Improving Access to Healthcare for Youth
in the Juvenile Justice System
Prepared by
Prepared for Presentation to
California Association of Probation Institution Administrators (CAPIA)
Annual Meeting September 2012
Connecting to Treatment
➛ Health Reform creates increased access to health
care for Californians – through expanded eligibility
and new benefits that include behavioral health care.
➛ Juvenile offenders are a high-risk, hard-to-reach
population, and the time spent in detention creates
an opportunity to connect them to traditional and new
community-based health care services.
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Knowing Your Options
➛ Jurisdictions that research and develop their options
for health care treatment for the youth under their
supervision or custody can provide smart health care
for their specific needs and culture.
➛ Providing smart health care can save the jurisdiction
money by shifting or sharing costs, and, ultimately, by
reducing recidivism.
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Participation in Medi-Cal and HBEX
➛ Across the state, Medi-Cal eligibility for youth brought
to detention averages about 65%.
➛ It is estimated that nearly all of the remaining youth
will be eligible for coverage in 2014 under the
federally subsidized Health Benefit Exchange (HBEX)
or Medi-Cal expansion.
➛ In 2014, there will be near universal health care
eligibility among documented youth brought to
detention.
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Changes to the Inmate Exception
➛ Health Reform creates a significant new opportunity
to serve youth whose families are eligible for federal
subsidies through the HBEX.
➛ These youth will be able to receive covered services
while detained in a correctional facility while awaiting
adjudication of charges.
➛ The Inmate Exception will still limit Federal Financial
Participation for youth receiving health care while
sentenced to time in detention or camp.
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Improved Access to Behavioral
Healthcare
➛ Health Reform requires parity between medical and
behavioral healthcare benefits.
➛ Justice system-involved youth have high rates of
substance use and mental illness compared to the
general population, which creates security risk, staff
pressures, and added environmental stress in the
detention setting.
➛ Improved access to behavioral healthcare in the
community and, when possible, in detention, could
have a significant positive impact on this population.
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Connecting to Treatment
➛ There are opportunities to connect youth who are
engaged by law enforcement to treatment at:
➛The front end, prior to admission to a detention
facility
➛During detention
➛Upon release
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Connecting to Treatment:
Enrollment and Coverage
➛ For all the options described on the next slides,
ensuring that youth are enrolled in a health plan and
that services are delivered according to the rules of
the plan will be the key determinants to increasing
access to care and collecting reimbursement for
services delivered through probation programs or in
the community.
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Connecting to Treatment:
Enrollment
Challenges to achieving enrollment in a detention
center setting:
➛ Who verifies eligibility and enrollment status? When?
➛ Who assists with enrollment? When? Where?
➛ Parental consent? Probation authority?
➛ Data requirements for enrollment
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“Front End” Connection to Treatment:
Law Enforcement
➛ Youth are most vulnerable at the time of their
encounter with law enforcement.
➛ This is especially true for the first or second arrest,
before they become “system involved.”
➛ We also know that once a youth is booked into a
detention facility, the likelihood of a return stay
multiplies.
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“Front End” Connection to Treatment:
Law Enforcement
➛ Crisis Intervention on the part of law enforcement
could keep some youth out of detention.
➛ The National Alliance on Mental Illness provides
resources and manuals for Crisis Intervention Teams
(CIT) for Youth.
➛ NAMI CIT for Youth Resource Center:
http://www.nami.org/Content/NavigationMenu/Find_
Support/Child_and_Teen_Support/CIT_for_Youth/CI
T_for_Youth.htm
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“Front End” Connection to Treatment:
Release with Court Date
➛ Many youth are picked up on a suspected violation
and then released with a “notice to appear” issued by
the officer at the scene, or at the detention center
because they do not meet the risk assessment
criteria.
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“Front End” Connection to Treatment:
Release with Court Date
➛ Probation has an opportunity to refer youth to (and
perhaps even make an appointment for) treatment or
programming at this “teachable moment” - especially
if there is the assurance that the court will look
favorably upon participation and compliance.
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“Front End” Connection to Treatment:
Pre-booking Assessments
➛ The brief health history and physical exam (”Safe to
Detain Assessment”) conducted prior to booking into
the detention center could be a billable service.
➛ A facility that can re-engineer its systems to conduct
assessments by an eligible provider prior to booking
may reduce its medical expenses for those exams.
