Policy and Process Changes
During the state’s 2015 legislative session SB 42 was introduced, which includes language indicating that incarceration is not a basis for denying or terminating an individual’s eligibility for Medicaid. The bill also permits individuals to apply for Medicaid while incarcerated and directs correctional facilities to inform the state Human Services Department (HSD) regarding the incarceration status of eligible individuals. The governor signed the bill into law in April of 2015. HSD plans to implement this new law in October 2015, starting with the New Mexico Corrections Department; the New Mexico Children, Youth and Families Department; and Bernalillo County Detention Center.
State Plan Amendments
In 2013, New Mexico’s Human Services Department (HSD) recognized that with the state’s expansion of Medicaid there would be a significant number of justice-involved individuals eligible for coverage through the program. Considering this, HSD submitted an amendment to their Medicaid state plan to allow for the implementation of Medicaid presumptive eligibility (PE) in their correctional facilities. PE allows for the temporary enrollment of an individual in Medicaid, if based on available income information the individual appears likely to be eligible for the program. This initial assessment of PE helps to streamline the initial eligibility assessment process, which is then followed by a full eligibility determination.
Application Process Changes
Officials from the Human Services Department (HSD) indicated that overall the presumptive eligibility (PE) process has been working well.
Enrollment as Part of Pre-Release Planning
As part of Presumptive Eligibility (PE) in New Mexico, the Medicaid Division of the New Mexico Human Services Department (HSD) has worked with the DOC to train staff to assess eligibility within the corrections facilities as part of pre-release planning.
Mailings and calls
When an individual is determined presumptively eligible for Medicaid in New Mexico, the Human Services Department’s (HSD) eligibility system also submits a full application. Although HSD is able to verify most of the required information for the full application electronically, the agency engages in post-release outreach mailings to individuals who need to submit documents that can’t be provided electronically. They send a “help us make a decision” form that the individual must return if their application is still pending. The form requires that the state have their address, which can be challenging given the transiency of this population. Individuals must follow-up to provide the additional information in order to complete the application.
Looking Forward: Future Issues to Address
State officials from the Medicaid agency indicated that they have begun planning efforts to implement care coordination for individuals leaving incarceration. They reported that they are having initial discussions with managed care organizations (MCOs) about ways to better connect these individuals to care providers in the community. Each individual that is enrolled undergoes a health risk assessment, but state officials noted that care coordination linkages could be strengthened. One of the ideas being considered is to have MCO representatives initiate the first contact in the correctional facility prior to the individual’s release date to develop a care coordination plan.