submitted by Christopher W. Bell, Vice President of Business Development for NaphCare, Inc.
View the entire newsletter: 2015 - NJAC County Biz - April
In 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law. There has been great speculation on how implementation would impact our criminal justice system. There are an estimated 14 percent of men and 31 percent of women in incarceration suffering from chronic mental illness and an even higher percentage with a substance abuse disorder, so the need for increased treatment services is crucial?.
I wanted to take this time to point out several facts and keys in utilizing PPACA to ensure your County is saving additional dollars within your inmate population.
In your State, NJ FamilyCare, your publicly funded health insurance program, includes Medicaid and Medicaid expansion populations. It has been estimated that about 17,000 adults incarcerated at NJ county jails are NJ FamilyCare eligible.
Here are some facts about the current New Jersey process:
- 1965 Federal law: Social Security Act Section 1905(a) Prohibits Federal Financial Participation (FFP) for medical care or services for inmates in a public institution, except as a patient in a medical institution.
- New Jersey state law – 42 CFR 435.1010: incarcerated individuals who are expected to be hospitalized for a 24 hour period or longer at a medical institution, are not considered to be an inmate during that time and can be covered by Medicaid, if otherwise eligible.
- Inpatient hospitalizations, greater than 24 hours are eligible for Medicaid fee-for-service payment (in the NJ Family Care program) and federal reimbursement.
- There is nothing in PPACA law that precludes the carrier from continuing to cover that individual while incarcerated and awaiting charge disposition.
It’s important to understand all of the above issues. As a medical provider for correctional facilities, NaphCare works with our partners to facilitate greater inmate access to insurance/Medicaid coverage upon intake and release, which can result in potential savings during off-site trips for correctional facilities nationwide. Medicaid eligibility will be expanded to include individuals under the age of 65 that meet certain criteria. It is also a fact that inmates have incomes between 133% and 200% of the federal poverty level. With that being said, a qualified medical partner in New Jersey should be prepared to assist in tracking those that are eligible while pending disposition of charges. An interface with the U.S. Department of Health and Human Services’ (HHS) newly-created data services hub verifies citizenship and eligibility. Tracking these statistics through an electronic health records system (EHR) is very similar to verifying coverage with third-party carriers. This additional check can save County financial resources in off-site trips for all that qualify.
EHR systems designed specifically for correctional settings create an exchange of information and allow maximization of resources, which can translate into County savings. Securing insurance information and eligibility upon booking determines if someone not yet sentenced may be covered by their personal insurance. At medical screening, jail medical staff can assist in determining statuses, as well as assess health care needs. It’s also important that a medical partner have a centralized scheduling department and on-site administrative staff that will follow up aggressively to collect reimbursement on behalf of your facility. Staff should communicate all insurance information obtained for billing purposes to the facility, which can result in additional savings.
Educating inmates that currently qualify for Medicaid and those who are eligible under the PPACA is also another important role for your medical partner. With PPACA, when inmates re-enter the community, they will have greater access to care. EHR systems assist with this transition and ensure greater access to medical providers and medication more efficiently. A correctional medical partner with a network management department can develop re-entry networks of providers and ensure that access to prescription drugs are made readily available. As part of such a re-entry program, inmates should be provided with information regarding the Medicaid enrollment process. It is vital for inmates to continue with any medical treatment plan, especially as it relates to chronic medical or behavioral issues.
For more information, please contact Christopher Bell at chris.bell@naphcare.com or (800) 834-2420.