➛ Mental health risk assessments may also qualify for
billing if conducted prior to booking by an eligible
provider.
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“Front End” Connection to Treatment:
ER Care Before Booking
➛ Sharp Decision – law enforcement and probation are
not responsible for emergency department care or
hospitalization for youth who are transported for
treatment prior to booking. (Sharp Healthcare vs County of
San Diego, Nov 15, 2007)
➛ Health insurance status is irrelevant to probation in
this context, as the financial responsibility rests with
the hospital.
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Post-Booking Connection to Treatment:
New Health Reform Provision
➛ Youth enrolled for coverage under the HBEX will be
able to receive covered services while detained in a
correctional facility awaiting adjudication of charges.
➛ Youth must be enrolled for coverage, and eligible
health service providers in the detention center must
provide covered services.
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Post-Booking Connection to Treatment:
In-patient Hospitalization
➛ Detention centers routinely transport youth in need of
inpatient care to off-site medical facilities that have the
necessary treatment capacity.
➛ Probation traditionally has been on the hook to pay
hospital charges for inpatient stays.
➛ In California, transaction prices for a day in the
hospital paid by commercial insurers increased by
more than 150 percent between 2000 and 2009 (an
average annual growth rate of 11 percent per year).
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Post-Booking Connection to Treatment:
In-patient Hospitalization
➛ “The 24-hour Rule” allows jurisdictions to shift the cost
of inpatient acute care to Medi-Cal (AB 396 Mitchell).
➛ Youth must be enrolled for coverage, and hospitals
often carry that burden.
➛ Funding would be FFP to the extent possible.
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Post-Release Connection to Treatment:
Connectivity
➛ Most youth who enter juvenile detention lack a stable
relationship with medical providers in their
communities.
➛ The time a youth spends in detention creates an
opportunity to connect him/her to community-based
health services.
➛ It the youth remain connected to community-based
health care providers upon release, their prospects for
continuing care will likely improve.
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Post-Release Connection to Treatment:
Connectivity
➛ Many jurisdictions provide case management and
aftercare to youth when they are released from a long
term commitment program or camp.
➛ In contrast, youth released directly from detention upon
adjudication frequently are not connected to the
services that could help them avoid re-arrest.
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Post-Release Connection to Treatment:
Connectivity
➛ Transition or reentry programs that connect youth and
their families to services may reduce recidivism.
➛Access to/assistance with Social Services for MediCal / HBEX enrollment
➛Appointments with community-based medical and
behavioral health systems
➛Placement in supportive, appropriate educational or
job training program
➛Meeting with assigned PO to clarify terms of release
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Post-Release Connection to Treatment:
Day and Evening Reporting Centers
➛ Healthcare services delivered at a Day or Evening
Reporting Center may be eligible for reimbursement
because the youth are not confined to an institution.
➛ Behavioral health services delivered by qualified
providers will be covered under new Health Reform
parity rules that allow for out-patient substance use and
mental health treatment.
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General Advice
➛ Partnering with local behavioral health care
providers, social services, and schools is essential to
creating connectivity to care for youth.
➛ Billing for services delivered in a detention center
requires that the youth be enrolled, health care
providers be eligible, and services be included in the
benefit package.
➛ Engaging the court and county governance in the
early stages of developing new approaches and/or
systems will help ensure success.
➛
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Specific Advice
➛ To the extent possible, facilities that can create
systems to determine eligibility and enrollment status
in a health plan, and to facilitate the enrollment of
youth and/or their families, may be able to offset
some of their medical costs.
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BSCC Proposed Regulation
➛ Proposed inclusion in the 2012-14 BSCC Title 15
regulations:
1324 Procedures: “establish procedures for the
collection of MediCal eligibility information and
enrollment of eligible youth (W&I Code 12029.5).”
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JOCHS Monterey
➛ Juvenile Offenders Community Health Project
(JOCHS)
➛ In Monterey County, we worked with Probation to
develop a transition program that appears to be
generating some positive results.
➛ Jose Ramirez, Probation Division Director for
Juvenile Hall, will tell us more about that project.
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Community Oriented Correctional
Health Services (COCHS)
➛ Website:
➛ Steve Rosenberg:
➛ Nancy Torrey:
www.cochs.org
srosenberg@cochs.org
ntorrey@cochs.org
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