Announcement and Application for Jurisdictions Interested
in Participating in the Connecting Criminal Justice to
Health Care (CCJH) Initiative
November 2015
This announcement solicits applications from state and local teams interested in
serving as learning partners in the Connecting Criminal Justice to Health Care
(CCJH) Initiative. Each state/local team will bring together officials
representing state and local criminal justice agencies, the state Medicaid agency,
and potentially other health care stakeholders, such as State Based Marketplaces,
health plans, hospitals, or other providers. Working with both national experts
and peers in other states, CCJH state/local teams will implement and refine
strategies to (1) at high-leverage intervention points, enroll the justice-involved
population into Medicaid or other health coverage; (2) develop coordinated and
integrated systems of care that meet the distinct needs of the justice-involved
population, including for comprehensive treatment of mental health and
substance use disorders; and (3) secure sustainable funding for health care
coverage furnished in jails and prisons, to the extent allowed by federal Medicaid
law. Beginning in January 2016, at least two states will receive CCJH technical
assistance lasting at least 9 months. CCJH’s national group will also help
state/local teams develop systems to monitor and evaluate the impact of CCJH
efforts. This announcement provides background and describes the criteria for
selection as a CCJH learning partner.
I.
Overview: Connecting Criminal Justice to Health Care
Justice-involved individuals are seven times as likely as the general population to experience
mental health and substance use disorders (M/SUD), infectious disease, and chronic health
conditions. 1 At both the front- and back-ends of involvement with the justice system, many
within this population would benefit from effective linkage to health coverage and care, with
potentially significant gains to public safety and state and local budgets. Those whose criminal
behavior reflects undiagnosed or untreated M/SUDs could be diverted into care as an alternative
to incarceration, but treatment resources fall far short of demand. For individuals reentering
communities after incarceration, disrupted medical care and treatment contribute to high rates of
re-incarceration, substance use disorders, needlessly high health care costs, and poor health
outcomes, including a 12-fold increase in the risk of death during the first 2 weeks after release. 2
Health care costs for prisoners impose significant and growing burdens on states and localities,
varying between an estimated 6 to 33 percent of institutional corrections spending. 3 Federal
Medicaid funds can pay for inpatient care furnished in non-correctional settings for at least 24
hours, but few states fully access those resources.
Major changes in the U.S. health care system present new opportunities for significant progress
1
on these longstanding challenges. In states expanding Medicaid to adults with incomes up to 138
percent of the federal poverty level (FPL), 4 between 72 and 90 percent of inmates qualify for
Medicaid, according to several states taking that step. 5 The justice-involved population also has
new opportunities for subsidized private coverage through health insurance Marketplaces.
Federal health legislation includes important features, many of which are little known, that allow
innovative strategies with the potential to support criminal justice agencies in realizing these new
opportunities. Powerful but underutilized tools are now available to streamline enrollment,
coordinate care, target enhanced services at high-need populations, and invest in information
technology (IT). The CCJH Initiative will bring these tools to bear in helping the justice-involved
population receive the kind of coverage and care that can prevent needless initial incarceration,
lessen recidivism following re-entry, and improve the fiscal environment facing criminal justice
agencies.
This solicitation invites states to apply to become one of at least two CCJH learning
partners. Jurisdictions will be selected in mid-December 2015. Preliminary CCJH
activities are scheduled to begin in January 2016.
CCJH participation requires active engagement from:
• State-level criminal justice agencies;
• Local criminal justice agencies in one major local jurisdiction (either a county or city) located
within the state;
• The state Medicaid agency; and potentially
• The State Based Marketplace (SBM), where applicable.
In addition, a CCJH state/local team may opt to include hospitals, other providers, health plans,
or other stakeholders with expertise in serving the justice-involved population.
