Ohio: State Strategies to Enroll Justice-Involved Individuals in Health Coverage

ohio-clipart-flag_map_of_ohio-555pxPolicy and Process Changes

Memorandums of Understanding (MOUs) between state agencies

The Ohio Department of Rehabilitation and Correction (ODRC) and the Ohio Department of Medicaid (ODM) have a MOU to facilitate the enrollment of justice-involved individuals via phone. The MOU describes how ODM telephone hotline representatives are provided with access to ODRC’s system which tracks information related to incarcerated individuals. This allows ODM representatives to verify data about individuals they are speaking with on the phone during the enrollment process. The MOU also specifies that ODRC must maintain the quality of the data, which includes identifying information along with individuals’ release dates. Ohio’s MOU can be viewed here.

Application Process Changes

In those Ohio Department of Rehabilitation and Correction (ODRC) prisons that have begun enrollment efforts, the Medicaid application process is initiated via phone with paper follow-up.

First, optional classes led by peer educators
As part of the Ohio Department of Medicaid (ODM) and the Ohio Department of Rehabilitation and Correction (ODRC)’s Medicaid Pre-Release Enrollment (MPRE) program, incarcerated individuals are selected (or volunteer) to be trained to act as peer-to-peer educators (Peer-to-Peer Medicaid Guides) in a voluntary pre-enrollment classes for others. The classes educate participants on the importance of health coverage and walk applicants through the enrollment process. A pre-release enrollment worksheet guides incarcerated individuals through the items they may need to research or ask family members about and lists questions they may be asked as part of the application process. The classes also use a video, created by justice-involved individuals, to educate participants about coverage and the Medicaid enrollment process. Currently, Ohio Medicaid and corrections officials are working to add one prison per month to the statewide program (there are a total of 27 facilities in the state – you can view a programmatic overview of the program’s rollout here). As a prison is added, ODRC staff members are notified about the MPRE program via an email memo. The memo is also meant to act as a reference so staff members can more easily field questions about the Medicaid pre-release enrollment process at the facility. View an overview of the Peer-to-Peer Medicaid Guide portion of MPRE here (this resource also contains a copy of the pre-enrollment worksheet, as an attachment). For more information about MPRE, see this presentation produced in partnership by the Ohio Department of Medicaid (ODM) and the Ohio Department of Rehabilitation and Correction (ODRC).
are offered to individuals 90-120 days prior to their release. The classes provide information about Medicaid coverage and preview the questions that will be addressed during the enrollment application phone call. During the classes individuals also sign authorization and other pre-enrollment forms, which ODRC collects and maintains.  After completing the classes, individuals use designated phones in each correctional facility to connect directly to the Medicaid enrollment center at specified times. Enrollment center phone staff as well as the trained peer counselors can assist with the process. The phone call allows the individual to select a Medicaid managed care plan, but does not entail official Medicaid eligibility determination and enrollment.  After all necessary forms have been collected, the ODRC sends individuals’ information in batches to the state’s Medicaid portal, where the eligibility determination is conducted.

The Medicaid agency indicated that while initially the enrollment process has been done manually, they are currently transitioning to automating the process. Generally, individuals begin the enrollment process approximately 90 days prior to release, and in most cases those who choose to apply and are found to be eligible are able leave the correctional facility with a Medicaid card. 

Enrollment as Part of Pre-Release Planning

Medicaid Enrollment Education/Training for Incarcerated Individuals

As part of the Ohio Department of Medicaid (ODM) and the Ohio Department of Rehabilitation and Correction (ODRC)’s Medicaid Pre-Release Enrollment (MPRE) program, incarcerated individuals are selected (or volunteer) to be trained to act as peer-to-peer educators (Peer-to-Peer Medicaid Guides) in a voluntary pre-enrollment classes for others. The classes educate participants on the importance of health coverage and walk applicants through the enrollment process. A pre-release enrollment worksheet guides incarcerated individuals through the items they may need to research or ask family members about and lists questions they may be asked as part of the application process. The classes also use a video, created by justice-involved individuals, to educate participants about coverage and the Medicaid enrollment process. Currently, Ohio Medicaid and corrections officials are working to add one prison per month to the statewide program (there are a total of 27 facilities in the state – you can view a programmatic overview of the program’s rollout here). As a prison is added, ODRC staff members are notified about the MPRE program via an email memo. The memo is also meant to act as a reference so staff members can more easily field questions about the Medicaid pre-release enrollment process at the facility. View an overview of the Peer-to-Peer Medicaid Guide portion of MPRE here (this resource also contains a copy of the pre-enrollment worksheet, as an attachment). For more information about MPRE, see this presentation produced in partnership by the Ohio Department of Medicaid (ODM) and the Ohio Department of Rehabilitation and Correction (ODRC).

