Affordable Care Act:
Health Coverage for Criminal
Justice Populations
Advocacy Denver
September 4, 2014
Colorado Center on Law and Policy
Colorado Criminal Justice Reform Coalition
Who we are
CCJRC and CCLP have partnered to help Colorado seize this historic
opportunity to connect criminal justice populations with needed health
care coverage and services. We coordinate a stakeholder group
specifically focused on this population and the ACA.
Advances the health,
economic security
and wellbeing of
low-income
Coloradans through
research, education,
advocacy and
litigation.
Advocates for
criminal justice
reforms and serves
as a resource for
people involved in
the criminal justice
system.
2
Overview
• Glossary of Criminal Justice terms
• Affordable Care Act (ACA) Overview
• Eligibility and Enrollment Info
• Accessing Healthcare Services
3
By the numbers
On any given day in Colorado, there are over 100,000 people who are involved in the
criminal justice system in some form. The majority will be eligible for Medicaid.
Probation – almost 76,000 adults in 2013
Department of Corrections (DOC) – approximately 18,000 adults in prison, 2,000 in
community corrections and 8,500 in-state parolees. Approximately 10,000 people a year
are released from DOC (850/month)
Community corrections (“halfway house”) - approximately 5,000 clients
DOC transition clients-still considered “inmates”
Diversion clients – sentenced to community corrections by court
Other – could include condition of probation and condition of parole placements
County jails – ???? Tens of thousands of people are released annually from jail after serving
a sentence or being released on bond
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Criminal Justice Terms – Glossary
ON BOND
When people are first arrested for an offense, they may be released from jail on bond
awaiting trial or other disposition of the criminal case. People on bond are living in the
community and they have not been convicted (or yet sentenced) for a criminal offense.
ON PROBATION
Probation is a sentence option for people convicted of either misdemeanor or felony
offenses where the person is living in the community and under supervision of a probation
officer with court oversight.
IN COMMUNITY CORRECTIONS
A community corrections program is commonly referred to as a “halfway-house”. This refers
to the role these programs play in housing people that are “halfway-in” or “halfway-out” of
prison. There are two phases of community corrections, a residential phase where people
live in the halfway house and a non-residential phase where they are supervised in the
community and are living at home and working but are still under some level of supervision.
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Criminal Justice Terms – Glossary
COMMUNITY CORRECTIONS (cont’d)
Diversion client - People who are sentenced directly to community corrections as the result of a felony
conviction. After completing the residential phase, a person is supervised on non-residential status
Transition client –Approximately 1/3 of people leaving prison will transition through a community
corrections program. They are called transition clients and are classified as “inmates” of DOC until they
are placed on parole.
Condition of probation client- The court may also require someone to complete a community
corrections program as a condition of probation. Generally these are people who have been convicted
of a felony offense but in some limited circumstances, someone convicted of a misdemeanor drug
offense may be placed in a community corrections program to receive residential treatment.
Condition of parole client – People sentenced to prison are also required to serve a period of parole
after release. The Parole Board may require that a parolee complete a community corrections facility as
a condition of parole. These people are on parole status, not inmate status.
SB 252 beds-revoked parolees- Some parolees who are revoked are eligible to be placed in a
community corrections program rather than being returned to prison. They are considered to be back
on “inmate” status.
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Criminal Justice Terms – Glossary
IN JAIL
Jails are operated by the local county, generally the county Sheriff’s Department. People can be in jail
for a number of different reasons. It is a very fluid population and people may not be in jail for a very
long time.
Pre-trial detainees-refers to people that are in jail who have not been convicted of a criminal offense
and have not (yet) made bond.
Convicted – serving jail sentence – refers to people who have been convicted and sentenced to serve a
period of time in jail. Usually this is for a misdemeanor conviction but people can also be sentenced for
a felony and required to do some jail time as a condition of probation. Some jails have a work-release
program or weekender program that allows people to leave jail to go to work, school, treatment, and
then return to jail either at night or over the weekend.
Immigration hold/detainer- Some people can be in jail because Immigration Control Enforcement (ICE)
has placed a hold or detainer pending a deportation investigation/hearing.
Other law enforcement/court detainer/hold –A person can be in jail when another law enforcement
agency or court has filed a detainer/hold because of pending criminal action in another jurisdiction.
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Criminal Justice Terms – Glossary
IN JAIL (cont)
Pending probation revocation - If a person is on probation and is noncompliant, a probation
officer can ask the court to revoke a person’s probation sentence for violation of a condition
or supervision (or for committing a new crime). In this circumstance, an individual may be
held in jail until the court holds a revocation hearing.
Pending community corrections revocation- If a person is sentenced to community
corrections and is noncompliant, a probation officer can ask the court to revoke the
community corrections sentence. In this circumstance, an individual may be held in jail until
the court holds a revocation hearing. Being in jail is usually temporary as the court will
impose a new sentence, most often a prison sentence.
