Tips for Tapping Medicaid for Youth With Justice Involvement
Beginning on Jan. 1, 2025, states have new requirements and opportunities to use Medicaid funding to support behavioral and physical health care for young people in juvenile justice facilities and adult jails. They can also use this funding to support continuity of care when these young people return home.
States can take the following steps now to help prepare for this change:
- Recognize which populations are eligible for the new requirements. Determining eligibility may require new or strengthened relationships among Medicaid, juvenile justice agencies, child welfare agencies, departments of corrections and local jails. States must provide young people with behavioral and physical health care if they are transitioning to the community from either a juvenile justice or adult correctional setting post-adjudication. In addition, qualifying young people must be:
- eligible for the Children’s Health Insurance Program (CHIP) and younger than 19;
- eligible for Medicaid and younger than 21; or
- former foster care youth under age 26.
- Evaluate current Medicaid assessment, suspension, enrollment and service capacity. States should improve processes related to Medicaid coverage for youth who have been incarcerated. This effort includes equipping systems to suspend eligibility or benefits temporarily, redetermining eligibility without requiring new applications and restoring coverage upon release. Many state Medicaid agencies have developed some, but not all, of these operational and technical processes.
- Assess data-sharing capabilities and capacity.State agencies may need to expand their data-sharing efforts to facilitate enrollment and connections to care upon release. Some states may need to develop memoranda of understanding in addition to implementing new or updated processes and protocols for cross-agency data exchange.
- Identify and engage key partners. States should move now to identify and engage essential collaborative partners. The new requirements to provide targeted case management services 30 days prior to release and for at least 30 days after release mean that states must know what community-based partnerships exist and what case management services they can provide.
- Set implementation priorities. Sequencing will be important. States should consider a phased implementation approach that starts with incarceration settings where relatively large numbers of youth are eligible for care.
- Consider applying for federal capacity-building funding. On Sept. 27, 2024, the Centers for Medicare and Medicaid Services released a competitive application for state capacity grants. It plans to award up to 56 grants of between $1 million and $5 million each. Both Medicaid and CHIP agencies in states and territories can use these planning grants to help states meet the new statutory requirements. States can also pursue Medicaid 1115 waivers for technology enhancements and data sharing linkages.
The steps, developed by the Center for Health Care Strategies with support from the Annie E. Casey Foundation, appear in a 22-page report, New Medicaid Opportunities to Support Youth Leaving Incarceration. This report spotlights efforts in New Hampshire, New Jersey, New Mexico, Oregon and Utah as examples of how states are aligning Medicaid funding with broader community and public safety goals. Its authors have also produced a related five-page policy cheat sheet.
Joe Ribsam, the Casey Foundation’s director of Child Welfare and Juvenile Justice Policy, urges jurisdictions to leverage this funding to build more comprehensive continua or systems of care “so young people can get the help they need without the negative consequences of justice system involvement, such as a criminal record.” He noted, “States can be strategic about bringing together system partners, including Medicaid agencies, around a shared vision for family and community well-being.”
