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

WashingtonPolicy and Process Changes

State Legislation

Prior to passage of the ACA, processes to enroll justice-involved individuals with severe mental illnesses in Medicaid had been in place in Washington due to a directive based on state legislation. In subsequent years the state also enrolled Medicaid-eligible incarcerated individuals if they were admitted for inpatient health care services for at least 24 hours to cover the cost of their stay. The Department of Corrections (DOC) is also able to sign Medicaid applications on behalf of incarcerated individuals for qualifying inpatient events, which facilitates the processing of the applications as DOC often found it to be challenging to obtain an incarcerated individual’s signature. This experience with enrolling justice-involved individuals in health coverage, though limited, helped inform work to expand these efforts after more justice-involved individuals became eligible for coverage through the expansion of Medicaid.

Memorandums of Understanding (MOUs) between state agencies

The Health Care Authority (HCA) developed a MOU for use between HCA and correctional facilities that outlines processes for enrolling incarcerated individuals in Medicaid prior to their release. In addition to defining roles and responsibilities for each agency related to conducting enrollment, the MOU describes guidelines for the application process. The MOU allows for the application process to begin 30 days prior to an individual’s release from incarceration, which can help to facilitate an individual’s Medicaid card being available to the individual on their release date. In addition to prisons, the HCA also signed MOUs with some of the state’s larger jails. Due to limited resources, the jails are primarily enrolling individuals in Medicaid to cover the costs of qualifying inpatient events. (link to text box, “Federal Rules on Medicaid Coverage and Incarcerated Individuals).

Application Process Changes

Staff members in state correctional facilities regularly facilitate group meetings with individuals nearing their incarceration release dates to provide information about Medicaid coverage and assist with completing paper applications.

The DOC designated three staff members
Ninety days prior to release, the Washington State DOC sends a letter to incarcerated individuals informing them about coverage options under the ACA, and notifying them that part of their release process will involve applying for Medicaid benefits. The DOC has created a FAQ for distribution during the pre-release process and is also in the process of creating a video to inform individuals about Medicaid benefits to help ensure that there is a consistent message about the availability of health coverage. Single adults without dependents complete a paper application. The facility staff members are trained to send scanned applications to the DOC headquarters, where they are reviewed for any possible problems (e.g. an incorrect Social Security number, missing information, etc.) After this, DOC staff members at the headquarters manually enter the information into Medicaid’s enrollment system.
in the state’s central office to process applications from all of the state’s correctional facilities. The DOC chose to centralize the process of inputting application information into the Medicaid eligibility system both because of limits on the number of staff members able to access the system but also to minimize staff work at the correctional facilities. An agreement with the Health Care Authority permits Medicaid application information to be entered into the system 30 days prior to individuals’ release dates, which allows time for the Medicaid cards to be sent to correctional facilities prior to the date that the individuals leave. Preceding the receipt of a Medicaid card, individuals receive a letter informing them that they have been approved for coverage and that they will receive related mailings with plan information; this letter also acts to confirm that the address for the individual is correct and will work for these future mailings.

Enrollment as Part of Pre-Release Planning

Medicaid Enrollment Education/Training for Incarcerated Individuals

Ninety days prior to release, the Washington State DOC sends a letter to incarcerated individuals informing them about coverage options under the ACA, and notifying them that part of their release process will involve applying for Medicaid benefits. The DOC has created a FAQ for distribution during the pre-release process and is also in the process of creating a video to inform individuals about Medicaid benefits to help ensure that there is a consistent message about the availability of health coverage.

Single adults without dependents complete a paper application. The facility staff members are trained to send scanned applications to the DOC headquarters, where they are reviewed for any possible problems (e.g. an incorrect Social Security number, missing information, etc.) After this, DOC staff members at the headquarters manually enter the information into Medicaid’s enrollment system.

Beyond Eligibility and Enrollment Strategies

Health Literacy Materials

The Department of Corrections (DOC) gives information and literature to individuals who did not enroll prior to release regarding how to access Navigators in their community to enroll in or use coverage.

Looking Forward: Future Issues to Address

Currently, after staff members at the central office for the DOC enter an applicant’s information into the eligibility determination system and an individual is determined eligible for Medicaid, multiple mailings for each individual are generated. Many individuals do not have a planned place of residence after their release from incarceration, and consequently these mailings are sent to DOC facilities. However, currently only individuals’ names are included on the mailings, and not DOC identification numbers. This limited amount of identifying information in addition to the volume of mail received results in challenges for correctional facilities in terms of ensuring that the mailings are distributed to the appropriate individuals. The departments have identified this as a barrier to being able to provide individuals with Medicaid cards upon release and are aiming to address this in the near future.