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HomeMy WebLinkAboutMinutes 09-27-2012$To LUCIE COUNTY PUBLIC SAFETY COORDINATING COUNCIL September 27, 2012 3t30 p.m. $To LUCIE COUNTY ADMINI$TRAT10N ANNEX BOARD OF COUNTY COMMISSIONERS CONFERENCE ROOM 3 1. Call to Order — Chairman Tod Mowery Z. Roll Call 3. Approval of Minutes- August 30, 2012 Meeting 4. Sheriff's Office Update — Sheriff Mascara/Major Tighe 5. Update by Criminal justice Coordinator- Mark Godwin e. judicial Update- Chief judge Levin 7. Old Business - None s. New Businesse - None 9. Adjournment Members: Suzanne Caudell Janet Collins State Attorney Bruce Colton Commissioner Tod Mowery Public Defender Diamond Litty Justine Patterson Sheriff Ken Mascara Chief Judge Levin John Romano Major Pat Tighe Judge Philip Vacucci PUBLIC SAFETY COORDINATING COUNCIL Minutes of Meeting September 27, 2012 Conveneds 3:34 p.m. Adjourneds 4:07 p.m. CALL TO ORDER Commissioner Mowery called the meeting to order at 3:34 p.m. in Conference Room # 3, 2300 Virginia Avenue, Fort Pierce, Florida. ROLL CALL Roll call was taken. Members Presents Members Absents Others Presents Commissioner Tod Mowery Chief Judge Steve Levin,19th Circuit Judge Philip J. Vacucci,19th Circuit Justine Patterson, Florida Department of Corrections Scott Harloff for Suzanne Caudell, CORE Program Garry Wilson for Ken Mascara, Sheriff of 51-C Major Pat Tighe, SLSO Janet Collins, Bail Association John Romano, New Horizons Bruce Colton, State Attorney Diamond Litty, Public Defender Mark Godwin, SLC Criminal Justice Coordinator Jack Miller, Magellan Health Ethel Rowland, Taxpayer Broderick Underwood, CJIS Analyst Lisa Savage, SLC Pretrial Program Ellyn Latimer, Touch Pay APPROVAL OF MINUTESs The minutes from August 30, 2012 were unanimously approved. Public Safety Coordinating Council September 27, 2012 Page 2 UPDATE by SLC Sherriff*s Office- Major Tighe on behalf of Sheriff Mascara: Major Tighe reported the inmate population at 1206 which includes 60 federal inmates in custody. As reported in previous meetings the mental health population is at 22 percent. Major Tighe passed out information from National Association of Counties (NACO) on County jails and the Affordable Care Act: Enrolling Eligible Individuals in Health Coverage. Please see attached. There was a few questions and answers among the group, Major Tighe said it is a must read. UPDATE by Criminal justice Coordinator- Mark Godwim Mark informed the members that Pretrial and the Drug Lab are doing well. Lisa Savage, Pretrial Manager reported that cases are moving. Major Tighe inquired about the case load and how many Pretrial officers were there. Ms. Savage replied about one hundred and seventy five (175) currently and the case load had not dropped below one hundred fifty (150) for about a year. There are seven Pretrial Officers in the field and they are on call twenty four hours a day, seven days a week. Mr. Godwin reported the Drug Lab is doing well in the new location and can provide a variety of panels for various drug testing needs. The Monthly Average Daily Inmate Population report was reviewed and discussed. Mr. Godwin introduced Ellyn Latimer who spoke briefly about the benefits of a Touch Pay Kiosk that can be utilized perhaps in the courthouse as a convenient method of payment. Please see attached flyer. Mark announced that he and the Assistant County Attorney, Katherine Barbiari, have attended Sentencing Hearings and presented motions to have offenders pay the Cost of Incarceration back to the County. One of our Commissioners saw an article in the National Association of Counties Newsletter and learned that other counties were taking action and asked if we had the availability to do the same. Broderick Underwood, C11S Analyst set up a data base to track it. Because of the upcoming holidays in November and December, Mr. Godwin inquired about the Public Safety Coordinating Council meeting schedule. Commissioner Mowery, Chairman decided to break for those months and meet again in January 2013. Public Safety Coordinating Council September 27, "12 Page 3 JUDICIAL UPDATE Chief Judge Levin gave a brief recap of the judicial assignments that will take effect in January 2013. An attachment of the assignments was included in last month's minutes. He reported both Mental Health and Juvenile Drug Court was going well and is successful. He attributed the success to the Drug Lab and the County and recognized the hard work staff puts in. Judge Yacucci reported that his Domestic Violence Diversion Program is also very successful because of the phenomenal work our service providers. They run a twenty six weeks Batter Intervention Program. Judge Yacucci also mentioned they run over ninety percent consistently and the folks are great. OLD