Medicaid Coverage for Incarcerated Youth: California’s Initiative

What is the Justice-Involved Initiative?

The Justice-Involved Initiative is a pioneering program under California’s Medicaid reforms, specifically designed to extend Medicaid coverage to incarcerated individuals. Historically, under the Medicaid Inmate Payment Exclusion Rule, federal Medicaid funds could not be used to cover healthcare costs for inmates of public institutions, which includes youth detained in correctional facilities. However, through the Justice-Involved Initiative, California has become the first state to receive federal approval to offer a targeted set of community-based Medicaid services to Medi-Cal-eligible, incarcerated youth and adults for up to 90 days prior to their release.

Eligibility Criteria for Pre-Release Services

For incarcerated youth to receive pre-release services under the Justice-Involved Initiative, they must meet the following criteria:

1. Medi-Cal or CHIP Eligibility: The youth must be eligible for either Medi-Cal or the Children’s Health Insurance Program (CHIP).
2. Custody: They must be in the custody of a youth correctional facility.

Unlike adults, there are no specific health care criteria for youth to qualify for these services. However, adults must meet one or more of the following health care needs:

• Mental illness
• Substance use disorder
• Chronic condition or significant non-chronic clinical condition
• Intellectual or developmental disability
• Traumatic brain injury
• HIV/AIDS
• Pregnant or postpartum

An important distinction in this program is that “youth” is determined by the correctional facility and not strictly by the individual’s age.

Available Pre-Release Services

The services available to incarcerated youth in the 90 days prior to their release include:

• Reentry Care Management Services: Coordination of care to ensure a smooth transition back into the community.
• Physical and Behavioral Health Clinical Consultation Services: Medical and mental health consultations to address immediate and ongoing health needs.
• Laboratory and Radiology Services: Diagnostic tests and imaging.
• Medications and Medication Administration: Access to necessary medications and management of medication regimens.
• Medication Assisted Therapy (MAT): Includes counseling and support for substance use disorders.
• Services by Community Health Workers (CHWs): Support from individuals with lived experience who can provide guidance and assistance.

Initiation of Pre-Release Services

The timing and initiation of these services depend on the length of stay and the anticipated release date of the incarcerated individual:

• Short or Unknown Length of Stay: Services should begin as close to intake as possible, once the individual’s Justice-Involved aid code is activated.
• Known Release Date (longer than 30 days stay): Services should commence within the 90-day period prior to their release.

Impact and Significance

The Justice-Involved Initiative represents a significant shift in how healthcare is provided to incarcerated populations, particularly youth. By extending Medicaid coverage to include pre-release services, California aims to improve health outcomes and facilitate a smoother transition back into the community. This initiative addresses the critical healthcare needs of incarcerated individuals, ensuring they receive necessary care before reentering society, which can help reduce recidivism and support overall public health.

Conclusion

California’s Justice-Involved Initiative is a groundbreaking effort to provide essential healthcare services to incarcerated youth and adults prior to their release. By ensuring these individuals receive the necessary medical, mental health, and support services, the initiative not only addresses immediate health needs but also supports their reintegration into the community. This innovative approach sets a precedent for other states to follow, aiming to enhance the well-being of justice-involved populations and promote more equitable healthcare access.

For more information, you can refer to detailed guidelines and policy documents provided by the Department of Health Care Services (DHCS).

1. Congressional Research Service: Medicaid and Incarcerated Individuals
   • Medicaid and Incarcerated Individuals
2. CalAIM Behavioral Health Initiative Frequently Asked Questions
   • CalAIM Behavioral Health Initiative FAQ
3. Department of Health Care Services, Medi-Cal Managed Care Plans by County (2023 and 2024)
   • Medi-Cal Managed Care Plans by County
4. Department of Health Care Services, Changes to Managed Care for the Child Welfare Population (April 2023)
   • Changes to Managed Care for the Child Welfare Population
5. Department of Health Care Services, All Plan Letter No. 22-005: No Wrong Door Policy
   • All Plan Letter No. 22-005
6. Department of Health Care Services, All Plan Letter No. 21-011 (Revised): Grievance and Appeals Processes
   • All Plan Letter No. 21-011 (Revised)
7. Medi-Cal Manual for Intensive Care Coordination (ICC), Intensive Home Based Services (IHBS), and Therapeutic Foster Care (TFC) Services for Medi-Cal Beneficiaries
   • Medi-Cal Manual Third Edition
8. Department of Health Care Services, Behavioral Health Information Notice No. 23-056: MOU Requirements for MHP and MCP
   • Behavioral Health Information Notice No. 23-056
9. Sample MOU Template
   • County-Child Welfare MOU

These resources provide detailed information about the Justice-Involved Initiative and related healthcare policies for justice-involved youth.