The recently enacted 250-page opioid epidemic bill — the Support for Patients and Communities Act — contains an important fix to improve continuity of Medicaid coverage for justice-involved children and youth. Beginning October 24, 2019, states may no longer terminate children and youths’ Medicaid eligibility just because they enter a juvenile justice facility, jail, or prison.
While this change in federal Medicaid law will make clear a longstanding policy that recipients cannot be cut off from coverage because they are incarcerated, some states have long terminated children and youths’ Medicaid upon entering a correctional institution, citing for justification a provision of the Medicaid Act called the “inmate exclusion.” The “inmate exclusion” prohibits states from using federal Medicaid funds to pay for Medicaid services while a recipient is an “inmate of a public institution.” An “inmate” is a child or adult who is being held involuntarily by law enforcement authorities in a public institution, such as adult prisons, jails and juvenile long-term secure facilities and detention centers. Being an inmate must not impact Medicaid eligibility.
Instead of terminating Medicaid eligibility, the individual’s Medicaid benefits should be “suspended” while an inmate and then unsuspended upon release. The Support for Patients and Communities Act puts this policy into law by prohibiting states from terminating eligibility upon entry and then requiring states to lift children and youth’s suspended status upon release. The Act also requires states to process applications and make eligibility determinations for those children and youth who are not eligible for Medicaid upon entry, but become eligible while in the public institution. States will remain responsible for paying for the health care costs for children and youth while they are inmates of a public institution, but children and youth cannot be required to reapply for coverage upon their release.
When a state wrongly ends coverage, it creates a barrier to health care coverage. This state-created barrier disproportionately harms children and youth of color and children and youth with disabilities. Children and young adults of color are more likely to be incarcerated than their white peers that commit similar offenses, and two-thirds of children in the juvenile justice system have a diagnosable mental health or substance use disorder. Terminating coverage prevents these children and youth from receiving counseling, intensive case management, medication assisted treatment, and other support they will need upon release. The median length of stay for children and youth in all types of juvenile facilities is a little more than three months, and children and youth are often held for much shorter times. In many cases, children, youth, and their families may never be informed that their Medicaid coverage has been terminated until after they are released and denied care.
The new federal law protects Medicaid for juveniles under 21 or former foster children up to 26. The law covers youth who are held in adult prisons and jails as well juvenile detention facilities or other public institutions.
Advocates should review their current state Medicaid policies and practices related to juvenile justice and corrections agencies to ensure they are complying with current federal Medicaid policy and to implement the new law. To ensure that children and youth have access to health care upon release, state policies and practices may need to be altered and computer systems updated well before the effective start date of October 24.