BUSINESSo None NEW BUSINESS: Major Tighe announced that the St. Lucie County court system has done a lot better than Miami Dade County. He was told a Judge and Jury finally convicted a murderer and sentenced him to twenty five years. The only problem was he spent sixteen (16) years in the Miami Dade county jail waiting to go to trial. Also Major Tighe mentioned at the last meeting he was given a sample package of Hemp Seeds (a cereal made out hemp), a citizen asked him if the K-9's would be able to pick up that sent. He was happy to report that the K-9 did hit on it. Announcements: Mr. John Romano, CEO of New Horizons of the Treasure Coast announced they are sponsoring a 5k run/walk at Digital Domain Park on October 6th at seven o'clock in the morning. Justine Patterson announced a reminder of a Town Hall Meeting with Secretary Tucker on October 2nd to be held at the Public Safety Training Complex on Kirby Road from 6 — 8 in the evening. Major Tighe and Chief Judge Levin will be speakers as well as the St. Lucie County 5heriff's Honor Guard. Public Safety Coordinating Council September 27, 2012 Page 4 ADJOURNMENTe Commissioner Mowery adjourned the meeting at 4:07 p.m. Submitted by, Carlene Busse THE NEXT MEETING WILL BE HELD October 25, 2012 at 3:30 p.m. in Conference Rm. #3, 2300 Virginia Ave. Fort Pierce, FL. St. Lucie County Criminal Justice System 2009�-----_ _- 2010 2011 ® ® 2012 1450 Average Daily Population 1350 1254 1250 12® e42= �"._. 07 n _\ 1220 1212 1GF9� 1171 1150 '" 1160 1�64 1167 ��� 1 1068 1086 1050 950 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Through 9/27/2012 1600 ® 2009 2010 2011 m ® ® 2012 1400 Bookings 1200 1051 1000 800 ® 18 ®®� 52® g6� ®®� 974 �9y,1.® --- •n.44 915 80-7 811 600 400 200 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec County Jails and the Affordable Care Act: Enrolling Eligible Individuals in Health Coverage Introduction In 2014 the Patient Protection and Affordable Care Act (ACA) will provide new health insurance coverage options for millions of Individuals through an expansion of Medicaid eligibility and the establishment of state -based health insurance exchanges. This brief will examine ways that counties may be involved in eligibility determination and enrollment processes for these newly eligible individuals, focusing particularly on Issues related to enrolling qualified Individuals held in countyjails as pre -adjudicated detain- ees and inmates preparing to reenter the community. Specifically the brief will assess some of the potential issues and challenges countyjail and human services staff may face in terms of enrollment procedures. The brief will also highlight examples of existing county based enrollment strategies that may be able to serve as models for developing processes to enroll individuals in countyjails who become newly eligible for health insurance coverage In 2014. ACA Coverage Expansion and Potential Erects on County Jails The ACA's significant expansion of health insurance coverage has many important implications for counties, as county governments provide the local health care safety net Infrastructure, public health functions and other health care services, as well as often govern, finance and operate local coverage and enrollment pro- grams. Counties also run and finance local jails, which are respon- sible for providing health care coverage forthe approximately 13 million Individuals who are booked into these facilities each year.' By 2014 the ACA requires that health insurance exchanges be es- tablished in each state, and states can either optto create and run their own exchange or allow the federal government to develop and operate the exchange in the state. Exchanges are Intended to be regulated insurance marketplaces where individuals without employer -sponsored health insurance will be able to obtain cover- age or small businesses can obtain coverage fortheir employees.2 Premium credits will be available for individuals and families with Incomes between 133-400%FPL based on a sliding income scale to help them purchase coverage through the exchanges. I Bureau oflustice Statistics, Prison and-lailmmates at Midyear Series: Jail Inmamsai Midyear2009—Statistical Tobles,btt jfbi usdoi eov/indeu cf 2t = bd ilgd�. 