The CCJH Initiative is being launched by the Bureau of Justice Assistance (BJA), through a
cooperative agreement with the Urban Institute (Urban) and Manatt Health (Manatt). It features
the use of the learning collaborative (LC) model, described below, to provide state and local
teams with technical assistance. These LCs will help state/local teams devise, implement, and
refine systems to accomplish the following goals:
• Provide Medicaid or other health coverage to the justice-involved population, at the
lowest possible administrative cost to justice agencies, on a routine basis. These
enrollment systems will focus at high-leverage intersection points, which will be selected after
consultation with state/local partners. Such points are currently expected to be: (1) initial
involvement with the justice system (such as at arraignment or bail setting); and (2) reentry
from jail or prison into the community.
• Develop integrated, comprehensive systems of care tailored to meet the distinctive
needs of the justice-involved population. Such plans should be offered to Medicaid
beneficiaries, cover the full range of necessary M/SUD services, integrate service delivery
between community and incarceration settings, and provide focused supports that facilitate
receipt of care after community reentry.
• Develop sustainable strategies to secure Medicaid and other federal funding as
allowed during incarceration. Strategies will not violate either the letter of the law or the
underlying policy goals of legal limits on the use of federal health care dollars to help states
and localities meet their Eighth Amendment obligations.
2
The CCJH Initiative will also equip participating justice agencies with tools needed to monitor
implementation and assess the impact of these integration strategies. More broadly, the Initiative
will both help state/local teams achieve important goals in their particular states while producing
issue briefs and webinars that share lessons learned with BJA and the broader criminal justice and
health policy communities.
II.
Potential Benefits to State/Local Participants
The CCJH Initiative will improve participants’ capacity to obtain allowable federal Medicaid
funding and to enroll the justice-involved population into comprehensive, coordinated health
care systems. Such measures offer promise to prevent incarceration on the “front end” of justice
involvement, to lessen recidivism after prisoners reenter the community, and to improve the
health status of justice-involved groups while achieving positive functional outcomes, including
recovery. Such efforts seek gains in public safety while saving taxpayer dollars. Several strategies
will help participating states and localities realize these goals:
• Each state/local team will bring together criminal justice agencies with the state Medicaid
program. Such collaboration will help develop policies that address the needs of both
Medicaid and criminal justice officials, while building relationships that could be helpful long
after the CCJH Initiative ends.
• Each state/local team will receive technical assistance that includes collaborating around
active problem-solving with their counterparts in other states. Such peer-to-peer learning is
often very effective.
• Leading national experts on Medicaid and the criminal justice system will provide assistance
and information about innovative options to expedite enrollment, build comprehensive and
coordinated systems of care, and obtain permitted Medicaid funding. Many of these
possibilities are not well-known within the justice community. 6
• The Initiative will use a “learning collaborative” model, which is a time-tested, structured
method for rapidly designing, implementing, and revising promising ideas, modifying them as
needed to succeed in diverse “real world” environments.
• National experts will help state and local justice agencies develop monitoring and evaluation
methods that use existing systems to produce information of value to policymakers. State and
local agencies may be able to use similar methods in other settings as well.
III.
Scope of the CCJH Initiative
The following technical assistance is available for teams from at least two states.
A. Participating in the CCJH Learning Collaboratives (LCs)
LCs can be a highly effective approach to fostering rapid progress on challenging issues and
building practical knowledge. Under the LC model, members of the collaborative come together
in several “learning sessions,” with state/local teams from different geographic regions who are
committed to achieving progress on a common set of high priority problems identified by
participants. Expert faculty direct the LCs, beginning with promising innovations, dubbed the
“change package.” Between learning sessions, “action periods” feature each state/local team
adjusting the “change package” to its particular environment by rapidly planning, implementing,
analyzing results, and adjusting course. The LC faculty is deeply involved throughout this
process.
3
Each LC session is carefully planned for maximum impact. After the first session, team members
share information about their progress and problems, serving as coaches along with faculty.
“Horizontal” learning from peers, not just “vertical” learning from national experts, is thus a
central feature of the LC approach. The process is intense but brief, focused on achieving
discrete and measurable objectives.
Before each LC begins, the Urban/Manatt team will work with state and local officials, via
teleconferences and initial site visits, to define the LC’s precise objectives, based on the most
important goals and most serious obstacles facing the justice officials within each LC’s domain.
