AB 720 Attachments

ATTACHMENT I
Non-financial Memorandum of Understanding
Contra Costa County Employment and Human Services Department, Health
Services Department and the Office of the Sheriff
Health Care Coverage Screening for Inmates of Detention Facilities in Contra Costa
County
The Contra Costa Employment and Human Services Department (“EHSD”), the Contra
Costa Health Services Department (“HSD”) and the Contra Costa County Office of the
Sheriff (“Office of the Sheriff”) enter into this Memorandum of Understanding (“MOU”)
pursuant to Assembly Bill No. 720 (“AB 720”), which pertains to the health care
enrollment of county jail inmates.
RECITALS:
1. In 2013, the California Legislature enacted AB 720.
2. The purpose of AB 720 is to enroll inmates in a county jail in the Medi-Cal
program or to facilitate application for private health insurance coverage through
Covered California.
3. In addition, AB 720 provides that county jail inmates who are currently enrolled
in the Medi-Cal program shall remain eligible for, and shall not be terminated
from, the program due to their detention, unless otherwise required by federal
law.
4. Under AB 720, the Contra Costa County Board of Supervisors, in consultation
with the Office of the Sheriff, is authorized to designate an agency to enroll
inmates in these health coverage programs. EHSD is the designated agency.
NOW, THEREFORE, THE PARTIES AGREE:
I. Term:
The initial term of this MOU is from August 1, 2014 to July 31, 2015. This MOU shall
automatically renew for successive one-year terms unless any party notifies the other
parties of a request for revision or termination of the MOU as provided in paragraph V.,
below.
II. HSD will be responsible for and agrees to the following:
A. The HSD Behavioral Health Liaison (“BHL”) will screen the inmates for
health care coverage. The BHL will notify EHSD of those inmates who have
current Medi-Cal coverage.
EHSD HSD SO AB 720 MOU 8/1/14
ATTACHMENT I
B. With the assistance of the Office of the Sheriff, the HSD BHL will distribute
the Medi-Cal Inmate Application packet to inmates screened with no health
care coverage. The Medi-Cal Inmate Application packet will include, at a
minimum:
•
•
•
•
Cover Letter
CCFRM 604 - Application for Health Insurance
Behavioral Health Release
Return Postage Paid Envelope
C. The HSD BHL will review the Application for Health Insurance for
completeness, provide assistance to the inmates for completion, and will
submit the completed Application for Health Insurance to EHSD.
D. The BHL shall also ensure that the inmate signs and dates any other required
forms, and provides appropriate verifications.
E. The BHL will submit to the Office of the Sheriff’s professional visitor jail
clearance process.
III. EHSD will be responsible for and agrees to the following:
A. EHSD will identify eligibility workers to process the Applications for Health
Insurance.
B. The eligibility workers will review all Applications for Health Insurance
completed and submitted by HSD Behavioral Health staff and, if necessary,
will follow up with Behavioral Health staff to obtain clarification and/or
further information.
C. If the “Authorized Representative” section of the Application for Health
Insurance is signed by the patient to designate the HSD BHL as their
Authorized Representative, the eligibility worker is permitted to discuss the
status of these pending applications with the BHL, as needed.
D. The eligibility workers will process each Application for Health Insurance
within seven (7) business days following receipt of a completed application
and appropriate verification.
E. EHSD will forward case disposition notices to the inmate and the HSD BHL.
F. EHSD will suspend Medi-Cal coverage for up to one (1) year for any inmate
that is determined by HSD Behavioral Health to have Medi-Cal and is
2
ATTACHMENT I
approved for Medi-Cal coverage while incarcerated. EHSD will immediately
notify the Office of the Sheriff of an inmate’s Medi-Cal coverage suspension.
G. If EHSD imposes a Medi-Cal coverage suspension pursuant to paragraph
III.F. above, EHSD will lift the Medi-Cal suspension after one (1) year or
upon the inmate’s release from the detention facility, whichever is sooner.
The Office of the Sheriff must provide necessary information to EHSD as
provided in paragraph IV.B. below.
H. EHSD agrees to advise the HSD BHL and the Office of the Sheriff of any
change in the process used by the eligibility workers that may negatively
impact this application process.
I. EHSD agrees to maintain confidentiality of inmate personal identifying
information received from any source.
J. EHSD agrees to collect and share with the HSD Behavioral Health
Department and Office of the Sheriff data showing the total number of
applications received, demographic categories, and application disposition
trends. The reports will be compiled and shared monthly, quarterly and
annually.
IV. The Office of the Sheriff will be responsible for and agrees to the following:
A. Provide a daily list of individuals who are arrested to EHSD, including the
inmate’s name, social security number and date of birth so that EHSD can
determine if the inmate is a current receipt of Medi-Cal benefits.
B. Provide advance notice to EHSD as soon as possible, but no less than thirty
(30) days, of the release date of each inmate whose Medi-Cal coverage was
suspended pursuant paragraph III.F. of this MOU so that Medi-Cal benefits
can be made available to the inmate upon his or her release.
C. Allow the placement of application packets and the installation of drop boxes
at County detention facilities.
D. Provide a Medi-Cal informational flyer to inmates incarcerated for less than
thirty (30) days at the time of their release. The flyer will be provided to the
Office of the Sheriff by EHSD.
V. Joint Obligations:
A. The parties will review this MOU, and the processes outlined therein, six (6)
months from the effective date. Any party may also request a review of the
3
ATTACHMENT I
terms of the MOU at any time. If the parties agree to revise any term of this
MOU, those revisions will be formalized in writing and executed as an
amendment to the MOU.
B. In the case of an unresolved dispute, each department will elevate the issue
to its appropriate administrative or executive representative. The
administrative or executive representative from each department will consult
one another on the issue and reach a joint resolution.
C. This MOU by and between EHSD, HSD and the Office of the Sheriff will
remain in effect until and unless one of the parties opts to terminate its
participation. Such termination must be exercised in writing to the parties to
this MOU at least sixty (60) days in advance.
____________________________________
Employment & Human Services Department
(Department Head or Designee)
Date: _________________________
__________________________________
Contra Costa Health Services Department
(Department Head or Designee)
Date: _________________________
__________________________________
Contra Costa Office of the Sheriff
(Department Head or Designee)
Date: _________________________
4
ATTACHMENT III
Medi-Cal Outreach and Enrollment Consent
By applying for health care coverage through the Medi-Cal Outreach and Enrollment program, I give my
consent to permit program representatives to gather the personally identifiable information required to
complete my online application for Medi-Cal benefits. I confirm that all information given to program
representatives is true and accurate to the best of my knowledge. I also understand that this information
will be used to apply for Medi-Cal coverage, as well as for monitoring my application status and retention
of benefits through the Medi-Cal Outreach and Enrollment Program sponsored by the Department of
Health Care Services for the State of California. Medi-Cal Outreach and Enrollment personnel will
safeguard all information to ensure its confidentiality and integrity, and to prevent unauthorized or
inappropriate access, use or disclosure.
_____________________________________
(Printed Name)
_____/_____/_____
(Date)
______________________________________
(Signature)

Download Report