New York wants to use federal Medicaid funds to cover the care of prison inmates. Experts say it's likely the CMS will approve the waiver.
States currently either terminate or suspend Medicaid coverage upon incarceration as law prohibits people in prison from receiving Medicaid federal funds. There is a provision that covers inpatient treatment provided by a medical facility not associated with the prison.
This scenario occurs in instances where a person goes to a hospital while in prison and remains there for over 24 hours.
Under a waiver request, New York state's Health Department wants federal Medicaid matching funds to provide care management and other supportive services to incarcerated individuals in the 30 days prior to their release. Eligible individuals would receive care management, clinical consultation services, and coverage of certain medications, including those treating behavioral health and substance use disorders.
These changes aim to enable continuity of care and an easier transition to community-based services and health home enrollment upon release. The CMS is taking comments on the waiver request through Nov. 20.
The state first hinted that it planned to ask for the permission this past spring. The fact that the state formally submitted a waiver may indicate the CMS is receptive to the idea, according to Sebastian Solomon, director of New York state policy at the Legal Action Center, an advocacy organization that coordinates the state's work group on health homes and criminal justice.
Solomon is optimistic about the waiver's success. “The fact that it is a limited proposal is something that works in its favor,” Solomon said.
Other advocacy organizations support the waiver and want to see even longer-term coverage.
“Thirty days may be too short a time to do adequate discharge planning and to set up linkages, as there are waiting lists for services in many counties,” Susan Ruff, advocacy director of the Southern Tier Independence Center, said in comment letter. Her organization advocates for low income and disabled individuals in the southern part of the state.
But the likelihood of the CMS approving the waiver is not clear. The CMS has yet to move forward on other states' similar proposals, according to Cindy Mann, the CMS' former Medicaid director who is now a partner at the law firm of Manatt, Phelps & Phillips.
The CMS, however, has granted waivers allowing states to bypass the "institutions of mental disease exclusion," which forbids federal funds from being used at inpatient psychiatric facilities. States have asked for that waiver to address substance use disorders, according to Deborah Bachrach, another partner at Manatt and a former New York Medicaid director.
In April, the CMS finalized a policy allowing Medicaid managed-care plans to pay the facilities for short-term stays lasting 15 or fewer days in a month.