1115 Waiver Carceral Expansion Factsheet (1).pdf

1 of 3 OHA 0197 (rev.05/23)

Level 3 - Restricted

MEDICAID DIVISION

1115 Waiver Strategic Operations Team

Oregon will offer health insurance coverage to people who are incarcerated before and through their release

Transitioning back to the community after incarceration is a stressful and often confusing time. It can interrupt health care services and other social supports. This can lead to increased overdoses, suicides, emergency department visits and other negative outcomes, including incarceration.

To address this need, Oregon Health Authority (OHA) will be expanding access to

Medicaid benefits through the Oregon Health Plan (OHP). The benefits will cover certain health care services for adults and youth in custody starting 90 days before their release and continuing after release.

To achieve this goal, Oregon is working with the Centers for Medicare and Medicaid

Services (CMS) to waive regulations that prohibit the use of federal funds to cover certain health care services during incarceration. This effort is part of OHA’s 1115

Medicaid Demonstration Waiver.

Who qualifies?

People who qualify for OHP benefits and are in the custody of any state, county or regional correctional institution, including:

• Oregon Department of Corrections

• County/regional jails

• Oregon Youth Authority

• Juvenile detention

What health care services will be offered?

OHA’s goal is to have adults and youth in custody who qualify enrolled in a coordinated care organization (CCO) before their release. CCOs are health plans that help people use their OHP benefits. Also, OHP will begin covering health care https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/OHP-Waiver.aspx https://www.oregon.gov/oha/HSD/Medicaid-Policy/Pages/OHP-Waiver.aspx

2 of 3 OHA 0197 (rev.05/23)

Level 3 - Restricted services 90 days before release. The benefits will also be available to people with short sentences and unknown release dates within the 90-day window.

Covered services:

• Screening for OHP eligibility

• Help applying for OHP

• Case management

• Medication-assisted treatment (MAT) services (medication combined with counseling for the treatment of substance use disorders)

• Medications at release

• Limited clinical services

• Medications and med administration

• Lab services

• Radiology

Note: Not all services need to be provided by correctional facilities directly. Services can be delivered by in-house providers, CCOs and community partners or any combination of Medicaid-eligible service providers. Creating and strengthening partnerships between correctional facilities and community providers will improve continuity of care for adults and youth post release.

What this means for organizations serving incarcerated people

OHP is working with CMS on implementation guidelines for this expansion of services.

Look for guidance from Oregon Health Authority in the coming months.

Will there be financial support to provide these services?

Yes! Oregon has applied for federal funding to help carceral facilities pay for the expanded services. Funding will support:

• Technology and IT services

• Hiring and training staff

• Onboarding the Electronic Health Record (EHR) system

• Paying for internal or outsourced billing systems

• Developing protocols and procedures

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Level 3 - Restricted

• Project management resources, including change management

• Planning and collaboration tasks

Next steps

• OHA will submit the State’s special terms and conditions (STC) and implementation plan to CMS.

o STCs must be approved for states to receive funding

• Correctional facilities will complete a readiness assessment. This will help determine a go live date for services and identify areas where support and/or funding are needed.

• Go live! (phased approach) o OHA is aiming to start going live with services on January 1, 2026 o Not all facilities need to be ready at the same time

For more information

Email OHP.CarceralPrograms@oha.oregon.gov

OHA Contacts for Oregon’s 1115 Medicaid Demonstration

• Adult carceral facilities: Rachael Lee

• Juvenile carceral facilities: Rosanne Ashby

• Child welfare population: Caitlin Payne

• Behavioral Health and Aid and Assist Population: Rhiannon Henry

You can get this document in other languages, large print, braille or a format you prefer free of charge. ContactOHP.CarceralPrograms@oha.oregon.gov. .