This preliminary work will also identify the appropriate state and local officials to include in each
LC and ensure that such officials have clear expectations about the work required of team
members. The Urban/Manatt team will then refine the change package that will be the initial
focus and curriculum of each LC’s work. LC meetings will be virtual, with a kick-off session
followed by meetings on specific issues at intervals chosen by collaborative members.
The LC process is designed to yield a robust body of knowledge about effective strategies, rooted
in real-world experience, that other justice and health agencies can use to tackle health issues
facing justice-involved populations. The CCJH Initiative includes three LCs:
LC #1: Linkage to enrollment and services. This LC will develop effective strategies, at key
intercept points within the justice system, to 1) enroll the justice-involved population into
Medicaid and other health coverage and 2) link those individuals to the coordinated,
comprehensive health care plans or systems that will be developed through LC 2. We will focus
on strategies that use innovative Medicaid business rules and data matches to minimize the need
for labor-intensive enrollment work by justice agency staff. The LC will include representatives
from key state health agencies, such as Medicaid and perhaps Marketplaces, and justice officials
representing the key intercept points for enrollment. We envision those points as occurring at the
“front end” of initial justice system involvement and the “back end” when prisoners reenter the
community, but initial conversations with state/local teams may change this focus. 7
LC #2: Coordinated, comprehensive systems of care. This LC will pursue at least two
strategies to further the development of coordinated and comprehensive systems of care
structured to meet the needs of the justice-involved populations. First, the LC will feature
discussions between justice officials and Medicaid officials about developing a targeted benefits
package for this population, including the coverage of M/SUD and other services that address
criminogenic needs. Second, this LC will develop policies to implement the “health home” model
or other approaches to provide justice- involved populations with health coverage that (1) is
integrated between incarceration settings and the community and (2) provides key supports that
promote access to care, not just a Medicaid or insurance card. We anticipate that this LC’s
membership will include Medicaid agency staff. It will also include state and local justice agency
staff familiar with health care provided in correctional settings and in the community, following
reentry. This LC may also include leading community-based health care providers or health plans.
LC #3: Sustainable funding for corrections-based health care. Including representatives of
state Medicaid agencies, perhaps Marketplaces, and health care officials from the state prison and
local jails, this LC will develop sustainable strategies to obtain appropriate federal funding for jailand prison-based health systems in three ways. This will include an effort to carefully define the
services for which Medicaid reimbursement can be appropriately claimed. It may also include IT
investments that allow the “suspension” rather than termination of Medicaid eligibility as well as
other, even more effective reimbursement strategies. In addition, the LC’s local partners will
4
develop and implement strategies for enrolling pretrial detainees into subsidized coverage
through Marketplaces if an initial analysis shows the possibility of obtaining significant insurance
payments for health care provided to detainees.
Each CCJH state/local team will have a designated TA liaison from the national CCJH group,
who will maintain regular contact with the team. The TA liaison will work with the state/local
team during action cycles and in preparation for learning sessions; assist the team coordinator
with trouble-shooting as needs arise; coordinate the provision of technical assistance; and provide
other support needed by the state/local team. Targeted technical assistance may involve
telephone calls or site visits and the use of web conferencing or other distance technologies.
B. Strengthening Capacity for Monitoring and Implementation
Challenges integrating justice system data across agencies and limited analytic capacity have long
bedeviled collaboration aimed at justice-involved populations. 8 To strengthen our state and local
partners’ capacity to document their work’s impact, early work within each LC will set
performance goals that define the LC’s success. Urban staff, expert at program evaluation and
experienced in working with criminal justice agencies, will collaborate with state/local teams to
apply a performance measurement perspective that translates these goals into concrete
performance indicators. This will include data elements to track key measures, local definitions
for those measures, and “scorecards” that serve as reporting vehicles. Each CCJH state/local will
have a designated evaluation lead from Urban.