2 Initially the exchanges will primorilyserve individuals purchasing cover- age on their own and small employers; in 2017statet will have the option to allow businesses with more than 100 employees to purchaseinsuronce from an exchange. There is a specific ACA provision related to the exchanges that could significantly impact countyjails, which states that"...an indi- vidual shall not be treated as a qualified individual, if at the time of enrollment; the individual is incarcerated, other than incarceration pending disposition of charges."' This provision will likely allow eligible individuals in custody pending disposition of charges to enroll in a health insurance plan offered through an exchange pri- or to conviction, or maintain coverage if they are already enrolled. A substantial number of individuals that enter into county jail custody have serious medical and behavioral health needs° and would benefit greatly from treatment to address these conditions. Additionally, as counties are responsible for providing health care services for county jail inmates and the overwhelming majority of individuals in jails lack any type of health insurance coverages this provision could potentially reduce countyjail health costs, In 2014 the ACA also expands Medicaid eligibility to include all individuals under age 65—including adults without children — who have incomes up to 133% of the federal poverty level (FPU.° Many individuals involved In the criminal justice system will fall into this category of adults who will be newly eligible for Medicaid, because a large majority of jail Inmates are young, low-income males' who did not previously qualify for the program. However, unless future administrative actions change existing federal rules, while these individuals will be eligible to enroll in the program they will not be able to receive Medicaid benefits in 2014. Presently some countyjail inmates meet Medicaid's eligibility requirements and are eligible to enroll in the program, but they are not covered by Medicaid. This is because federal law does not allow for federal Medicaid funding —Federal Financial Participa- tion (FFP)—to pay for medical care provided to individuals who are "inmates of a public institution," which is commonly referred to as the"inmate exception." This results in counties covering the full cost ofjall inrnates'health care services rather than eligible detain- ees receiving coverage through Medicaid- 3 PPACA51312(f)(1)(8). 4 National Commission onCorrectional Health Care, The Health Status of Soon -To -Be -Released mmotes: AReport to Congress, Vohnae 2 (2004). 5 McDonnell Maureen, Laura Brookes, Arthur Wright and Daphne l ile. "Realizing the Potential of National Health Care Reform to Reduce Criminal Justice Fxpenditures and Recidivism Among Jail Populations." Community oriented Correctional Health Serviceslssue Paper. Janumy2011. 6 In 2014 states will be allowed the option to create a Basic Heolth Plan for uninsured individuals who hove incomes between 133-20096FPL, who would otherwise be eligible forpreaunum tax credits on the exchange. The Basic IJealth Plan will offer individuals Standard Health Plans and benefits for these Plans must be of least equivalent to the essential health benefits package determined by the Secretary ofthe U.S. Department of Health and Human Services and that premiums do not exceed those in the exchanges. 7 "The Implications of Expanded Medicaid Eligibility for the Criminallustice Population: Frequently Asked Questions."Community Oriented Correctional Health Services. May201I- County Jails and the Affordable Care Act Enrolling Eligible Individuals in Health Coverage an In the criminal justice system Whose eligibility for the program is not linked to Supplemental Security. income (SSI)."This benefit termination occurs primarily because of the Inmate exception, as I well as because some states'information management systems may not be designed to accommodate benefit suspension. Of particular issue for counties are pre -adjudicated Individuals, be- cause benefit termination often occurs priorto official conviction and even though many Individuals are injail forvery short periods of time. Upon their release from jail, Individuals whose benefits are terminated must reapply for Medicaid, and the process of regain- ing benefits may take many months. Particularly for individuals with chronic medical or behavioral health Issues, this unnecessary disruption:bf benefits can cause serious delays In their ability to access needed care and treatment Additionally, lack of access to medical and behavioral health care services can also potentially Increase recidivism rates for these individuals. However unlike the provision allowing eligible pre -adjudicated Inmates to obtain health insurance coverage through plans on the exchanges, the ACA does not provide further clarity regarding Medicaid and the pre -adjudicated population' This means that '.. while many individuals in jail pending disposition of charges will '.. meetthe new Medicaid income requirements in 2014 and will be able to enroll in Medicaid, any medical services they receive will not be covered through the program while they are Incarcerated (barring an existing exception mentioned In Box 1). irollment