Pending parole revocation- If a parolee is non-compliant, a parole officer can file a complaint
requesting that the Parole Board revoke parole. The parolee may be taken to jail awaiting
the parole revocation hearing.
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Criminal Justice Terms – Glossary
IN PRISON
Prisons are operated or under contract with the state Department of Corrections
or federal Bureau of Prisons. People in prison have been convicted of a felony and
sentenced to serve a period of time in prison.
ON PAROLE
Parole is a period of supervision following release from prison. People on parole
are still under the jurisdiction of the Department of Corrections and supervised by
a parole officer and are considered parolees – not inmates.
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ACA is a Game Changer
• People involved in the criminal justice system have
substantially higher rates of medical, psychiatric, and
addiction problems as compared to the general public.
• Majority of justice involved population – 70 to 90
percent – do not have private or public health
insurance.
ACA expands coverage to nearly everyone.
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Medicaid & Connect for Health
Colorado
Medicaid
• Free or low-cost public
health insurance program
Connect for Health Colorado
(Marketplace)
• Marketplace to purchase
health insurance & apply for
• Administered jointly by the
federal financial assistance
state & federal government
to help cover the cost of
• Colorado Department of
purchasing health insurance
Health Care Policy &
• Can choose from a variety of
Financing (HCPF)
health plans
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New Coverage Options
Medicaid
Connect for Health Colorado
(Marketplace)
Expanded to cover all
Coloradans up to 133% FPL
(about $1300/month),
including single adults.
Private insurance, including tax
subsidies to those up to 400%
FPL (about $3800/month).
Estimated 2/3 of justice
involved population will be
eligible for Medicaid.
Estimated 1/3 of justice
involved population will be
eligible for premium subsidies.
12
2014 Federal Poverty Guidelines
Size of
Family
133%
138%
185%
200%
300%
400%
1
$15,521
$16,105
$21,590
$23,340
$35,010
$46,680
2
$20,921
$21,707
$29,101
$31,460
$47,190
$62,920
3
$26,321
$27,310
$36,612
$39,580
$59,370
$79,160
4
$31,721
$32,913
$44,123
$47,700
$71,550
$95,400
5
$37,120
$38,516
$51,634
$55,820
$83,730
$111,640
6
$42,520
$44,119
$59,145
$63,940
$95,910
$127,880
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Comprehensive Coverage
Under the ACA, both Medicaid and private health plans
offered through the Marketplace must provide 10 essential
health benefits.
o Ambulatory patient services
 10 Essential Health Benefits
 Free preventative coverage
 Mental health and substance
abuse coverage parity
o
o
o
o
o
o
Emergency Services
Hospitalization
Maternity/newborn care
Mental health/substance abuse
Prescription drugs
Rehabilitative and habilitative
services and devices
o Laboratory services
o Preventive and wellness
care/chronic disease
management
o Pediatric services, including oral
and vision care
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Eligibility and Enrollment of
Justice Involved Populations
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Eligibility Depends on CJ Status
Eligibility to enroll in health coverage through Connect for
Health Colorado or Medicaid differs & depends on the person’s
involvement in the criminal justice system.
Most are eligible for coverage, some are not.
Clients are NOT eligible for coverage if BOTH:
• they are an inmate of a public institution (i.e.,
under the control of state, county, federal
government or municipality), AND
• they can be charged criminally with escape if they
leave the institution without authorization.
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Eligibility during Pretrial Phase
Marketplace
Pretrial Status
Eligible for
Medicaid?
Eligible for
Coverage?
Eligible for
Tax Credits?
- On bond or diversion pending disposition
Yes
Yes
Yes
- In jail pending disposition
No*
Yes**
Yes
* The jail or prison facility is responsible for all health care services provided in-house.
Medicaid can reimburse for medical care provided to an incarcerated person admitted as
an inpatient in a hospital for at least 24 hours. Medicaid enrollment for this purpose can
occur at any point during the hospitalization up to 90 days after release from the hospital.
** Private insurance may pay for inpatient or outpatient services received while someone is
in jail pretrial as long as the person continues to pay premiums and receives treatment innetwork.
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Eligibility while serving a sentence
Serving Sentence
Eligible for
Medicaid?
Marketplace**
Eligible for
Eligible for
Coverage?
Tax Credits?
In Jail
No*
No
No
In Prison
No*
No
No
Probation
Yes
Yes
Yes
Parole
Yes
Yes
Yes
* The jail or prison facility is responsible for all health care services provided in-house. Medicaid can
reimburse for medical care provided to an incarcerated person admitted as an inpatient in a hospital
for at least 24 hours, including individuals residing in a Community Corrections facility.
**Marketplace enrollment must be discontinued within 30 days of being sentenced to a period of
incarceration.
