Eligibility and Billing for Criminal Justice Involved Populations
The Department and the federal Centers for Medicare and Medicaid Services (CMS) have created several documents that explain the Health First Colorado (Colorado's Medicaid program) eligibility and enrollment of criminal justice involved populations. The documents below include specific guidance to counties and providers regarding when Health First Colorado can pay for medical services for incarcerated populations and how and when they can be enrolled in Health First Colorado.
- June 1, 2016 - Medicaid Eligibility of Individuals Residing in Community Corrections Facilities (or "Halfway Houses")
This Policy Statement provides that Health First Colorado-covered services are now available to residents of Community Corrections facilities ("Halfway Houses") who would otherwise be Health First Colorado eligible. This policy supersedes any previous guidance on this topic.
- December 12, 1997 - CMS Letter Concerning the Clarification of Medicaid Coverage Policy for Inmates of a Public Institution
The purpose of this memorandum is to clarify the current Health First Colorado coverage policy for inmates of a public institution.
- Medicaid Policy for Incarcerated or Inmates in a Correctional Facility (Agency Letter 14-006)
Since January 1, 2014, the Affordable Care Act has created new opportunities for health coverage for individuals involved in the criminal justice system, including county jail inmates. Inmates who become hospitalized or are released from jail or prison may be eligible to receive coverage through Health First Colorado.
- HCPF CBMS Data Entry Guidance for Incarcerated Individuals - March 2014
This technical guidance for county eligibility workers explains how applications should be processed for incarcerated individuals.
- Medicaid Policy for Billing Inmates Hospitalized at Least 24 Hours (Agency Letter 14-011)
This agency letter explains how inmates in correctional facilities are not eligible for Health First Colorado unless they are admitted to a hospital outside the correctional facility for at least 24 hours.
- FAQs for Sheriffs and County Jails
This document answers frequently asked questions from county jails and sheriffs regarding Health First Colorado eligibility and enrollment for inmates and individuals releasing from jail.
- Best Practices for Counties: Medicaid and Criminal Justice Populations
The recommendations and best practices below may help counties to build partnerships, create budget savings, and connect criminal justice involved individuals with needed coverage and care.
County Intersections with Health First Colorado
In addition to increased collaboration with the Department of Corrections, the Department is also working to strengthen Health First Colorado enrollment for the criminal justice involved population. Jails are overseen by the counties (incarceration does not exceed more than 365 days) and the prisons are overseen by the Department of Corrections (incarceration, at a minimum, exceeds 366 days). The Department currently engages the county jails in two manners: 1) An ongoing state-workgroup designed to provide the counties with a platform to discuss issues relating to Health First Colorado and the jail population, and 2) A toolkit for the counties to demonstrate the advantages of Health First Colorado enrollment for individuals prior to booking and those individuals leaving jail.
This Health First Colorado enrollment toolkit is designed to explain:
- The advantages of Health First Colorado enrollment for individuals leaving jail
- Health First Colorado coverage for inpatient hospital services that exceed 24 hours
- The advantages of Health First Colorado coverage prior to booking
The Health Information Office at the Department hosts a state workgroup titled: Medicaid and the Jail Involved Population
- This workgroup's function is to serve as a consistent venue to field and address county concerns regarding the intersection of Health First Colorado and the criminal justice involved population
- This workgroup also explores ongoing successes among counties, offers assistance to the counties in their efforts to improve care-coordination for this population, and brainstorms ideas on how Health First Colorado access can be improved for the population.
Community Corrections: Policy and Correspondence
The Centers for Medicare and Medicaid Services consider diversion clients, transition clients, and other populations residing in community corrections facilities to be inmates of public institutions and therefore ineligible for Medicaid (see Section 1905(a) of the Social Security Act).The State of Colorado believes these individuals should be eligible for Health First Colorado. While the State continues to urge the federal government to reconsider its decision, residents of Community Corrections remain ineligible. In contrast, individuals associated with Community Corrections facilities who do not reside in the facility may be eligible for Health First Colorado. The correspondence below details discussions between the Department, Colorado's Congressional delegation, and federal agencies.
Correspondence between Attorney General Suthers and CMS
- September 2012 Letter from Attorney General Suthers to CMS
Attorney General Suthers explains why participants in the State's community corrections programs should not be considered inmates of a public institution, and should be eligible for federal Health First Colorado funding.
- January 2013 Response from CMS to Attorney General Suthers
CMS does not agree that federal Medicaid funding is available to pay for services to individuals who are required as a result of a criminal conviction to reside in community corrections facilities.
Correspondence between the Department and CMS
- May 2012 Department Letter to CMS Regarding Eligibility of Individuals Residing in Colorado Community Corrections Facilities for Health Care Services Funded with Federal Financing Participation
- The Department informs CMS of plans to implement a formal policy allowing individuals residing in community correction program residences to be determined to be Health First Colorado eligible when they are categorically and financially eligible.
