In a July 23 letter to state health officials, the Centers for Medicare and Medicaid Services (CMS) issued guidance on providing Medicaid and Children’s Health Insurance Program (CHIP) services to incarcerated youth. The letter responds to statutory requirements in the Consolidated Appropriations Act, 2023 (CAA, 2023) that affect the availability of some Medicaid services for incarcerated youth and modifies CHIP eligibility for children who become incarcerated.
Medicaid Services
States must provide any medical or dental screenings and diagnostic services in accordance with Early and Periodic Screening, Diagnostic, and Treatment requirements in the 30 days prior to release for eligible juveniles and no later than one week afterwards, per the CAA, 2023. The state also must provide targeted case management services, including referrals, under the Medicaid state plan.
For Medicaid, an eligible juvenile is an individual younger than 21 who was determined eligible for Medicaid immediately before becoming an inmate of a public institution or while an inmate of a public institution, or who is eligible under the former foster care children eligibility group.
States will have the option to receive federal financial participation for providing Medicaid coverage to eligible juveniles who are inmates of a public institution while pending disposition of charges.
CHIP Services
Under CHIP, states must provide screening, diagnostic, and case management services otherwise available under the CHIP state plan 30 days prior to release.
The CAA, 2023 permits states to suspend or continue providing services rather than terminate CHIP coverage while a child is an inmate of a public institution, aligning eligibility with existing Medicaid requirements. States may not terminate CHIP eligibility at the end of a child’s continuous eligibility period if the child is still incarcerated. State plan services may be provided if they are not covered by the carceral facility. The CAA, 2023 also requires redeterminations of CHIP coverage prior to the child’s release.
States will have the option to grant CHIP eligibility to children while they are inmates pending disposition of charges.
These changes are effective Jan. 1, 2025. States must submit Medicaid and CHIP state plan amendments by Jan. 1 to implement the required coverage in the CAA, 2023.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.