Each team’s monitoring and evaluation work will include baseline data collection, much of which
will be helpful in applying to join the Initiative. State/local teams will collaborate with their
evaluation leads to identify key data gaps, including limitations in data integration across systems
and shortcomings in capacity to extract, analyze, and report information. After state/local teams
decide on the above-referenced data elements, data definitions, and performance measurement
scorecards, they will work with their evaluation lead to develop a process for routinely updating
the scorecard to track and report on future progress, including after the CCJH Initiative is
complete. This includes a longer-term assessment of impact on health coverage, health care
utilization, health care costs, health status, recidivism, and criminal justice costs, which may not
fully materialize during the time-limited Initiative.
C. Implementing Technical Assistance
The first six weeks of CCJH implementation will focus on refining the initiative’s approach and
the structure of each state/local team. During the planning period, the CCJH national group will
conduct phone calls and potentially site visits with each state/local team. This national-state
collaboration will build on work that state/local teams have done to prepare their proposals to
participate in the CCJH Initiative. This planning phase has several goals:
• Documenting the baseline of past and current practice, including—
 Characteristics of the justice-involved population;
 Relationships and prior collaboration (if any) between state and local criminal justice
and health agencies (Medicaid, Marketplace, and M/SUD programs);
 For LC 1, past and current efforts to enroll the justice-involved population into
Medicaid and other health coverage;
 For LC 2, experiences with the community-based health systems and health plans
that, through Medicaid or otherwise, serve the justice-involved population; and
 For LC 3, the status of efforts to obtain federal reimbursement for health care
5
services furnished to incarcerated individuals.
• Analyzing the precise issues, within each LC area, that represent the highest priority to state
and local team members;
• Adjusting each LC’s plans to better meet the needs of state/local teams;
• Potentially adjusting the precise team memberships (agency and position) whose participation
is needed for each LC’s effective operation, including from within state criminal justice
agencies, local criminal justice agencies, the state Medicaid program, and perhaps state
agencies responsible for M/SUD services and the Marketplace;
• For each identified team member, defining roles and responsibilities, including clear
expectations about responsibilities for learning sessions and action periods; and
• Finalizing the structures and policies that each team will use to ensure effective and
coordinated management and operations (including during action periods).
IV.
Eligibility
To qualify, a state/local team needs participants in each of the following categories:
• State criminal justice agencies, including officials or staff responsible for handling initial
contact with the criminal justice system, providing health care in prison, structuring reentry,
and overseeing post-release integration into the community; 9
• Local criminal justice agencies from a single, major jurisdiction (either county or city)
within the state, including officials or staff responsible for handling initial contact with the
criminal justice system, providing health care in jail, structuring reentry, and overseeing postrelease integration into the community;
• The state Medicaid agency, including officials responsible for eligibility, enrollment
policies and systems, health care delivery system reform that focuses on care coordination
(including via Medicaid health homes), coverage of M/SUD services, and Alternative Benefit
Plans for low-income adults; and
• Other health agencies or organizations deemed necessary by the state/local team.
Examples could include leaders of state and/or local government agencies that focus on
M/SUD services; providers or health plans, public or private, with perspectives that appear
likely to help one or more LCs accomplish its goals; and SBM officials. Because SBM open
enrollment begins in November 2015, it may not be possible to recruit SBM officials in time
for inclusion in a state/local partnership proposal. In such cases, an application can indicate
that, after the award, team members plan to solicit involvement from Marketplace officials.
More broadly, the inclusion of any “other health agencies or organization” is not required; it
is entirely a matter of applicants’ judgment.
V.
Project Timeline
Applications for participation in the project are due on December 18, 2015. State/local
teams selected to participate will be notified of their selection on or about December 28, 2015.
Selected teams will be asked to complete a set of initial planning tasks between notification of
their selection and “kick-off” phone calls or site visits with the Urban/Manatt team. Technical
assistance will be provided over a 9-month period, from January 1, 2016, through September 30,
2016. It is possible that additional assistance may be funded after the end of the initial period.
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VI.
Expectations of CCJH Teams
Prospective CCJH state and local agencies are asked to make commitments involving both
process and substance. Standards are comprehensive yet flexible, encouraging applicants to shape
their CCJH strategies to reflect state/local circumstances, resources, and priorities:
• Becoming a partner within a CCJH state/local team is a 9-month commitment.
