Improving continuity of care, efficiency and savings throughout the incarceration lifecycle
With almost 69 million enrolled individuals, Medicaid serves more participants than any other Federal health care program and represents one-sixth of the national health care economy. Medicaid program directors, managers, and inspectors are responsible for improving Medicaid beneficiary continuity of care and combating Medicaid program fraud, waste, and abuse.
As a Medicaid professional, you are pulled in many directions and challenged with ensuring compliance with fiscal controls, leveraging fraud prevention, and improving national Medicaid data to support program integrity. Yet, your agency may lack the people, time and data needed to determine changes to beneficiary eligibility status due to incarceration. With data access limited to your state’s Department of Corrections database, you can’t search other states’ incarceration databases to locate individuals who may no longer be eligible for Medicaid benefits.
Perhaps there is little or no money in your budget to hire additional staff to weed out ineligible recipients. Your agency’s integrity could be compromised and overpayments to healthcare providers may be a serious problem.
In 2017, over 2.3 million individuals were incarcerated in U.S. state, local, and federal facilities. Compared to the general population, individuals in jails and prisons suffer 3x the rate of serious mental illness, 4x the rate of substance abuse disorders, and 4-9x the rate of active tuberculosis (TB), HIV infection, and Hepatitis C.
Many incarcerated individuals require a variety of ongoing behavioral and physical health services, creating a critical need to facilitate the appropriate treatment program, funded by the appropriate authority. Strengthening continuity of care for incarcerated Medicaid recipients, while also reducing improper payments, is a common need within the Medicaid community.
Appriss Safety operates the nation’s most comprehensive and current incarceration data network, having direct jail management system interfaces with over 2,900 jails and DOC facilities. Collaborating with Medicaid agencies across the country, we have identified a critical need for access to real-time incarceration data to avoid gaps in care and improper payments while beneficiaries are in the various stages of incarceration.
With this in mind, Appriss developed its Program Integrity Solution for Medicaid. This solution gives Medicaid agencies access to accurate and timely data, positively affecting continuity of care for incarcerated Medicaid beneficiaries. Agencies are able to place “watches” on their beneficiary lists, and receive alerts when a monitored beneficiary is:
Appriss’ Program Integrity Solution for Medicaid seeks to ensure that incarcerated Medicaid beneficiaries receive seamless continuity of care and that the appropriate parties finance their care.
As the developer of the nation’s most comprehensive incarceration database, and as a tech industry leader with expertise in data integration, Appriss’ value proposition to Medicaid agencies is two-fold: We offer Medicaid agencies access to real-time, nationwide incarceration data and a team of experts to implement the solution and support our clients.
With our breadth of data and technical expertise, and utilizing real-time alerts, Medicaid agencies can address many of the challenges that coincide with incarcerated beneficiaries:
Medicaid payments can be suspended or terminated when beneficiaries become incarcerated and reinstated once they are released, preventing overpayments and eliminating lapses in care.
Seamless continuity of care supports and informs beneficiaries’ healthcare providers and helps beneficiaries suffering from behavioral health issues avoid future incarceration.
Beneficiaries who are released from incarceration, and whose coverage has been reinstated, are less likely to rely on costly emergency care, easing the financial burden on taxpayers.
Appriss Safety’s extensive, real-time incarceration data, coupled with our unmatched industry expertise, gives us the knowledge and skills required to successfully partner with Medicaid agencies to resolve the challenges regarding incarcerated beneficiaries. This effective solution has the power to vastly improve agency efficiencies, save countless dollars, and enhance the quality and continuity of care for a very vulnerable segment of our society.