Processes and •ocedures for Newly Eligible dividuals ough the ACA's expansion of health coverage, many individr 10 Also, in September201 tthe U.S.Department ofHealthpndHumonSer- vices proposed a partnership model for the health insurance exchanges called for In the ACA. The partnership model is intended to provide states with additional exchange design options and will allow for states to per- form some of the exchange functions and have the federal government operate other functions. For more information, see wwwhealthcare_eov/ news/fat[sheets/2011/09/exChamge5O-9192011a html L., County Jails and the Affoolable Care Act: Enrolling Eligible Individuals in Health Coverage Particularly in states where county human services agencies cur- rently determine whether families are eligible for Medicaid, coun- ties will likely continue to help certain individuals with enrollment in some way because of the ACA's requirement of a "no wrong door"approach for individuals applying for coverage. However, how countyjails may be involved in the enrollment process re- mains a question, and their role has likely not yet been considered much in state -level exchange planning efforts. Issues Related to Enrolling County Jail Inmates Eligible for Health Coverage Conducting eligibility determination and enrollment is outside ofthe traditional scope ofthe core function ofjails. While some jails already help enroll eligible individuals into public assistance programs such as Medicaid as part of their pre-release planning services, it Is important to recognize that jails must focus on their primary purpose and direct the majority oftheir resources on Inmate population management and public safety concerns. However, many countyjails experience a substantial number of individuals that cycle in and out of detention due to untreated mental health and substance abuse problems. Although health coverage does not guarantee access to services, enrolling these individuals into appropriate health plans may increase the likeli- hood that they will be able to obtain more consistent physical and behavioral health care. Increased access to appropriate treatment also has the potential to reduce the re -arrest rates of these Individ- uals and consequently lessen the overall burden on countyjails. Considering these factors, counties may want to take the initiative in beginning to plan for the development of processes to enroll Individuals in jai I pending disposition of charges who fall into the eligibility category for exchange plan coverage. Addition- ally, regarding Medicaid, even though recently issued federal regulations state that current rules regarding FFP and inmates are not changed through the ACA, countyjails can continue to enroll those who are Medicaid -eligible into the program to help expedite access to treatment and maintain continuityof care upon their release from incarceration. I he following paragraphs outline some of the potential key issues related to enrolling eligible individuals Involved in the criminal justice system into the new health coverage options that will become available beginning in 2014. There are a number of other challenges not addressed here related to ensuring that he ACA's expansion of health coverage translates into meaningful access to medical and behavioral care for the unique needs of this popula- tion, such as having an adequate and qualified health provider workforce as well as potential complications associated with handling medical records and billing. 4 ' 1 • Ensuring county jails are considered as a point of contact with newly eligible individuals The ACA specifically requires states to provide targeted outreach to facilitate the enrollment of u nderserved and vulnerable popula- tions In Medicaid or the Childress Health Insurance Program." To fulfill the intention of this provision, exchange planning by state administrators should include consultation with a wide range of local level stakeholders, such as county officials, community pro- viders, as well as criminal justice authorities.'t For example In Massachusetts, which established a state -based health insurance exchange in 2006, evaluations of enrollment data show that a substantial portion of low-income young adults with behavioral health issues were not receiving substance abuse treat- ment and were much less likely to be enrolled in health programs than the general population." Since a large portion ofjail detainees have many of these same population characteristics, evidence from Massachusetts'experience appears to demonstrate the importance of including the criminaljustice system in enrollment efforts. Also some of the individuals who will be newly eligible in 2014 may not be aware that they qualify for health coverage. A number