Background
More than 400,000 adults and youth are released from California prisons and jails annually. Until now, due to a federal Medicaid law known as the “inmate exclusion,” inpatient hospital care was the only service that could be covered by Medicaid for individuals considered an “inmate of a public institution.” Recognizing the opportunity to improve the continuity of health care services for justice-involved individuals, California is using a Medicaid 1115 demonstration waiver to provide a targeted set of Medi-Cal services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. California is the first state to be approved to provide these services. The Medi-Cal justice-involved initiative will reduce gaps in care, improve health outcomes, and prevent unnecessary admissions to inpatient hospitals, psychiatric hospitals, nursing homes, and emergency departments.
About This Toolkit
This toolkit includes turnkey communications resources to help you spread the word about the newly approved justice-involved initiative, lift up California’s broader transformation of Medi-Cal, and reinforce DHCS’ commitment to a healthier, more equitable health system for all.
Member Communications
When connecting with members and families of justice-involved individuals, please reference the Member FAQ below. It includes clear messaging on the tangible benefits for members as well as information about how this initiative ties to the broader goals of Medi-Cal transformation.
Provider Communications
When engaging with providers, please reference the Provider FAQ below for comprehensive information on eligibility criteria, available services, and more.
Social Media Posts
Below are suggested social media posts for you to share across your organization’s platforms. Please feel free to tailor for your organizational voice. We also encourage you to share and amplify DHCS social media content on Facebook and Twitter as we all work to spread the word.
Justice-Involved Waiver Approval Talking Points
- DHCS' justice-involved initiative is part of CalAIM, a broad initiative to transform Medi-Cal.
- The state's priority is to ensure all Californians have access to high-quality and timely care.
- Through the CalAIM initiative, we are creating a new standard for person-centered and equity-focused health care, including for the currently and formerly incarcerated.
- People re-entering the community after incarceration have significant physical and behavioral health needs and are at high risk of injury and death, especially in the initial period after release.
- The justice-involved initiative ensures continuity of coverage through Medi-Cal pre-release enrollment and provides key services to support a successful re-entry.
- Pre-release services will be anchored in comprehensive care management and include physical and behavioral clinical consultation, lab and radiology, Medication Assisted Treatment (MAT), community health worker services, and medications and durable medical equipment.
- For those eligible, a care manager will be assigned, either in the carceral setting or via telehealth, to establish a relationship with the individual, understand their health needs, coordinate vital services, and make a plan for community transition, including connecting the individual to a community-based care manager they can work with upon their release.
- Under the initiative, county jails, county youth correctional facilities, and state prisons will:
- Ensure all eligible individuals are enrolled in Medi-Cal before release.
- Provide targeted Medi-Cal health care services to youth and eligible adults in the 90 days prior to release to prepare them to return to the community and reduce gaps in care. Eligible adults include those who have a mental health diagnosis or suspected diagnosis, a substance use disorder or suspected diagnosis, a chronic clinical condition, a traumatic brain injury, intellectual or developmental disability, or are pregnant or postpartum. All incarcerated youth in a youth correctional facility are eligible with no clinical criteria required.
- Provide “warm handoffs" to health care providers to ensure that individuals who require behavioral and other health care services, medications, and other medical supplies (e.g., a wheelchair) have what they need upon re-entry.
- Work with community-based care managers to offer intensive, community-based care coordination for individuals at re-entry, including through Enhanced Care Management.
- Work with community-based care managers to make Community Supports (e.g., housing support or food support) available upon re-entry if offered by their managed care plan.
Member FAQ (Key Messages For Members/Families of JI Individuals)
1. When can JI individuals access services?
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DHCS expects correctional facilities to launch pre-release services between October 1, 2024
through April 2026.
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Once their facility offers pre-release services, youth and eligible adults in jails, youth correctional facilities, or prisons can begin receiving targeted Medi-Cal services 90 days before their expected release date. Anyone who is incarcerated is eligible for pre-release services, provided they meet other criteria, including those who are incarcerated for a short term
2. How do eligible individuals enroll in Medi-Cal?
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County jails, youth correctional facilities, prisons, and designated entities are responsible for identifying individuals potentially eligible for Medi-Cal, assisting them with the application, and submitting the application to County Social Services Departments (SSDs).
3. Who is eligible to receive services prior to release?
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All individuals incarcerated in a youth correctional facility are eligible; no clinical criteria are required.
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Eligible adults include those who have a mental health diagnosis, a substance use disorder, a chronic or significant clinical condition, a traumatic brain injury, intellectual or developmental disability, HIV/AIDS, or are pregnant or postpartum.
4. What can JI individuals expect to happen during the 90-day pre-release period? What services will be provided?
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For those eligible for pre-release services, a care manager will be assigned to establish a relationship with the individual, understand their health needs, coordinate needed services, and plan for community transition. This includes connecting the individual to a community-based care manager (i.e., ECM provider) who they can work with upon their release.
