Administration of Justice 11/05/2010
Medicaid Waiver: Inmate Health Costs
Over the last several months, the state of California and
the federal government have been negotiating a five-year Medicaid
Section 1115 hospital financing waiver. On November 2, agreement
on the waiver, referred to as the “Bridge to Reform,” was
announced. Under the terms of the agreement, the state will
receive approximately $10 billion in federal funds over five
years; these resources will be invested in California’s health
care delivery system to prepare for national health care
reform.
A very small piece (annually about a $130 million slice of a $2
billion pie) of the waiver relates to public safety. In the
closing days of budget negotiations, the state unveiled a
proposal by which the state and counties could benefit from
federal reimbursement for hospital inpatient services received by
state prisoners, certain parolees, and county jail inmates.
Specific details on implementation of this aspect of the waiver
are limited at this time, but the Department of Health Care
Services recently issued a white paper outlining the
broad concepts and structures contemplated for this aspect of the
waiver. (The statutory provisions for the inmate health costs
were codified in AB 1628, the public safety trailer
bill.)
The principle behind the inmate health component is to draw down
federal reimbursement for costs now borne exclusively by either
the state or local governments. Under the proposal, local
Coverage Expansion and Enrollment Demonstration (CEED) projects
would:
- Be required to agree to include prison inmates in their CEED project for inpatient hospital services. The CEED project would be compensated by the Department of Corrections and Rehabilitation (CDCR) for these costs. The intent is that there will be no net increase in county expenditures; CDCR and federal funds would cover the county cost, including administrative costs. Eligibility would be based on county of last legal residence prior to arrest.
- Allow for seeking federal reimbursement for the care of adult inmates incarcerated in county correctional facilities for expenditures incurred for inpatient services in community hospitals if the county determines the inmates to be eligible for Medi-Cal or the local CEED projects. (Counties that choose this option will remain responsible for the non-federal share of the costs to serve county inmates eligible for Medi-Cal or CEED projects.) In order to get the jail inmate reimbursement benefit, the county must agree to include the prison population in its CEED project.
As with all aspects of the waiver, CSAC is mindful that there is an incredible amount of work to be done to implement the waiver – within state government, county government, public and private hospitals, health plans, clinics and providers. It should be noted that this particular element of the waiver likely will be among the elements implemented in later phases of the waiver process. CSAC will provide updates as additional details become available.
Little Hoover Commission to Revisit Governor’s Reorganization Plan for Juvenile and Adult Corrections
The Little Hoover Commission is holding a hearing on November 18
in Sacramento to follow-up on its 2005 report: Reconstructing
Government: A Review of the Governor’s Reorganization Plan
Reforming California’s Youth and Adult Correctional Agency. In
2005, the commission reviewed Governor Schwarzenegger’s
reorganization plan as it related to juvenile and adult
corrections and concluded that the Legislature and Governor
should implement the recommendations. Further, the commission
committed itself to monitoring both the juvenile and adult
systems; the November 18 hearing fulfills that commitment. The
hearing will feature speakers such as the current CDCR Secretary
Matt Cate, Jeanne Woodford, a former secretary and undersecretary
of the department, and Wendy Still, Chief Probation Office for
the City and County of San Francisco among others.
To view the November 18 hearing agenda, click
here.
Assembly and Senate Joint Legislative Audit Committee holds Hearing to Discuss the Closure of State Juvenile Justice Facilities
Last month, the Division of Juvenile Justice (DJJ) announced that
it would be closing the Preston Youth Correctional Facility in
Amador County in June 2011. This announcement sparked renewed
interest in how the DJJ adapts to meeting the needs of its
shrinking juvenile population. (The juvenile population at the
state level has steadily declined due in part to the state’s
investment in and incentives for increased local intervention and
treatment options, a decrease in juvenile crime rates, as well as
legislation adopted in 2007, SB 81 (Chapter 175, Statutes of
2007), which shifted responsibility for the certain juvenile
offenders from the state to counties.)
In a hearing on November 4 before the Joint Legislative Audit
Committee, DJJ officials were asked to discuss their decision to
close the Preston facility. By way of background, DJJ has closed
a total of nine juvenile detention facilities and/or camps since
2003 to address its decreasing population, which at its height
was roughly 10,000 wards (a figure that now stands at
approximately 1,300 youth). DJJ currently has five facilities
operating (three in Northern California and two in Southern
California) and, as asserted in yesterday’s hearing, DJJ does not
believe that the shrinking youthful offender population can
justify ongoing operation of this number of facilities. Further,
DJJ officials explained that they also are constrained by
economics and have to respond to budget reductions made by the
Legislature and Governor.
The hearing focused mostly on how the DJJ arrived at its decision
to close the Preston facility and what tools were used to analyze
all five facilities to determine which of DJJ’s facilities would
be subject to closure. The committee intends to hold another
hearing regarding DJJ closures in January 2011. Further, there
will be a town hall meeting in Amador County in December to
discuss the Preston facility specifically. CSAC will update
counties on the upcoming January 2011 hearing as soon as more
information is made available.
To view the press release announcing the pending closure of the
Preston Youth Correctional Facility, click
here.