health-reform-20

New York 1115 Waiver Application Summary

August 15, 2019

McDermott+Consulting

On August 9, 2019, New York announced it will be submitting a Section 1115 Medicaid Demonstration waiver application to the Centers for Medicare and Medicaid Services (CMS) to provide Medicaid services to certain incarcerated individuals about to be released from county jails and New York State prisons. Below is a summary of the waiver. The New York Department of Health (DOH) will accept comments on the proposal through September 14, 2019. After this comment period, New York State will review and incorporate necessary comments, and then submit the waiver application to CMS for approval.

Background

Justice-involved individuals suffer from substance abuse disorders, mental and behavioral health conditions and chronic diseases at a disproportionate rate. In New York, 83 percent of incarcerated individuals are in need of substance abuse treatment upon release, and the rate of mental illness in jails has reached nearly 40 percent. While state and local correctional facilities provide medical care, incarcerated individuals often experience disruption in care when they are released. The goal of the waiver is to strengthen the relationship between the care provided inside jails and prisons and the care offered by Medicaid providers upon release, and to ensure a seamless transition to community-based services for incarcerated individuals reentering the community who are high-risk. To do this, the state will provide covered incarcerated individuals with certain Medicaid services 30 days prior to release.

Covered Individuals

Eligible individuals will be Medicaid-enrolled incarcerated individuals who have two or more chronic physical or behavioral health conditions, a serious mental illness, HIV/AIDS, or an opioid use disorder, and who are scheduled to be discharged from a jail or prison within 30 days. New York also suggests that providers be allowed to engage individuals in county jails within the first 15 days of incarceration.

Covered Services

New York seeks to provide the following Medicaid services to eligible individuals:

  • Care management to be provided through Health Homes working closely with the individual’s managed care organizations.
  • Clinical consultation services, provided by a physician, nurse practitioner, licensed/registered/certified substance use disorder or mental health specialist, to facilitate continuity upon discharge.
  • A medication management plan and certain medications, including long-acting or depot preparations for chronic conditions; acute withdrawal medications; or suppressive, preventative, or curative medications, including PrEP and PEP that will facilitate the maintenance of medical and psychiatric stability while facing the challenges of transitioning back to the community.
Implementation

To implement this demonstration, New York will identify individuals who are currently in a Medicaid suspension status and who meet the high-risk criteria and then connect them to a Health Home or managed care plan care manager 30 days prior to release. Currently, this is more easily accomplished in the State prison system where there is more certainty around release dates and there are systems in place for data exchanges and high-risk identification. The State is now working to create data exchange processes between county jails, State criminal justice agencies and DOH. The State will phase in the demonstration by beginning the program in the State prisons, followed by an expansion to county jails.

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