of these individuals will have interactions with the criminal justice system, and their time in custody could be an Important oppor- tunity to provide them with information about health coverage options. As states develop their overarching enrollment outreach strategies, they should recognize that it will be Importantto con- nect with staff at local jails and the wider Justice system, such as public defenders, probation officers and others. • Lack of staff capacity at jails to assist with/conduct screening and enrollment A number of jail inmates will require assistance in applying for health coverage, as they may have limited literacy skills and/or lack experi- ence using computers,14 orcorrectional authorities may determine that all enrollment activities should be conducted specifically byjail staff. However manyjails have staffing constraints and may have lim- ited personnel available to engage in the additional work associated with conducting the enrollment of eligible inmates. 11 PPACA 4220IBdH)B) 72 McDonnell, Moomen, Laura Brookes, Arthur Ludgio and Daphne Bailie. "Realizing the Potential ofNatlonal Heath Care Reform to Reduce Criminal Justice Expenditures and Recidivism Among Joil Populations." Community Oriented Correctional Health Services Issue Paper. January2011. 13 ExecutIve Reportofthe Working Grouponifeaith Reformond Criminal Justice: knpiimtions for the Delivery of Behavioral Health Services to the CrimiredJustice Population Cycling through Jails Community Oriented Cor- rectional Health Servlces. Septetnber20ll. 14 Ibid. and "The hopllcations m Health Reform for the 9Million People Who Cycle Through U.S. Jails Each Year. Frequently Asked Questions." Coal- munityOriented CorrectionalHealthServices. May2011. County Jails and the Affordable Care Act: Enrolling Eligible Individuals In Health Coverage The ACA does establish a Navigator program to provide funding to entities that have the capacity to provide outreach and applica- tion assistance. Entities with experience enrolling individuals into federal prugrarns—such as county human services agency staff — May opt to participate in the program and could potentially assist with enrolling eligible individuals injails. Yet it will be important to remember that some county human service agencies, nonprofit organizations and other entities serving as Navigators may lack experience working with jail populations and there may be chal- lenges associated with establishing better connections between these agencies and correctional authorities. • Barriers related to jail environment and jail population characteristics While jails may serve as an important place of interaction with a substantial portion of the newly eligible individuals, there will be enrollment challenges due to the nature and constraints of the jail setting. First, high turnover rates are common in jail populations —a substantial portion of jail detainees are released within 48 hours, although the average length of detention varies front two weeks to two months." Since a significant number of individuals are released in a matter of days, for a large portion of the Justice -involved population there may not be sufficient time during their stay in Custody to conduct eligibility determination and enrollment in Medicaid or an appropriate health plan on the exchange. Also, some county jails that currently conduct Medicaid enrollment just prior to an Inmate's release have encountered complications associated with inmates'scheduled release dates frequently changing, making itdlfficult to track individuals and connect them to coverage in a timely way. Another challenge is that some inmates will not have the ap propriate documentation needed for enrollment, as they may lack or not have on hand at the time of their arrest any form of government -issued identification.— Furthermore, for a variety of reasons some justice -involved individuals might be reluctant to enroll in health coverage." 15 -The Implications of Expanded Medicaid Eligibility for the Criminal Justice Popularion: FiequentlyAsked Questions."CommunityOriented Cor- rectional Health Servires_ May2011. 16 "7helmplications of Expanded Medicaid Eligibility for the Criminal Justice Population: Frequently Asked Questions."Community Oriented Cor- rectional Health Services, May 2011. 