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Health care providers will ensure individuals who require behavioral and other health care services, medications and other medical supplies (e.g., a wheelchair) have what they need upon re-entry so they can continue to receive the care they need after their release.
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Members can also qualify for post-release enrollment in Enhanced Care Management and Community Supports, including housing and food supports, to help them build stability as they re-enter the community.
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ECM care managers can meet Medi-Cal members via telehealth prior to their release to establish a relationship and support their reentry into the community.
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List of Pre-Release Services
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Care management;
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Physical and behavioral health clinical consultation services;
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Laboratory/radiology;
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Community health worker services;
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Medications, consistent with the full scope of covered outpatient drugs under Medi-Cal state plans, and medication administration; and
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Medication Assisted Treatment (MAT).
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Individuals who qualify will receive covered outpatient medications and durable medical equipment (DME) in hand upon release, consistent with approved state plan authorities and policy.
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Pre-release care managers will be responsible for:
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Establishing a trusting, working relationship with the member;
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Conducting a needs assessment, as appropriate, during their initial meeting with the individual;
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Scheduling and coordinating clinical consultation services, if necessary;
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Coordinating pre-release medication including MAT;
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Developing a transitional care plan (i.e., discharge plan);
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Sharing the final transitional care plan with community-based providers (electronically, if possible);
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Coordinating post-release DME medication, including MAT;
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Coordinating with the individual's post-release providers, including specialty behavioral health providers or other community-based providers on an as-needed basis;
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Sharing relevant information and the transitional care plan with post-release support and providers (e.g., post-release care manager, MCP) to support care coordination; and,
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Conducting a warm handoff with the individual's post-release care manager (e.g., ECM provider) if different than the pre-release care manager.
5. Where can members go for more information and answers to their questions?
Provider FAQ (Key Messages For Providers)
1. What are the behavioral and physical health eligibility criteria for pre- release services for individuals who are justice-involved?
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Adults:
- Mental illness, defined as confirmed or suspected mental health diagnosis based on specified criteria;
- Substance use disorder, defined as confirmed or suspected diagnoses based on specified criteria;
- Chronic condition or significant clinical condition, defined as confirmed or suspected diagnoses based on specified criteria;
- Intellectual or developmental disability (I/DD), defined as a disability that begins before an individual turns 18 and is expected to continue indefinitely and present a substantial disability;
- Traumatic brain injury or other condition, where the condition has caused significant cognitive, behavioral, and/or functional impairment;
- Positive test or diagnosis of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS); or
- Currently pregnant or within 12 months postpartum.
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Youth:
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All youth under 21
and former foster youth between 18-26 years of age do not need to demonstrate a
health care need to qualify for pre-release services.
2. What pre-release services will healthcare providers be responsible for providing? What services will correctional facilities be responsible for facilitating?
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Care coordination and connecting individuals with the care they need;
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Physical and behavioral health clinical consultation services;
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Laboratory/Radiology;
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Community Health Worker services;
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Medications, consistent with the full scope of covered outpatient drugs under Medi-Cal State Plans, and medication administration; and
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Medication Assisted Treatment (MAT);
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Providing qualifying individuals with covered outpatient medications and Durable Medical Equipment (DME), ensuring they have these supports in- hand upon release, consistent with approved state plan authorities and policy.
3. What will pre-release care managers be responsible for?
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Establishing a trusting, working relationship with the member;
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Conducting a needs assessment using a DHCS-provided template during their initial meeting with the individual;
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Scheduling and coordinating clinical consultation services, if necessary;
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Coordinating pre-release medication, including MAT;
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Developing a transitional care plan (i.e., discharge plan);
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Sharing the final transitional care plan with community-based providers (electronically, if possible);
-
Coordinating post-release DME medication, including MAT;
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Coordinating with the individual's post-release providers, including specialty behavioral health providers or other community-based providers on an as-needed basis;
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Sharing relevant information and the transitional care plan with post-release support and providers (e.g., post-release care manager, MCP) to support care coordination; and,
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Conducting a warm handoff with the individual's post-release care manager (e.g., ECM provider) if different than the pre-release care manager.
4. How will this initiative increase access to MAT?
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To increase access to MAT in carceral settings and improve the standard of care in delivering these services to justice-involved populations, the provision of MAT will be a required pre-release service.
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DHCS will work with correctional facilities to build off their current progress in providing MAT and provide technical assistance to CDCR, jails, and youth correctional facilities to ensure all facilities are able to provide MAT.
5. How do eligible individuals enroll in Medi-Cal?
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County jails, youth correctional facilities, prisons, and designated entities (DHCS/MCED's preferred term for application assisters) such as county offices will be responsible for identifying individuals potentially eligible for Medi-Cal, assisting them with the application, and submitting the application with County Social Services Departments.
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County jails, youth correctional facilities, and designated entities should submit Medi-Cal applications at intake or as close to intake as possible. Prisons will start this process, at an appropriate time closer to the release date.
6. Where can providers go for more information and answers to their questions?