- May 2012 CMS Response to Suspension of Medicaid Eligibility for Incarcerated Persons
CMS argues that since the offender is deemed to have escaped from custody when they abscond from a community corrections facility, community corrections programs are in fact acting on behalf of law enforcement as de facto prisons and that residents are inmates. They conclude that residents of Community corrections facilities are ineligible for Health First Colorado.
Correspondence between Representative Diana DeGette and U.S. Department of Health and Human Services
- January 2010 Letter from Representative DeGette to Secretary Sebelius
Representative DeGette requests formal guidance from Secretary Sebelius on whether individuals residing in a community corrections facility are eligible for Health First Colorado.
- March 2010 Letter from Secretary Sebelius to Representative DeGette
Secretary Sebelius clarified guidance issued in 1997 and 1998 concluding that community corrections residents were inmates of a public institution for the purpose of Health First Colorado eligibility in part because public institutions include residential placements other than traditional prisons, including placements obtained through private contractors.
- June 2010 Letter from Representative DeGette to Secretary Sebelius
Representative DeGette disagrees with CMS's interpretation that residents of community corrections facilities are ineligible for Health First Colorado. DeGette argues that residents are not inmates inmates and that, even if CMS considers residents of community corrections to be, they are eligible for federal Medicaid funding because they reside in private institutions.
Stakeholder letter to U.S. Department of Health and Human Services
- January 14, 2010 Colorado Lawyers Committee Letter to Secretary Sebelius
The Colorado Lawyers Committee argues that federal Medicaid funding should be available for residents of Colorado's private community corrections facilities. The Committee asks Secretary Sebelius to give guidance to the CMS regional office regarding the eligibility of community corrections resident
Proposed Department Policy on Community Corrections
In 2009, the Department proposed a policy concerning funding of health care services for those in Community Corrections. The Department requested that stakeholders provide comments on the proposed policy.
Suspension of Health First Colorado Eligibility for Incarcerated Populations
In 2008, the Colorado state legislature passed SB 08-006, requiring the Department to suspend eligibility for any Health First Colorado member who becomes incarcerated. The Department is actively working to fully implement this law.
- Senate Bill 08-006
- July 31, 2008 Department Letter to CMS with Questions Concerning the Implementation of SB 08-006
In 2008, the Department asked CMS for guidance in implementing SB 08-006.
- December 2, 2008 CMS Letter Responding to the Department's Questions Regarding the Implementation of SB 08-006
CMS responded to the Department's July letter with detailed guidance regarding the implementation of SB06-008.
- May 29, 2009 Department Letter to CMS with Proposed Policy on the Suspension of Benefits for Inmates
In 2009, the Department provided CMS with a proposed policy for the suspension of benefits for inmates. The Department requested CMS review and comment on the draft policy.
- CBMS Limited Medicaid Benefits for Incarcerated Individuals
The Department's policy on medical assistance for individuals incarcerated in a public institution.
Other States and Stakeholders
- August 18, 2004 National Association of State Medicaid Directors and American Public Human Services Association Letter Responding to the May 25, 2004 CMS Letter
In 2004, The National Association of State Medicaid Directors and the American Public Human Services Association argued that it is important for CMS to clearly state that Medicaid suspension of benefits is a state option, not a mandate that states are not required to provide Medicaid benefits at 100% state cost to inmates and that FFP is available for administrative costs related to eligibility determinations and suspension of benefits for this population.
Inmates Receiving Care at Correctional Care Medical Facility of Denver Health Medical Center
- December 23, 2009 Department Letter to CMS Regarding Individuals Receiving Services in a Correctional Care Medical Facility are Eligible for Health Care Services Funded with Federal Financial Participation
The Department explains why individuals receiving services in the Correctional Care Medical Facility (CCMF) of Denver Health Medical Center (Denver Health), which is a unit designed exclusively to treat inpatient referrals from the Denver county detention facility, can be deemed eligible for health care services funded with Federal Financial Participation (FFP).
- August 16, 2010 CMS Response Regarding Individuals Receiving Services in a Correctional Care Medical Facility are Eligible for Health Care Services Funded with Federal Financial Participation
In this letter, CMS clarifies that inmates receiving care in the Correctional Care Medical Facility of Denver Health Medical Center are eligible for federal Medicaid funding.
Disproportionate Share Hospital (DSH) payments
- August 16, 2002 CMS Letter Concerning DSH Payments for Inmates
In 2002, CMS clarified that states cannot make disproportionate share hospital payments to hospitals in order to cover the cost of care for inmates of a public institution who become hospitalized.