17 Some incarcerated individuals may be unwilling to enroll in federal assistance programs due loissues such as delioquentchild-supportpayments or theirinvolvementwith gangs. (Executive Report of the Working Group on Health Reform and Crimieatitislice, Implications for the Delivery of8ehav- iocal Health Services to the Crirainaliestice Population Cycling through Jails. Community Oriented Correctional Health Services. September 2017.). Also, some jails that hove tried to enroll Incarcerated individuals at tire time oftheir release fiomjail found that after their release individuals were reluctant to stay and complete any necessary enrollment paperwork. • Information technology challenges Assuming thatjail staff do become involved In enrolling eligible individuals into new health coverage options, one of the issues that will need to be considered is the Information technology ca- pacityofJails- For somejails there may need to be new hardware Installed to connect with the state exchange. There also may be some complications associated with county Information technology staff permitting electronic linkages to the exchanges and issues related to establishing appropriate protec- tions to ensure private health data are not compromised. Coun- ties that opt to enroll eligible Incarcerated individuals will need to work with state exchange planning commissions and state Medicaid agencies to develop streamlined electronic enrollment processes and procedures. • Challenges associated with eligibility changes Individuals in jail pending disposition of charges who are in the ex- change eligibility category should be able to enroll in an exchange plan or if already enrolled in one be able to maintain this coverage, although how exactly plan benefits and billing would operate for this population is unclear. However if an individual is adjudicated guilty the ACA requires that the enrollee must report this to the state exchange as s/he would no longer be eligible for coverage. In practice this would most likely require correctional facility staff or other eligibility determination workers associated with the jail to report this eligibility change to the exchange. Yet federal rules also allow a member of the enrollee's household to report the eligibility change and the state exchange itself is permitted to verify incarcera- tion status via certain data sources. Regardless, questions remain about how exactly this reporting process and coverage termination would occur within the jail set- ting. The rules further state that inmates are permitted to apply for exchange coverage to help coordinate potential coverage upon release from incarceration and that newly released qualified indi- viduals are eligible for a special enrollment period. The ACA also requires that individuals self report when their income changes to account for potential changes in the amount of premi- um subsidy support available to help them purchase exchange plan coverage.l'his reporting is necessary because they may experience an income increase or drop that affects whether they are eligible for either Medicaid or exchange plan coverage. For individuals injails, similar to reporting changes in eligibility status, it is unclear how this income change reporting might occur. Additionally with income shifts there are other complications associated with maintaining coverage of health services for incarcerated individuals. For example, if an Individual is held in custody pre -adjudicated for a substantial period of time and enrolled In an exchange plan, without any income this person would likely eventually fall Into Counry)ails and the Affordable Care Act Enrolling Eligible Individuals in Health Caverage 6 County Jails and the Affordable Care Act Enrolling Eligible IndlVlduels to Health Coverage County jails and the Affordable Care Am Enrolling Eligible Individuals In Health Coverage the Allegheny County Jail, the county Department of Human Services (DHS), the Court of Common Pleas (criminal division), and the county Health Department. The Jail Collaborative has initiated comprehensive planning that includes reentry programming which begins when individuals enter countyjaiLThe wide range of service coordination provided to incarcerated individuals includes helping them apply for medical assistance and connecting them to substance abuse treatment and/or mental health services. So- cial workers at the jail assist in Completing Medicaid enrollment applications and supporting documentation prior to a planned release and send the information to the local County Assistance Office. Allegheny County DHS Justice Related Services and community - based service coordinators may then also assist or accompany individuals to the In -community office appointment with the local the County Assistance Office to complete the application process for Medicaid and to coordinate appropriate treatment and support services post -release. In addition, the Allegheny County Jail has developed a Discharge Center where staff help individuals with their release by assisting with such items such as medications, transportation, and appropriate clothing for their release.These types of practices In Allegheny County and other counties