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Santa Clara County details CalAIM prerelease rollout and gaps in Medicaid reactivation for people leaving custody
Summary
County custody health officials updated supervisors on the CalAIM justice-involved (JI) prerelease program, saying thousands have been enrolled but that technical and timing gaps — including that most people in custody lack a known release date — can delay Medi‑Cal reimbursement and services on reentry.
Custody health officials told the Public Safety and Justice Committee on May 8 that Santa Clara County has started prerelease Medi‑Cal services under the state CalAIM Justice‑Involved (JI) initiative but faces technical and timing gaps that can create coverage interruptions when people leave custody.
The county reported activating Medi‑Cal prerelease services for more than 4,200 adults and nearly 200 youth since CalAIM JI began in the county last October, Michelle Delacayo, who oversees the CalAIM JI initiative, said at the committee meeting. “We’re teeing them up so that there’s no delay when they’re released,” Delacayo said, describing processes to help applicants complete Medi‑Cal enrollment while incarcerated.
Supervisors pressed staff for details on when the aid code is turned on and how the county prioritizes people for enhanced services. Delacayo said the county is using three parallel processes: (1) helping people without active Medi‑Cal apply while incarcerated, (2) working on suspensions and reactivation of existing Medi‑Cal benefits (suspension typically occurs around day 28 of incarceration), and (3) manually activating the CalAIM JI aid code in the state portal. She said the county has begun activating the JI aid code very early — “we’ve gotten to day 7 of incarceration” — because about 90% of people in custody do not have a firm release date.
Supervisor Ellenberg asked for performance and outcome measures in future updates, including the percentage of people leaving custody with a discharge or reentry plan, rates of repeat admissions, and engagement in care coordination. “Ultimately, what I’m fundamentally interested in is understanding whether these efforts are making a meaningful impact for people both in custody and as they transition back into the community,” Ellenberg said.
Delacayo said the JI aid code can reimburse certain services provided during incarceration — lab tests, x‑rays, physician visits and medications — if the code is turned on and claim dates align. On the day of release the JI aid code is turned off and standard Medi‑Cal in the community should resume; county staff said they are working with the state to reduce errors and to automate communication between systems so activation/unsuspension is not dependent on a person calling the social services agency after release.
Acting Public Defender Damon Silver praised the CalAIM JI team and emphasized that the program is technically complex but that county staff have been recognized statewide. Under‑sheriff Rodriguez and other justice partners said they want to see one‑year outcome reporting; staff offered to return with an annual update containing more detailed performance data. The committee voted to receive the report and asked staff to return with additional metrics and clarifications in a future report.
County staff identified alternatives and mitigation for the gaps: partnering with the Social Service Agency to expedite applications, improving notification to re‑activate suspended benefits, automating portal entries where possible, and prioritizing people with known release dates and referrals (for example, from probation or public defender) for deeper reentry care coordination. Delacayo said the county is also expanding partnerships with community organizations and faith‑based reentry centers and is tracking early caseloads through care coordination teams.
Supervisors and partners emphasized that, while reactivating benefits is important to county reimbursement, the primary goal is continuity of care at release. “I will offer my opinion here that it makes no sense to suspend reimbursement for care while someone is in custody,” Supervisor Ellenberg said during the discussion, calling the federal rule that suspends benefits during incarceration “very unfortunate.”
The committee recorded specific clarifying requests — including a breakdown of how many people received each CalAIM JI service, the timing of JI aid code activation, measures of reentry‑plan completion, and rates of claims adjudication where JI codes overlap with community Medi‑Cal — and asked staff to provide those data in follow‑up reports.
Ending: Committee members and justice partners said they will continue refining automated processes with the state and will return to the committee with an annual, data‑driven update on program performance, reentry outcomes and technical fixes to reduce gaps in coverage and reimbursement.
