Memorandum
Date: March 7, 2023
To: The Honorable Lake County Board of Supervisors
From: District 2 Supervisor, Bruno Sabatier
Subject: Consideration of Letter Requesting a Change to Federal Law Regarding Medicaid Inmate Exclusion Policy
Executive Summary:
In the amendments to the Social Security Act in 1965, an exemption for Medicaid coverage was added for inmates in a public institution. This exception is known as the Medicaid Inmate Exclusion Policy (MIEP). With very few exceptions, the large majority of medical care provided to the inmates in the Hill Road Jail Facility are covered at cost with no reimbursements available to the county. Medicaid is the federal program that provides health insurance for programs for people with low income. Medi-Cal is California’s Medicaid health care program.
Recent legislation has created CalAIM which now provides some alterations to the MIEP. Within 90 days of leaving the jail, inmates can have their Medi-Cal re-activated or initiated. While certain types of care, under CalAIM, can be provided and reimbursed, CalAIM’s intention is mainly to ensure that inmates leaving county jails have health coverage and a discharge plan if they have known complications for continuity of care. However, these changes will minimally impact the true cost of healthcare that is provided to our inmates at the county jail.
In 2010, our contract for medical services in our jail was approximately $1 million. In December, 2022, the Board of Supervisors signed a contract for $4.5 million. This is almost 450% increase over the course of 12 years. This is unsustainable.
The National Association of Counties (NACo) is pushing for MIEP reform. There is a request for pre-trial inmates, inmates not yet convicted of a crime, to not have their MediCaid put on hold or stripped. However, while the letter drafted supports NACo’s efforts to make this change, the letter that is drafted also requests to look at eliminating MIEP altogether. We know that with new laws and due to certain court cases such as Brown v Plata that a reduction in state prison populations has resulted in larger county jail populations. In addition, the length of time that inmates are now sentenced to county jail has increased. The added pressure to provide adequate medical services in our jail will eventually come to breaking point, we need a change.
If not budgeted, fill in the blanks below only:
Estimated Cost: ________ Amount Budgeted: ________ Additional Requested: ________ Future Annual Cost: ________
Purchasing Considerations (check all that apply): ☐ Not applicable
☐ Fully Article X. <https://library.municode.com/ca/lake_county/codes/code_of_ordinances?nodeId=COOR_CH2AD_ARTXPU_S2-38EXCOBI>- and/or Consultant Selection Policy <http://lcnet.co.lake.ca.us/Assets/Intranet/Policy/Policies+$!26+Procedures+Manual/Ch4_2021v2.pdf>-Compliant (describe process undertaken in “Executive Summary”)
☐ Section 2-38 <https://library.municode.com/ca/lake_county/codes/code_of_ordinances?nodeId=COOR_CH2AD_ARTXPU_S2-38EXCOBI> Exemption from Competitive Bidding (rationale in “Executive Summary,” attach documentation, as needed)
☐ For Technology Purchases: Vetted and Supported by the Technology Governance Committee <http://lcnet.co.lake.ca.us/Assets/Intranet/Intranet+Forms/Information+Technology/AdvPlan.pdf> (“Yes,” if checked)
☐ Other (Please describe in Executive Summary)
Consistency with Vision 2028 <http://www.lakecountyca.gov/Government/Directory/Administration/Visioning/Vision2028.htm> (check all that apply): ☐ Not applicable
☐ Well-being of Residents ☐ Public Safety ☐ Disaster Prevention, Preparedness, Recovery
☐ Economic Development ☐ Infrastructure ☐ County Workforce
☐ Community Collaboration ☒ Business Process Efficiency ☐ Clear Lake
Recommended Action: Approve letter requesting a change to Federal law regarding Medicaid Inmate Exclusion Policy and send to all state and federal representatives.