• The proposed CCJH team must consist of fully engaged partners who are willing to
undertake systemic changes in policy and practice and sustain them over time.
• Each partner agency must commit, for all three LCs: (1) to prepare for and participate in all
learning sessions; and (2) to carry out rapid cycles of planning, implementation, analysis, and
adjustment of policy or practice during each action period.
• Each partner agency must commit to working with Urban staff to develop and implement
systems for monitoring CCJH implementation and outcomes.
• Each state/local team must commit to using a management structure and approach to ensure
that all agencies within the team work together efficiently and effectively during action
periods and in preparation for learning sessions.
• Each state/local team must designate a CCJH lead agency with a dedicated staff member
assigned to coordinate the various CCJH activities. We expect that the coordinator will work
at least half-time on this project. The coordinator will serve as a main point of contact with
the CCJH national group. The coordinator can work for any state/local partner organization,
so long as the coordinator’s mandate is to achieve larger CCJH goals and not only those of
the coordinator’s home organization.
• Teams must agree to work with local, state, and national partners on an ongoing basis,
including by sharing information with BJA, the national team, CCJH teams in other states,
and the field about all non-confidential elements of the CCJH effort as it develops. When the
CCJH national group develops materials for broader use by BJA and the field, teams may be
asked to review and comment on drafts.
• CCJH state/local teams must be prepared to support program operation and staffing costs
associated with this project. Teams selected will receive technical assistance to facilitate CCJH
implementation, as well as evaluation support. However, grant funds will not support state or
local program operations or staffing.
• CCJH teams must commit to the ongoing self-evaluation of their CCJH efforts, and to adapt
and modify their CCJH efforts as indicated by the results of their self-evaluation.
VII.
Application and Selection
Applications are invited from state and local agencies interested in collaborating to connect
justice-involved populations to available sources of health coverage and care. Applications should
come from a partnership with a designated lead agency. Application narratives should not exceed
18 single-spaced pages, although shorter applications are encouraged. Exhibits and attachments
may account for an additional 5 pages. Each application should address the expectations
described in the previous section and the prerequisites and selection criteria identified in this
section.
Since resources may not permit working with more than two state/local teams, every effort will
be made to select applicants where the conditions for maximum impact are present, as well as
teams that together represent diverse jurisdictions. CCJH implementation requires systemic
7
change, so we seek applications from jurisdictions that are already moving in this general
direction. Other selection criteria are listed below.
A. Prerequisites
Applications that do not fulfill the following three requirements will not be considered:
1. Letter of Interest and Commitment from Team Members: Each application must include a
joint letter signed by the leaders of all participating state and local agencies, as well as any
partnering providers or health plans. The letter should explain why the team wants to participate
in this Initiative. It should also affirm the commitment of all partnering organizations (1) to
participate fully in each LC; and (2) to use the CCJH national group’s assistance to develop or
strengthen systems of monitoring and evaluation. The letter does not count against any
application page limits.
2. Letters of Commitment from Jurisdictional Chief Executives: Each application must
include letters from the Governor and the chief executive of the partnering local jurisdiction
stating a commitment that participating in the CCJH initiative will be a priority for partner
agencies that are accountable to the Governor or local chief executive. These letters do not count
against any application page limits.
3. Medicaid expansion: States that have not expanded Medicaid have important options
available for connecting justice-involved populations with health coverage. 10 However, to help our
LCs function most effectively with different state/local teams pursuing common priorities, we will
consider only applications from states that have expanded Medicaid eligibility to all non-elderly
adults with incomes up to 138 percent of FPL.
B. Selection Factors
The following factors will help us select participating CCJH teams from among applicants that
meet the above prerequisites. Please have your application address each factor.
