin pays AIDS Service Organizations participating in the state’s ACA Section 2703 Health Homes program a monthly case rate for care management activity and an annual fee for completing an assessment and developing or updating a care plan.
Measuring Results
Wisconsin has identified two specific goals for its ACA Section 2703 Health Homes program:
  1. Reduce the risk of complicating opportunistic infections and improve health outcomes;
  2. Ensure the integration of oral health care and medical health care for HIV patients.
Wisconsin will use public health surveillance data, claims data from the state’s Medicaid Management Information System, and enrollees’ medical records to track the state’s performance on these goals.
The state’s Medicaid agency and the Wisconsin Division of Public Health (DPH) will collaboratively assess program implementation.
Costs savings will be calculated using a pre/post analysis of Medicaid claims data for health home enrollees, as well as comparing the costs for Medicaid enrollees with HIV that are not participating in the health home program.

 
 
 

Wisconsin

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In Wisconsin:
 
  • Most Medicaid services are delivered primarily through Medicaid Health Maintenance Organizations (HMOs). When families are enrolled in ForwardHealth (the state Medicaid program) they are also enrolled in an HMO. If there are multiple HMOs available in the area where the family resides they are able to select between them. Once families are enrolled the HMO sends them an enrollment packet with information related to the services they can receive. Medicaid will cover certain services – such as behavioral or oral health services – if they are not among those provided by the HMO in which the beneficiary is enrolled.
  • There were a total of 1,173,355 beneficiaries enrolled in Wisconsin’s Medicaid program as of July 2011. Of these 747,046 were enrolled in managed care. 366,441 beneficiaries were enrolled in Commercial MCOs, 344,602 were enrolled in Medicaid-only MCOs, and 34,975 were enrolled in a Prepaid Inpatient Health Plan (PIHP) to receive either Long Term Care services (33,990) or Mental Health wraparound services (985). Wisconsin delivers mental health and substance abuse wraparound services to children with severe emotional disturbances through two programs called Children Come First and Wraparound Milwaukee.
 
Wisconsin provides EPSDT services through HealthCheck, the state’s EPSDT program. This includes all behavioral health, mental health, and dental services provided through the benefit. As of 2013, 585,552 individuals were eligible for EPSDT through Wisconsin’s Medicaid program. According to CMS data from 2013, Wisconsin achieved an EPSDT screening ratio of 97% and a participation ratio of 71%. 145,930 children received dental services of any kind, with 132,181 receiving preventive dental services.
 
Last updated June 2014
 
Medical Necessity
Under Wisconsin’s administrative code (DHS 101.03(96m)), medical necessary services are:
 
“(a)Required to prevent, identify or treat a recipient’s illness, injury or disability; and
(b) Meets the following standards:
  1. Is consistent with the recipient’s symptoms or with prevention, diagnosis or treatment of the recipient’s illness, injury or disability;
  2. Is provided consistent with standards of acceptable quality of care applicable to the type of service, the type of provider and the setting in which the service is provided;
  3. Is appropriate with regard to generally accepted standards of medical practice;
  4. Is not medically contraindicated with regard to the recipient’s diagnoses, the recipient’s symptoms or other medically necessary services being provided to the recipient;
  5. Is of proven medical value or usefulness and, consistent with s. DHS 107.035, is not experimental in nature;
  6. Is not duplicative with respect to other services being provided to the recipient;
  7. Is not solely for the convenience of the recipient, the recipient’s family or a provider;
  8. With respect to prior authorization of a service and to other prospective coverage determinations made by the department, is cost-effective compared to an alternative medically necessary service which is reasonably accessible to the recipient; and
  9. Is the most appropriate supply or level of service that can safely and effectively be provided to the recipient.”
Initiatives to Improve Access
  
Reporting & Data Collection Managed care contracts in Wisconsin require that enrolled children receive at least 80% of the expected number of HealthCheck screens; managed care organizations that fail to meet this metric face recoupment of some of their capitation payments.
Behavioral Health
Children are screened for behavioral health issues during HealthCheck preventive visits.
 
