Enhancing Health Coverage for Juvenile Justice-Involved Youth

OJJDP Coordinating Council

November 13, 2013

Diane Justice, Senior Program Director

National Academy for State Health Policy				

Health Needs of Justice-Involved Youth

70 percent have a mental health condition

Substance use is common 

 Physical and behavioral health services are an essential component of community support systems

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Improving Health Coverage for Juvenile Justice-Involved Youth

Project of the National Academy for State Health Policy

Supported by the Models for Change Initiative of the MacArthur Foundation 

Identify state strategies to enhance health coverage and retention

 Address Medicaid program eligibility and enrollment

 Focus on collaboration between Medicaid and Juvenile Justice Agencies

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Medicaid Eligibility Tools for Enhancing Coverage and Retention

Federal law forbids Medicaid funding from being used to pay for care or services for individuals who are inmates of a public institution

Securing health coverage immediately upon release from a facility is important to continuity of care, access to medications, physical and behavioral treatment

States can terminate or suspend Medicaid eligibility when a juvenile justice-involved youth has been incarcerated

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Suspension of Medicaid Eligibility

Suspension allows the state to restore Medicaid benefits relatively quickly 

Provides the youth immediate access to benefits upon release

Has been difficult to implement because of programing changes required to eligibility information systems

Currently states are revamping eligibility systems due to ACA changes—ideal time to adopt suspension policies

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Other Eligibility Simplifications Helpful to Juvenile Justice-Involved Youth

Continuous eligibility:

Allows children to maintain Medicaid or CHIP coverage for up to one year, even if child’s family has change in circumstances

If a Medicaid or CHIP-enrolled child enters and leaves a juvenile detention facility during the 12-month eligibility period, they can remain eligible after release

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Other Eligibility Simplifications Helpful to Juvenile Justice-Involved Youth

Presumptive Eligibility:

Allows qualified entities to determine, based on a simplified calculation of family income, whether a child is likely to be eligible for Medicaid

Youth can receive temporary eligibility pending a final eligibility determination by the Medicaid agency

Speeds access to services

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Enrollment Partnerships between Medicaid and Juvenile Justice Agencies 

Collaboration to facilitate Medicaid enrollment during community re-entry planning

Established by state legislation or interagency agreements

Juvenile justice program staff, case managers, and/or probation officers complete Medicaid applications for  youth while in custody

Medicaid agencies designate a special pathway and contact to expedite enrollment

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Enrollment Partnerships Between Medicaid and Juvenile Justice Agencies

Oregon: Outstations Medicaid eligibility employee to the juvenile justice agency to make real-time eligibility determinations

Texas, Washington, Colorado: Juvenile justice facility staff screen youth for potential eligibility, complete applications, submit to designated Medicaid agency contacts

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Community Outreach and Enrollment Strategies for Health Coverage 

As with institution-based program enrollment strategies, collaboration between Medicaid and juvenile justice agencies is essential

Lessons adapted from Medicaid and CHIP efforts targeted to adolescents: 

work with community-based entities trusted by the target population; 

use venues frequented by adolescents such as school activities and sporting events; 

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Collaborative Outreach Strategies (continued)

Engage agencies that provide support to juvenile justice-involved youth such as service providers, probation officers, courts

Use social media, websites, and information conveyed through mobile devices and smart phones

Co-locate in-person health coverage navigators in juvenile courts, probation offices and make health coverage an integral components of a community support system

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Collaboration Between Medicaid and Juvenile Justice Agencies on Benefits

Adoption of evidence-based practices is essential to addressing the behavioral health needs of juvenile justice-involved youth

Multisystemic Therapy, Functional Family Therapy and Multidimensional Treatment Foster Care are widely recognized effective in treating juvenile justice-involved youth with serious behavioral health needs

A Washington state study identified significant cost savings and benefits of these practices compared to traditional treatments

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