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

coloradoPolicy and Process Changes

State Legislation

In 2008, the Colorado state legislature passed and the governor signed SB08-006, which allows for the suspension of Medicaid benefits upon incarceration (see Title 25.5-4-205.5). Specifically, if an individual enrolled in Medicaid becomes incarcerated, the state law allows for an individual’s Medicaid enrollment to be suspended rather than terminated.

Despite federal rules prohibiting the use of federal Medicaid funds to cover the costs of medical care provided to incarcerated individuals, the Department of Health and Human Services has indicated that Medicaid-eligible individuals who become incarcerated retain their eligibility for the program. However in most states, when an individual enrolled in Medicaid is incarcerated, coverage is terminated rather than suspended and these individuals are removed from the Medicaid rolls. Federal policy does not require that states terminate these individuals’ Medicaid coverage. Advocates of suspension policies have noted that one key benefit is that when individuals with suspended Medicaid coverage are released from incarceration, their Medicaid benefits can be more easily reinstated. Consequently these individuals have the potential to more readily access needed medical and behavioral health services once they reenter the community. Now that more justice-involved individuals are Medicaid-eligible due to the ACA, states may want to consider enacting policies and procedures to implement suspension. Currently, only a relatively small number of states have implemented policies to suspend rather than terminate individuals’ Medicaid coverage upon incarceration. Additionally, some states that have established suspension policies have not implemented suspension features into their eligibility systems. Most commonly this is because the technical challenges and the considerable financial investments required are too significant to warrant the large system changes needed to implement suspension. Furthermore, with the implementation of the ACA’s real-time eligibility determination and enrollment requirements, some state officials that NASHP interviewed indicated that there could be less of a need for individuals with Medicaid coverage to be placed in a suspension status upon incarceration. However other state officials noted the potential value of implementing suspension, particularly for individuals who lose Medicaid coverage during a short-term jail stay, because initiating and completing a new application for these individuals can be logistically challenging.

However, based on conversations with state officials from the Department of Health Care Policy and Financing (HCPF) – Colorado’s Medicaid agency – and this HCPF memo from March 2014, the department has not yet implemented a function within its systems to suspend Medicaid upon incarceration. Therefore correctional facilities are still required to terminate coverage for those individuals who are enrolled in Medicaid and become incarcerated. HCPF’s systems will have suspend functionality in 2016.

Application Process Changes

The Department of Health Care Policy and Financing (HCPF) and the DOC worked together to develop procedures to efficiently process Medicaid applications for incarcerated individuals. DOC officials indicated that when Colorado implemented the ACA’s Medicaid expansion, initial enrollment efforts focused on enrolling individuals in Medicaid for qualifying inpatient health care services. To broaden the scope of these efforts to include individuals leaving incarceration, the DOC hired two full-time nurse case managers to specifically focus on processing applications as part of pre-release planning. Case managers at the correctional facilities send a permission form signed by the incarcerated individual to the nurse case managers at the DOC’s central office. The nurse case managers complete applications electronically based on information in the DOC’s database. Most of the individuals transitioning to the community who are found to be Medicaid-eligible are able to leave the correctional facility with a Medicaid card. If the card is not available prior to an individual’s release, the nurse case managers contact the correctional facility case managers to provide them with the individual’s Medicaid eligibility number and the contact number of a nurse case manager who can provide further assistance.

To ensure accurate and timely eligibility determinations, HCPF has given the DOC limited access to PEAKPro, an online tool to help authorized state agents assist Coloradans. DOC may apply for Medical Assistance on the individual’s behalf if the individual agrees. Most eligibility determinations are made in real time, although in some cases a manual determination must be made. In spring of 2015, HCPF transferred the responsibility for processing manual DOC applications to an eligibility and enrollment contractor that regularly handles a large volume of applications.

HCPF has also provided the DOC with other types of assistance. For example, they developed software specifically for the DOC to enter in and track the status of applications, which has helped streamline the overall application process. Additionally, they have provided the DOC’s nurse case managers who process applications with direct support to address issues. Previously the enrollment applications were handled through a hybrid paper-electronic process, but as of spring 2015 the application process is conducted entirely online. The DOC has reported that the short-turn around time of the application processing is very efficient and that this has helped with their overall ability to handle a large volume of applications.

Enrollment as part of pre-release planning

Application Assistance

In the state’s prisons, enrollment is folded into already-existing processes the DOC uses to help released individuals gain or regain benefits as part of their transition back into the community. Two nurse case managers based at the DOC central office complete applications electronically for incarcerated individuals in all 24 facilities, including private facilities. Once an individual is enrolled, DOC ensures that they have their Medicaid card within their possession upon release. If a Medicaid card is not received prior to release, the DOC ensures that the individual knows their Medicaid number and has access to a phone number to reach the case manager/nurse if they have any questions. Additionally, individuals who may have opted out of enrollment assistance pre-release can later choose for parole staff to connect them to the case manager/nurse.

Post-release Outreach

Parole office

Parole staff and community reentry specialists offer application assistance to anyone who did not have the opportunity to be enrolled while they were still incarcerated or if they previously declined to be enrolled but since changed their mind.

Cross-Agency Coordination and Partnerships

Officials from the DOC recognized the importance of developing a strong relationship with the Department of Health Care Policy and Financing (HCPF) to improve continuity and coordination of care for individuals leaving incarceration. Therefore, initial internal and interagency conversations began as early as 2011. Both DOC and HCPF reported that a strong partnership and good communication between the two agencies has existed for many years, which has helped greatly in the process of implementing enrollment procedures for the justice-involved population. The agencies credit this very good working relationship both to the long-standing partnership and the fact that there is support for these efforts from the leadership of both departments.