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Eligibility in Community
Corrections/Half-Way Houses
Community Corrections
Eligible for
Medicaid?
Marketplace
Eligible for
Eligible for
Coverage?
Tax Credits?
- - Residential diversion clients
No
?
?
- - Residential transition clients
No
?
?
- - Non-residential diversion clients
Yes
Yes
Yes
- - Non-residential transition clients
Yes
Yes
Yes
- - Condition of probation*
Yes
Yes
Yes
- - Condition of parole
No
?
?
- - SB 252 beds (parole revoked)
No
No
No
* As a condition of probation, the court can order a defendant convicted of a drug offense to complete treatment in a residential treatment
program provided in a community corrections facility (CRS 18-1.3-204(2.2)). These people are not subject to prosecution for escape if they
leave the facility (CRS 18-8-208(11)). Therefore, they are Medicaid eligible while residing in the community corrections facility.
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When Can I Begin the Enrollment
Process?
• Medicaid
• Can enroll at anytime throughout the year
• Process may begin 41 days prior to release
• Connect for Health Colorado
• Open Enrollment: Nov. 15, 2014 – Feb. 15, 2015
• Release from incarceration is considered a
“qualifying life event,” which allows someone to
purchase health insurance from the Marketplace
outside open enrollment timeframe within 60 days
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Identification Needed to Enroll
• Identification and verification of citizenship is required
for enrollment in Medicaid and Connect for Health
Colorado
 Name
 Social Security Number or Legal Permanent
Resident Documentation
 Date of Birth
 Income information
21
Resources to help with Enrollment
Step 1
Connect with enrollment specialists
• County Department of Human Services
• Medical Assistance Sites
• Health Coverage Guides
• Mobile Van/Onsite Services
22
Applying for Coverage in Colorado
County Department of Human Services &
Medical Assistance Sites
•
•
•
Call to schedule an appointment
Can help enroll in Medicaid and other
public benefits (food assistance, etc.)
Online mapping tool to find the nearest
location:
http://www.colorado.gov/apps/maps/hcpf.map
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Applying for Coverage in Colorado
Health Coverage Guides
•
•
•
•
Resource to help with enrollment for both
Medicaid & Connect for Health Colorado
Will need appropriate documentation
On average, an hour for Medicaid enrollment
Can take an additional hour to sign up for a
plan on Connect for Health Colorado if not
eligible for Medicaid
http://connectforhealthco.com
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PEAK Mobile Enrollment
Health Access Express –
Denver Health
Outreach enrollment van
that will come to your site
to help with enrollment
Call or go online
to schedule an appointment:
303-912-0263 | 303-503-1472 | 720-376-8535
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Apply Online
You may also apply directly online:
http://coloradopeak.force.com/
Each County also
has a PEAK contact
that can assist with
completing an
application
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How to Access Care through Medicaid
Medicaid is administered by the Colorado Department of Health
Care Policy and Financing (HCPF).
Physical Health
Care
Coordination
Behavioral
Health
Managed Care
• Accountable Care Collaborative (ACC) is
Medicaid’s primary health care program.
• It is comprised of Regional Care
Collaborative Organizations (RCCOs) and
Primary Care Medical Providers (PCMPs).
• Behavioral Health Organizations (BHOs) are
responsible for care coordination.
• BHOs contract with community mental
health centers and other treatment
providers.
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ACC – Regional Care Collaborative
Organizations
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RCCO Contact Information
RCCO 1: Rocky Mountain Health
Plans
• (970) 254-5771 or (800) 667-6434
RCCO 2: Colorado Access
• (303) 368-0035 or (855) 267-2094
RCCO 3: Colorado Access
• (303) 368-0037 or (855) 267-2095
RCCO 4: Integrated Community
Health Partners
• (855) 959-7340
RCCO 5: Colorado Access
• (303) 368-0038 or (855) 384-7926
RCCO 6: Colorado Community
Health Alliance
• (303) 256-1717 or (855) 627-4685
RCCO 7: Community Care Central
Colorado
• (719) 314-2560 or (866) 938-5091
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Behavioral Health Organizations (BHO)
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Behavioral Health Organizations (BHO)
Contact Information
•
•
•
•
•
Access Behavioral Care Denver
• (303) 751-9030 or (800) 984-9133
Access Behavioral Care Northeast
• (970) 221-8508 and (844) 880-8508
Behavioral Health Inc.
• (720) 490-4400 or (877) 349-7379
Foothills Behavioral Health Partners
• (303) 432-5950 or (866) 245-1959
Colorado Health Partnerships
• (800) 804-5008
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Contacts
Colorado Criminal Justice Reform Coalition
Terri Hurst, Policy Coordinator
terri@ccjrc.org
Colorado Center on Law & Policy
Elisabeth Arenales, Esq.-Director of Health Program
earenales@cclponline.org, 303-573-5669 x 302
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Questions
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