The ACA is coming: Riverside and San Bernardino start talking about “Obamacare”

150 150 Christopher Nelson

An alarm bell will sound on January 1, 2014. That is the day that the Affordable Care Act (otherwise known as the ACA or “Obamacare”) will go into effect. Many do not realize that the new law has a massive criminal justice component to it and that California will be throwing away countless amounts of money and opportunity if counties aren’t prepared.

Representatives from corrections and health care in Riverside and San Bernardino counties gathered in Riverside yesterday to start the conversation about what the benefits will be and how to take advantage of them.

“We can’t just be a culture of control where we incapacitate people for the rest of their lives,” said Jay Orr, CEO of Riverside County and keynote speaker at the California Forward Partnership for Community Excellence-sponsored convening.

“It just doesn’t work. We’ve tried. If you release people out of jail and into the community without care, they’re going to contribute to the growing health care crisis we have in the Inland Empire,” Orr said.

Perhaps the most surprising statistic of the day was that the Sheriff’s Departments typically pay more to Medi-Cal, the state-backed medical safety net program, than hospitals do. 

“Currently, 90 percent of justice-involved individuals have no health care whatsoever and jails become the de facto health care providers in many counties,” said Steve Rosenberg, President of Community Oriented Correctional Health Services (COCHS), with “justice-involved” being a fancy term for anyone who is sentenced, on probation, serving time or under post-release supervision of any kind. 

It really puts the amount of money being spent locally on inmate health care into perspective, as well as how the ACA stands to have a huge impact here.

For starters, the expansion of eligibility is massive. Originally, Medi-Cal was available only to those with children and below a certain income threshold. As Rosenberg pointed out, a vast majority of those “justice-involved” individuals are generally childless adults with no medical coverage whatsoever.

When enrollment for the newly expanded state Medi-Cal program (under ACA guidelines) begins on October 1 of this year, pretty much anyone in the justice system, whether on parole or just convicted, can be enrolled as long as they are an adult aged 18-64 and making less than 138 percent of the Federal Poverty Line.

Furthermore, inpatient stays for an inmate at a hospital or another off-site medical facility will be covered, as well as treatment or care that is received while in the community after release. And while addiction treatment through Medi-Cal was previously reserved for pregnant women and IV drug users, it now expands to include all manner of residential recovery, detoxification and day treatment for many of those behind bars with substance abuse issues.

“Treatment saves dollars,” Rosenberg said, citing an example from Washington state where simply exposing more people to substance abuse treatment, regardless of successful completion of the program, lowered arrest rates across the board. “Without care, these people will continue to be frequent flyers,” he said.

But here is the real kicker: a full 100 percent of all costs billed to Medi-Cal for these newly eligible from 2014-2017 will be reimbursed by the Federal government. Between 2017 and 2020, this will gradually drop to 90 percent.

This represents a massive savings to counties, one that can’t possibly be quantified until it actually goes into effect, although the California Institute for Mental Health’s (CiMH) preliminary estimates project as much as $16 million in new revenue for a county like Alameda and up to $162 million for one the size of Los Angeles through 2019.  Capturing the full breadth of those savings is where things get tricky.

The catch: those who were previously enrolled in Medi-Cal and who were receiving treatment at the old 50/50 reimbursement split will continue under the old split, even for the expanded services. New enrollment is the key here.

And that new enrollment begins on October 1, or in 61 short days. May aspects of the talks of who would handle this influx of new enrollments, at least for San Bernardino and Riverside counties, essentially began yesterday. The good news is that Gov. Brown restructured Medi-Cal and removed many of the barriers to enrollment, providing a wide array of online and in person avenues to get someone in the system. Enrollment administrative activities are also eligible for up to 50-75 percent reimbursement (a holdover from the old model).

Representatives from various county health care agencies, probation, Sheriff’s departments, parole and non-profits like COCHS huddled together in two county-specific breakout sessions designed to brainstorm, introduce stakeholders to each other and start to figure out who can help who do what.

The emphasis was not just coming away with a vision, but something resembling an executable plan with clear first steps. Everyone in attendance was in awe of what the ACA has to offer the county in savings and expanded treatment for those who need it most.

But they were equally in awe of the task at hand. The Partnership’s goal with these convenings is not just to serve up the pie in the sky, but to figure out how to slice it and determine who is getting which piece. Only time will tell, but one thing is clear: every single newly eligible person who is enrolled by January 1, 2014 is yet another huge step toward success in realignment and overhauling California’s criminal justice system for the 21st Century.


Christopher Nelson

All stories by: Christopher Nelson