1. Why are the team’s agencies interested in participating in the CCJH Initiative?
Provide a problem statement describing the key issues facing state and local partners, using
relevant data and other information, and provide a vision statement for what you hope to
achieve. In describing current and past practice, consider the elements stated in section III.C,
above (relationships between criminal justice and health agencies; efforts to enroll the justiceinvolved population into Medicaid and other health coverage; etc.), and described with more
detail in the Appendix. Within each LC issue area, what are the most important gaps and
challenges that you see in current policies and procedures, how do you hope to address them
within the LC, and what outcomes do you see as the highest priorities for accomplishment? Will
state/local partners build on the Initiative’s short-term efforts, if follow-up funding is not
available?
2. What is the nature of the proposed partnership, and who is involved? Strong leadership,
clear commitment, and contributions from many organizations and agencies will be necessary
for success. Please address the following:
• Describe your team’s leadership (including the choice of lead agency), the composition of
your partnership, and your strategy for recruiting key partners not yet engaged.
• What local jurisdiction and local criminal justice agencies are committed to participation?
Why are they well-positioned (1) for successful implementation of CCJH systemic changes
8
•
•
•
•
and (2) to serve as a good testing ground to learn how local justice agencies can effectively
make such changes? Is the local jurisdiction sufficiently large that its work will both achieve a
significant short-run impact and garner significant national attention? Are local health care
providers committed to partnering with local justice agencies to develop effective systems of
care that address the needs of the justice-involved population?
Describe your team’s management and collaboration and explain how it will ensure full LC
participation of all agencies, including both learning sessions and action periods.
What factors make interagency cooperation a priority for participating agencies?
Does your proposed team have sufficient influence to make systemic change, despite likely
barriers and challenges?
Is the team’s membership sufficiently broad to represent stakeholder interests and to take
action in all policy areas addressed by the project?
3. Who will serve as the CCJH coordinator for your jurisdiction? Identify who will serve as
the CCJH coordinator, where this person will be based, and how much of his/her time will be
devoted to the effort; we envision that no less than a half-time commitment will be needed for
the team’s effective participation in the Initiative. Please describe the coordinator’s
responsibilities other than CCJH. As continuity in this position could be important to success,
please explain how you plan to ensure stability in this position.
4. What is your team’s capacity to generate and use relevant Medicaid and criminal
justice data? Please describe criminal justice agencies’ management information systems
(MIS), including those used in courts, jails, prisons, probation and parole departments, etc.
What are their current major uses and constituencies? What information is recorded (e.g., jail
and prison population data, data on health program enrollment, etc.)? Do state and local justice
agencies have research and analysis units or staff people who produce regular data reports?
What data in the criminal justice agencies’ MIS systems are potentially relevant to Medicaid
eligibility? Please address the following:
• What type of information is routinely maintained in criminal-justice agencies’ MIS systems,
including demographic data, screening and assessment information, and program
participation data? Also, please describe the staff capacity available to retrieve and analyze
data as well as the nature of the systems within which data are stored.
• What mechanisms integrate data across criminal justice agencies (e.g., a common data
warehouse serving multiple justice agencies)?
• Can data be matched efficiently and effectively among justice MIS systems and between
justice MIS other data systems (such as Medicaid eligibility and enrollment systems)? What
data-sharing agreements (if any) are in place to share data among team partners?
• Do justice MIS systems include unique identifiers that can be used to match individual data
across data systems?
• Do justice MIS systems comply with the National Information Exchange Model (NIEM)? Is
the Medicaid eligibility and enrollment system NIEM-compliant?
• What reports are generated from justice agencies’ MIS data? How are those reports used (e.g,
to flag emerging problems, guide policy development, inform management, etc.)?
• Describe key limitations to your partners’ MIS systems and other data-collection and dataprocessing efforts.
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VIII. Submission Guidelines
Please submit applications and all supporting attachments in electronic form to
CCJH@urban.org by 5 pm Eastern time on December 18, 2015. [Note, this is an
extension from the previously announced deadline of December 11.]
A webinar for prospective CCJH applicants, with a Q-and-A period, is scheduled for November
30, 2015, 1:00-2:30 pm ET. The webinar can be accessed at:
https://manatt.webex.com/manatt/j.php?MTID=m79f1d639c1a0649ea7edd168cf251d39.
