Access to Medicaid

1
Access to Medicaid MedicationsThe New York
State Medication Grant Program
Dan Abreu, M.S. CRC Policy Research
Associates DAbreu_at_prainc.com
C. Terence McCormick, MSW, MPA CARES, LLC (www.
CARESLLC.com) CARES-TMcCormick_at_Earthlink.net
2
Authorizing Authority Kendras Law

• To provide medications and other services
  necessary to prescribe and administer medications
  to treat mental illness during the pendancy of a
  medical assistance eligibility determination..for
  persons who have received services services
  from a . Mental health unit of a correctional
  facility

2001
3
Eligibility Criteria
Medication Grant Program

• have received mental health services in a
  correctional facility
• have a mental illness
• prescribed psychiatric medications
• applies for Medicaid prior to or within one week
  of release from a correctional facility

4
Program Components
Medication Grant Program

• Transition Managers
• Funding for Medications and Related Expenses
• Benefits Manager and Pharmacy Access
• Medicaid Applications
• Local Mental Health MGP Coordinator
• State Mental Health Financial Oversight

5
Medication Grant Program
Enrollments
6
Participating MGP Counties
Medication Grant Program
Potential MGP Coverage
7
2004 MGP Enrollments
Medication Grant Program
8
Medication Grant Program
County Jails Releases 2004

• Total enrollments 1441
• 793 Used MGP 55 Utilization
• 648 Did not use MGP 45
• 73 of All MGP Enrollees Received Medicaid

9
(No Transcript)
10
Medication Grant Program
Prison Releases 2004

• Total enrollments 1376
• 498 Used MGP 36 Utilization
• 878 Did not use MGP 64
• 81 of All MGP Enrollees Received Medicaid

11
(No Transcript)
12
Transition Management
Medication Grant Program

• 80 jail transition managers
• 24 prison pre-release coordinators

13
Medication Funding
Medication Grant Program

• Funds guarantees payment for providers for
  participants found ineligible for Medicaid
• Medications
• Augmenting medications
• Clinical services necessary to prescribe
  medications
• Administration of the MGP program

14
Medication Related Expenses
Medication Grant Program

• screening visits with a mental health
  professional
• medication evaluation/diagnostic visits with a
  physician,
• provision of injectable medications by nurse,
• follow-up visits to monitor for medication side
  effects and/or to adjust dosages and laboratory
  tests.

15
Pharmacy Benefits Manager
Medication Grant Program

• Formulary (essential and augmenting medications)
• MGP Fax applications
• 3700 Pharmacies
• Program Usage Reports

16
Social Services
Medication Grant Program

• Medicaid Applications
• Training Jail Transition Planners
• Social Service/Mental Health MOU

17
Local Mental Health
Medication Grant Program

• MGP Coordinator
• Jail Transition Planner
• Application for reimbursable services
• Social Service/Mental Health MOU

18
Local Mental Health MGP Coordinator
Medication Grant Program

• Oversees entire local MGP program
• Receives Medicaid applications from Transition
  Managers
• Verifies reimbursement requests for medications
  and services to Medicaid ineligibles
• Receives program usage reports from Benefits
  Manager
• Submits termination notices to Benefits Manager

19
State Mental Health
Medication Grant Program

• Distributes discharge planning funds
• Negotiates contract with Benefits Manager
• Approves MGP plans submitted by counties
• Approves payment for services to applicants found
  ineligible for Medicaid
• Negotiates coordination between State prison
  discharge planners and local mental health MGP
  Coordinators
• Provides oversight and technical assistance

20
Technical Aspects
Medication Grant Program

• Developing a pharmaceutical formulary
• Creating a coding system for referrals from
  jail/prison unit
• How to handle Medicaid ineligibles
• Prescription refill time limits

21
CNYPC Outpatient Diagnoses
(Primary)
Caseload7730
January 1, 2004
22
MGP Enrollment DiagnosesPrison
MGP Prison Enrollees 2968
10 did not report a Diagnosis
23
MGP Enrollment Diagnoses Jail
MGP Jail Enrollees 2907
51 did not report a Diagnosis
24
Prescriptions Filled
Medication Grant Program
Prison Releases
Jail Releases
25
Medication Grant Program
Definitions MGP Utilizations - utilizing MGP
card post release Medicaid Enrollment -
completing Medicaid enrollment post
release Aftercare Studies - civil inpatient
releases keeping follow-up appointments Compliance
Studies - of seriously mentally ill taking
prescribed medication
26
(No Transcript)
27
(No Transcript)
28
Medication Grant Program
29
Lessons Learned
Medication Grant Program

• Many Participants receive Medicaid prior to
  release or within the time of their 2-week supply
  of medications from corrections has run out
• Medication non-compliance reduces numbers of
  program participants
• MGP utilization rates consistent with the
  compliance of other populations with mental
  illness
• Prisons need guaranteed access to all established
  MGP programs
• Application packets for all local programs need
  to be uniform for prison referrals

30
THE END
Medication Grant Program
31
(No Transcript)