Since the 1960's states and local jurisdictions have not been able to draw down federal Medicaid or Children's Health Insurance Program (CHIP) funding to treat youth who are held in local detention centers or state-run commitment facilities do to the "Inmate Exclusion" policy. On January 1, 2025, some of these restrictions are being lifted, and states will now be required to provide some Medicaid/CHIP services to youth returning home after a period of commitment and can chose to provide services for youth who are being held pre-trial.
The Consolidated Appropriations Act (2023) made two changes to Medicaid and CHIP. Section 5121 which is mandatory, and requires states to leverage Medicaid and CHIP to support youth returning home after a period of incarceration by providing Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) and Targeted Case Management (TCM) services. Section 5122 is optional and allows states to offer a broader array of services to youth pre-trial.
This statutory change is an opportunity for states and local jurisdictions to deepen their Continuums of Care and ensure that young people are connected to community-based health services so that there is no gap in services as they transition back home. This policy change will impact not only youth in the juvenile justice system, but also those youth housed in adult jails and correctional facilities. The populations that are impacted include: Medicaid-eligible youth under age 21; CHIP-eligible youth under age 19; and former foster youth up to age 26.
The following websites offer resources that can help local and state jurisdictions navigate this change in the law:
- Medicaid's webpage on CAA 5121 (mandatory) and CAA 5122 (optional)
- Medicaid Guidance SHO #24-004 on the provision of Medicaid and CHIP services to Incarcerated Youth
- Frequently Asked Questions on implementation
- Medicaid Guidance SHO #24-005 on Best Practices for Adhering to Early and Periodic Screening, Diagnostic, and Treatment Requirements (EPSDT)
- National Association of Medicaid Directors (NAMD) Website on the new law
- Center for Healthcare Strategies (CHCS): New Medicaid Opportunities to Support Youth Leaving Incarceration: Building Community Well-Being and Advancing Prevention Efforts
- Health & Reentry Project (HARP): Medicaid's New Role in Advancing Reentry: Key Policy Changes (primary focus on youth ages 18-26).
- Bureau of Justice Assistance' National Training and Technical Assistance Center (NTTAC) website
In addition, the Federal Government has resources dedicated to ensuring states can comply with the new law:
- The Center for Medicaid and CHIP Services (CMCS) is offering two rounds of grant funding to support jurisdictions with their State Planning to comply with this law. One was offered in November 2024, and one will be offered in March 2025.
- In November 2024, the Health Resources and Services Association (HRSA) granted nearly $52 million to more than 50 local community-based health providers to improve their care to the formerly incarcerated population.
- 1115 Waivers through CMCS continue to be an opportunity for states to enhance re-entry services for young people returning home.
Finally, OJJDP training and technical assistance providers who support a variety of membership associations are educating their members and stakeholders through webinars, presentations, and materials. As these materials become available, OJJDP will share them with the field.
Young people who have contact with the justice system have a variety of unmet and/or high-level needs including elevated Adverse Childhood Experiences, complex health needs, and increased incidence of behavioral health diagnoses, including co-occurring substance use disorders. Building partnerships with community providers, pushing services into to facilities so relationships can be maintained upon release, and leveraging telehealth services for youth in rural, Tribal, or other areas with limited health providers will be critical to making this policy succeed for young people's long-term health and wellness.