which have robust reentry support services can serve as models for how enrollment could occur in jails in 2014. Additional information regarding the Allegheny County programs is available at www.alleghenycoui)ty.us/dhs/jail.aspx. e Post -Release Enrollment: Alameda County, CA California's Bridge to Reform program is a Medicaid Demonstra- tion Waiver that is designed to help the state plan for implernenta- tion of the ACA's health care coverage expansion provisions. One of the primary initiatives of the program is the Low -Income Health Program (LIHP) coverage expansion effort that uses federal Med- icaid matching funds available through the waiver to help expand health care coverage for low-income individuals In the state prior to ACA Medicaid eligibility changes in 2014. Alameda County is one of the many counties in the state that have LIHPs, and their program, Health PAC, is an expansion of the existing County Medical Service Program and aims to cover all County residents with income under 200%FPL-The program has a component that focuses on enrolling individualsjust after their release from jail during their probationary period, specifically focusing on the ABI09 population."' While the effort is a pilot program, county leaders view the initiative as a positive step toward connecting justice -Involved individuals to appropriate health care services that could potentially be expanded in the future. 19 A6109Isa billpassed in 2011 by the California State Legislature to address the U.S. Supreme Court order that mandated that California reduce its prison populotian by May 2013 to address overcrowding tssues. The law moves inmates considered to be low -risk from state prisons to countyiails, and this is sometimes referred to as prison realignment." e Preparing for 2014: Salt Lake County, UT In Salt Lake County, UT, the Division of Behavioral Health Services within the county's Department of Human Services has helped lead efforts to plan for how the justice -involved population within the county will be affected by the ACA's expansion of Medicaid and creation of health insurance exchanges. By actively commu- nicating with their state Medicaid office, they were able to gather Information demonstrating that most inmates in the county's jail system will fall Into the new Medicaid expansion population category. To develop strategies for enrolling these newly eligible individuals, they have created a health care services integration coordinator position to help anticipate and plan for some of the issues that thejail will need to consider in 2014. Additionally, the county is currently actively enrolling eligible inmates in Medicaid so that they will be able to receive benefits upon their release. This process has been facilitated by the county directly employing state Medicaid eligibility determination workers by paying the Medicaid administrative match rate, as well as by working with other community partners. Conclusion There are a number of challenges to be addressed in terns of de- veloping enrollment processes for incarcerated individuals who will become newly eligible for health coverage through the ACA and there are still unanswered questions related to the law's Implemen- tation. Consequently many counties will not be ready to enroll all eligible individuals in jails by 2014 or may choose to wait to develop enrollment strategies for this population group until after the ACA's coverage expansion provisions have taken effect. However, there are a number of reasons that some counties may choose to consider beginning enrollment planning efforts for justice -involved individuals. The ACA's expansion of health cover- age can better connect individuals involved in the criminaljustice system to appropriate medical and behavioral health care services, which in turn has the potential to reduce recidivism rates as well as countyjail health care costs. Considering the many possible public health and criminal justice system benefits, counties may want to begin taking incremental planning steps now and continue to move forward on developing enrollment processes and proce- dures for eligible individuals in countyjails even after 2014. Additional Resources For further information on this topic and related issues, please see: • NACo's health reform implementation page: www.naco.org/ h ea Ith reform i m element • NACo's criminal justice programs: www.naco.org/programs/ csd/Pages/Ju sti ce.aspx • Community Oriented Correctional Health Services (COCHS): www.cochs.org .Our first -to -market proprietary solutions increase transaction revenues,eliminate the expense of manual -payment processing and cash -management activities, and provide real-time posting and reporting. 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