Dial In: 866-922-3257; Guest Code: 792054
Before and after the webinar, you can ask about the application process by contacting the project
manager at Urban:
Jesse Jannetta, Project Manager
The Urban Institute
2100 M Street, N.W.
Washington, DC 20037
Telephone: 202-261-5593
JJannetta@urban.org
Important notice:
This project was supported by Grant No. 2015-CZ-BX-K011 awarded by the Bureau of Justice
Assistance. The Bureau of Justice Assistance is a component of the Department of Justice's
Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National
Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for
Victims of Crime, and the SMART Office. Points of view or opinions in this document are those
of the authors and do not necessarily represent the official position or policies of the U.S.
Department of Justice.
10
Appendix: Information about current and past efforts to link the
justice-involved population to health coverage and care
As explained earlier, proposals will need to describe the baseline of past and current practice
relevant to CCJH. Such a description might touch on elements like the following:
• Characteristics of the justice-involved population, including
 available data describing the size and demographics of people involved at key stages
of the justice process, 11
 the duration of each stage, 12
 insurance status at intake and upon release,
 health status (including M/SUDs or other chronic conditions), and
 estimated eligibility for Medicaid or Marketplace subsidies;
• Relationships and prior collaboration (if any) between state and local criminal justice and
health agencies (Medicaid, Marketplace, and M/SUD programs);
• For LC 1,
 past and current efforts to enroll the justice-involved population into Medicaid and
other health coverage, 13
 the administrative capacity at key criminal justice intercept points to integrate new
health enrollment activities into ongoing operations,
 data gathered by criminal justice agencies that could help demonstrate eligibility for
Medicaid or Marketplace subsidies (collectively termed, w local justice agencies can
effectively make 14
 technical and legal obstacles to transferring such data electronically from criminal
justice agencies to IT systems that serve Medicaid or the Marketplace,
 IAP policies and practices under consideration that could streamline enrollment of
the criminal justice population (such as Medicaid presumptive eligibility and the use
of data from non-Medicaid agencies to verify or establish IAP eligibility), and
 any other significant factors that facilitate or obstruct efforts to enroll the justiceinvolved population into IAPs;
• For LC 2,
 experiences with the community-based health care systems and plans that, through
Medicaid or otherwise, serve the justice-involved population (including the extent of
coverage for treatment of M/SUDs, coordination of care between community and
criminal-justice settings, and supports that help the justice-involved population
effectively utilize available services),
 the health care needs of the justice-involved population,
 the extent to which such needs are currently being met,
 Medicaid or the Marketplace implementation of policies and practices that could
help address the distinctive needs of the justice-involved population, 15 and
 any other significant factors that facilitate or obstruct the receipt of timely, highquality, comprehensive, coordinated health care by those within the justice-involved
population who have been enrolled in Medicaid or other coverage;
• For LC 3, the status of efforts to obtain federal reimbursement for health care services
11
furnished to incarcerated individuals, including
 the extent, nature, and cost of inpatient or institutional services that are furnished
off the prison or jail grounds for at least 24 hours per spell of illness,
 state efforts to suspend rather than terminate Medicaid eligibility upon
incarceration,
 the nature and cost of IT investments and other steps that would be needed to
suspend eligibility or otherwise access Medicaid funds as allowed by federal law,
 local efforts to obtain Marketplace reimbursement for incarcerated individuals who
have not yet been convicted, and
 any other significant factors that facilitate or obstruct the receipt of legally available
federal funds to defray the cost of providing health care to incarcerated individuals.
We do not expect any proposal to include all or even most of these details, but we have provided
this list to give potential bidders an idea of the kinds of baseline information that might be useful.
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Endnotes
National Institute of Corrections, “Solicitation for a Cooperative Agreement—Evaluating Early Access to Medicaid
as a Reentry Strategy,” Federal Register 76, no. 129 (2011): 39438-39443.
2 Ingrid A. Binswanger, et al., “Release from Prison—A High Risk of Death for Former Inmates,” New England
Journal of Medicine 356, no. 2 (2007): 157–165
3 Government Accountability Office (GAO). Medicaid: Information on Inmate Eligibility and Federal Costs for
Allowable Services, GAO-14-752R, September 5, 2014, citing The PEW Charitable Trusts, Managing Prison Health
Care Spending (Philadelphia, Pa.: Revised January 2014).