Application Assistance

Two to three days after attending a pre-enrollment class, incarcerated individuals review the forms necessary for the ODM to allow individuals to enroll in Medicaid, including an authorization form that allows ODM to conduct a background check. At this stage, already knowing what questions they will be asked, incarcerated individuals can use a specific phone to directly connect to ODM to select a managed care plan. As part of a hybrid telephonic-electronic process, the ODRC batches individuals’ information to ODM’s Medicaid portal for eligibility screening. The applications and forms are maintained within the individual’s master records. Ohio is working towards automating these processes by early April 2016. Additionally, all individuals who are being released receive a standard notice informing them about the Affordable Care Act, their potential eligibility for Medicaid, and resources for enrollment outside of the incarceration facility.

During this part of the process, incarcerated individuals are also asked to fill out a medical release summary. Ohio screens every survey participant to identify individuals with complex health needs or indicators for complex health needs, referred to as “critical risk indicators” or CRIs. Individuals with CRIs have the opportunity to participate in a videoconference with a representative from a managed care plan selected by the individual prior to release. Together, the managed care plan and individual create a transition plan for that individual, scheduling doctor’s appointments, and organizing transportation and communication.

If an incarcerated individual is approved for Medicaid and signs onto a managed care plan, ODRC extracts the Medicaid card information and managed care plan card information, and scans both so that incarcerated individuals have both within their possession upon release.

Beyond Eligibility and Enrollment Strategies

Health Literacy Materials

Upon release, all individuals–even those who did not participate in the pre-release enrollment program–are provided with a reference sheet with information about the importance of health coverage, how to enroll in Medicaid upon release, and how to use insurance coverage and access providers.

Access to Care

When incarcerated individuals begin the Medicaid application process and are determined eligible, they then select a managed care plan. Additionally, the Ohio Department of Rehabilitation and Correction staff members assess their health records to determine if they might have a medical and/or behavioral health condition that would qualify them for case management. These individuals with complex needs are given a transition plan prior to release, which includes having a video conference with a representative from their managed care plan, scheduling appointments with providers, and coordinating support services such as transportation.

Cross-Agency Coordination and Partnerships

Officials from both Ohio’s Department of Rehabilitation and Correction (ODRC) and the Ohio Department of Medicaid (ODM) indicated that communication between the two departments began in 2013 through efforts to ensure that the costs of inpatient hospitalizations of incarcerated individuals were billed to Medicaid. Then with the state’s expansion of Medicaid, the two agencies initiated conversations to determine how to implement enrollment processes for justice-involved individuals prior to their release, which led to a focus group of staff from the two departments, which met regularly for about a year. There are still weekly meetings between the two departments, and both the ODRC and ODM reported that these are critical for addressing issues efficiently. They also reported that these regular meetings have led to greater understanding of each department’s systems and processes. Additionally, in recognition of the fact that many justice-involved individuals reentering the community need to access behavioral health services, the workgroup includes representatives from the Department of Mental Health and Addiction Services.

Looking Forward: Future Issues to Address

State officials from the Department of Rehabilitation and Correction (ODRC) mentioned that they are working with the Medicaid department to develop procedures to be able to claim Medicaid administrative matching funds to offset some of the costs associated with implementing enrollment processes.

Additionally, while ODRC noted that the peer-to-peer enrollment assistance program
As part of the Ohio Department of Medicaid (ODM) and the Ohio Department of Rehabilitation and Correction (ODRC)’s Medicaid Pre-Release Enrollment (MPRE) program, incarcerated individuals are selected (or volunteer) to be trained to act as peer-to-peer educators (Peer-to-Peer Medicaid Guides) in a voluntary pre-enrollment classes for others. The classes educate participants on the importance of health coverage and walk applicants through the enrollment process. A pre-release enrollment worksheet guides incarcerated individuals through the items they may need to research or ask family members about and lists questions they may be asked as part of the application process. The classes also use a video, created by justice-involved individuals, to educate participants about coverage and the Medicaid enrollment process. Currently, Ohio Medicaid and corrections officials are working to add one prison per month to the statewide program (there are a total of 27 facilities in the state – you can view a programmatic overview of the program’s rollout here). As a prison is added, ODRC staff members are notified about the MPRE program via an email memo. The memo is also meant to act as a reference so staff members can more easily field questions about the Medicaid pre-release enrollment process at the facility. View an overview of the Peer-to-Peer Medicaid Guide portion of MPRE here (this resource also contains a copy of the pre-enrollment worksheet, as an attachment). For more information about MPRE, see this presentation produced in partnership by the Ohio Department of Medicaid (ODM) and the Ohio Department of Rehabilitation and Correction (ODRC).
has worked well, their vision for the enrollment process is to have individuals apply on their own at kiosks or mini-tablets within the correctional facilities. This would minimize staff involvement further, and the inputting of identifying information such as Social Security numbers could be automated which would also streamline the overall process.