Managed care contract language requires that managed care organizations develop relationships—through memoranda of understanding or contracts—with community agencies that deliver behavioral health services to Medicaid beneficiaries.
 
Wisconsin Medicaid covers Screening, Brief Intervention, and Referral to Treatment (SBIRT) services for enrollees 10 years of ago and older. Substance abuse screening tools approved for use by the state are:
  • The AUDIT,
  • The DAST,
  • The ASSIST,
  • The CRAFFT, and
  • The POSIT.
Wisconsin Medicaid is a partner to two initiatives called Children Come First and Wraparound Milwaukee. These are multi-agency, community based programs of mental health and other drug abuse services for children with severe emotional disturbances (SED). The goal of the programs is to both keep children with SED out of institutions, and to reallocate resources previously used for institutionalization of SED children into community-based services. 
Support to Providers and Families
Support to Providers
 
Wisconsin Medicaid maintains a ForwardHealth Portal, which provides provider information (including provider handbooks) and serves as an interface to the MMIS. The portal also includes a page with useful links for Managed Care Organizations (MCOs).
 
Support to Families
 
Wisconsin has a program called Healthy Start, Grow Smart. This initiative created a series of fourteen free booklets, starting with Pregnancy and running through Twelve Months. These booklets are available in English and Spanish, and help new parents with developmental milestones, and information that is relevant for doctor visits during the child’s first year. Wisconsin also has a HealthCheck toll free hotline for families that have questions or problems with the program.
Care Coordination
Managed care contracts in the state encourage managed care organizations to “assist with the coordination of covered mental health services” by establishing contractual relationships with community-based mental health agencies and school-based providers.
 
The Wraparound Milwaukee program contacts with eight community agencies for over 100 care coordinators to facilitate the delivery of services to the SED children in the program using an individualized wraparound approach.
Oral Health
Children are given mouth exams as part of a HealthCheck preventive care exam. Children who need additional dental care are referred to a dental provider and these services are covered by HealthCheck.  
 
HealthCheck nursing agencies are reimbursed by Medicaid for providing dental sealants to Medicaid beneficiaries under age 21.
 

 

Wisconsin

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NASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.

 

At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.

 

If you have information about accountable care activity in your state, please email skinsler@oldsite.nashp.org.

 

Last updated: October 2012

Wisconsin

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No HIE Strategic Plan available yet.

Wisconsin

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The Wisconsin ABCD Screening Academy Project built on existing initiatives and develop statewide training and technical assistance strategies to educate healthcare providers on the integrating of validated, objective screening tools into primary care practices.  Many of these plans were incorporated into the state-wide implementation of BadgerCare+, an effort to expand coverage through a redesign of the state Medicaid program.

Specifically, the ABCD Screening Academy activities in Wisconsin included:

  • Supporting improvements in screening practices by developing a screening website for providers, families and other stakeholders seeking to improve the quality of pediatric care. 
  • Sustaining and spreading improvements through the creation of an inventory of what professionals are using recommedned screening tools and seeking ongoing funding opportunities such as the CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) Research Topic of Interest (RTOI) grant for additional assistance in training family physicians on integrating screening into well child care. 
Title Description Date Published Activity
Description of Wisconsin Division of Public Health- DHFS Developmental Screening Survey (Wisconsin DHFS) This resource provides a description of the Wisconsin survey designed to identify what methods primary care providers in Wisconsin are using to assess child development. December 2007 Gauging Success: Measurement and Evaluation
Questions for Wisconsin Division of Public Health- DHFS Developmental Screening Survey

(Wisconsin DHFS) This survey was developed to collect information on the use of developmental screening in clinical practice by Wisconsin primary care providers.

 December 2007 Gauging Success: Measurement and Evaluation
Wi Survey Questions.pdf 125.4 KB
Wi Survey Description .pdf 76.4 KB

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