4 Nominally, expanded eligibility extends to 133 percent of FPL. However, 5 FPL percentage points are subtracted
from gross income in determining Medicaid eligibility; as a practical matter, the upper threshold of financial eligibility
is thus 138 rather than 133 percent of FPL.
5 GAO, op cit.
6 Such innovative approaches may involve maximizing the use of criminal justice data to automate determination of
Medicaid eligibility; presumptive Medicaid eligibility for people re-entering the community; modifying Medicaid’s
Alternative Benefit Plans to focus comprehensive coverage of M/SUD on the justice-involved population; using
Medicaid health homes to develop coordinated, integrated systems of care that (1) provide service both in the
community and in jails or prisons and (2) use community health workers (perhaps people who previously
transitioned from incarceration to the community) to use “hands-on” methods of helping newly released people
obtain care, including driving them to appointments; drawing down enhanced levels of federal funding for a broad
range of information-technology investments; enrolling pre-trial detainees into subsidized Marketplace coverage; and
tailoring Medicaid verification rules to expedite enrollment of the justice-involved population. Using the final general
approach to provide a more specific example, the Federal data hub used to verify state residence for purposes of
determining eligibility for Medicaid and Marketplace subsidies relies on U.S. Postal Service (USPS) data. Parolees and
probationers may not yet have an address within the USPS system, but they are legally required to stay in the state
and should be considered state residents. LC 1 could work with state health officials to address this easilyoverlooked set of circumstances, developing an Medicaid/Marketplace business rule that automatically classifies
parolees and probationers as state residents.
7 For example, another intercept point might be post-conviction probation.
8 Buck Willison, J, J. Jannetta , H. Dodd, S.R. Neusteter, K. Warwick, K. Greer, & A. Matthews. (2012). Process and
Systems Change Evaluation Findings from the Transition from Jail to Community Initiative. Washington, DC:
Urban Institute.
9 The latter function includes but need not be limited to probation and parole.
10 See, for example, case studies from North Carolina
(http://medicaiddirectors.org/sites/medicaiddirectors.org/files/public/nc_case_study.pdf) and Oklahoma
(http://ps.psychiatryonline.org/doi/pdf/10.1176/ps.62.1.pss6201_00730); an analysis of SAMHSA-supported
efforts to enroll vulnerable people, including the justice-involved population, into disability-based cash assistance and
Medicaid programs (http://soarworks.prainc.com/); a checklist of evidence-based behavioral health services and
supports that are likely to be important to the justice-involved population (https://csgjusticecenter.org/wpcontent/uploads/2013/04/SAMHSA-GAINS.pdf); and Legal Action Center’s interactive map which includes
relevant resources and contacts in every state (http://lac.org/resources/state-profiles-healthcare-information-forcriminal-justice-system/).
11 Relevant sub-populations could include (1) arrestees; (2) those who, pre-trial (a) are held in jail or prison or (b)
remain in the community; (3) those incarcerated in (a) jail or (b) prison; and (4) those who return to the community
from incarceration in (a) jail or (b) prison.
12 Relevant data may include such things as the median and average length of incarceration in jail and prison as well
as the median and average time from arrest to case disposition.
13 Relevant information might include, for people at particular stages of justice involvement, the percentage that
completes a Medicaid application and the percentage of such applications that are approved.
14 Potentially relevant data might include social security number, which can be used to confirm citizenship and
obtain other information relevant to eligibility; so-called “A numbers” for immigrants, which can be used to confirm
satisfactory immigration status; the identity of immediate family members, whose income and needs may affect
eligibility for Medicaid or Marketplace subsidies; date of birth; state of residence; etc.
15 Examples of such policies or practices might include Medicaid coverage of M/SUDs, Medicaid’s use of different
alternative benefit packages for different populations, the Medicaid health home option, other care coordination
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initiatives, etc.
14