The Puerto Rico Department of Health (PRDoH), the State Medicaid Agency, is applying for funding under Section 206 of the Consolidated Appropriations Act (CAA), 2024: State Planning Grants to Promote Continuity of Care for Medicaid and CHIP Beneficiaries Following Incarceration (Grant). Through this grant, the Puerto Rico Medicaid Program (PRMP), a division of PRDoH, will engage interested parties and plan and implement activities needed to support continuity of care following incarceration.
During the first two years of the grant, activities will concentrate on promoting continuity of care for incarcerated eligible juveniles and implementing compliance and quality improvement measures. A primary focus of the first year will be complying with the new requirements under Section 5121 of the CAA of 2023, including implementing enhanced eligibility procedures, new pre- and post-release targeted case management (TCM), and diagnostic and screening services. New requirements relating to adult inmate eligibility will also be addressed. In the second year, the focus will be on improving services, policies, procedures, and systems. During the final two years, Puerto Rico will evaluate options for expansion potentially using an 1115 waiver to include adults. This will allow for the expanded provision of Medicaid-funded services to inmates. As part of Grant activities, Puerto Rico will determine whether to target subpopulations for receipt of certain services.
As the grantee, PRMP will lead the project and coordinate with Administración de Seguros de Salud (ASES), its partner agency, which is responsible for overseeing services and contracting with managed care organizations (MCOs). Puerto Rico Medicaid is fully managed care. PRMP will collaborate with the Department of Corrections and Rehabilitation (DCR) to ensure accurate and timely Medicaid eligibility determinations for individuals entering, leaving, and in correctional facilities. DCR contracts with a separate entity to provide medical, dental, behavioral health, and social work services to incarcerated individuals. DCR, PRMP, and ASES will collaborate to develop TCM and diagnostic and screening policies and procedures. This includes enrolling providers, defining services, and making necessary system changes. Re-entry services will include connecting individuals with health related social needs (HRSN) such as housing and employment. PRMP plans to contract with implementation assistance contractors (IACs) to assist with capacity building, planning, and required reporting. DCR and ASES will both be Grant subrecipients.
PRDoH will use the $4,990,048 Grant funds to hire staff, engage contractors, and make operational and system improvements. PRMP expects to hire a project lead, a corrections eligibility specialist, and a half-time administrative assistant. DCR will also hire a project lead. The IAC will support PRMP and other interested parties. Activities will include training and outreach and supporting an ongoing workgroup including PRMP, ASES, DCR, MCOs, community organizations, and individuals with lived experience. Funds will also be used for implementation support from contractors to help with project and program management, eligibility and enrollment system updates, actuarial experts to conduct financial analysis and set capitation rates, and PRMP’s Medicaid Management Information System (MMIS) vendor to add the TCM provider type to the provider enrollment portal (PEP), pay new capitation rates, and enhance reporting. Other important system updates will include bi-directional eligibility information sharing with DCR and ensuring accurate claims payments.
Because, among other gaps, PR does not currently have Medicaid-funded TCM for eligible individuals transitioning from incarceration facilities, strong eligibility information-sharing capability, or capacity to explore an 1115 waiver, this Grant is expected to yield significant positive results.
