Medicaid and Corrections
Recent Medicaid guidance and legislative developments offer new opportunities for correctional leaders to leverage Medicaid to enhance outcomes for people who are incarcerated. With the passage of the SUPPORT Act, the Consolidated Appropriations Acts of 2023 and 2024, and new guidance around the Medicaid Section 1115 Reentry Demonstration Opportunity, prisons and jails have more opportunities to work with their state Medicaid agencies to support individuals not only during incarceration but also during the critical transition from incarceration to the community.
This webpage provides a curated list of resources to support correctional leaders in taking full advantage of these new opportunities.
Consolidated Appropriations Acts (CAA) of 2023 and 2024
The Consolidated Appropriations Acts (CAA) of 2023 and 2024 include significant provisions impacting Medicaid, corrections, and reentry services. Both acts introduce reforms to ensure that people transitioning from incarceration to their communities receive necessary medical and support services. These reforms help to reduce gaps in coverage and improve overall reentry outcomes.
- Coverage Requirements (Section 5121): The requirements mandate coverage for necessary screening, diagnostic services, and targeted case management before and after release for youth and young adults who are post-adjudication in correctional facilities and eligible for Medicaid or the Children’s Health Insurance Program (CHIP). This includes a Medicaid-eligible individual who is under 21 years of age or CHIP-eligible individual who is under 19 years of age; and an individual between the ages of 18 and 26 who is eligible for Medicaid under the mandatory former foster care children group.
- State Medicaid and CHIP Programs are required to provide:
- Screening and Diagnostic Services: Screening and diagnostic services in accordance with state-determined standards and the Early and Periodic Screening, Diagnostic, and Treatment requirements for Medicaid or the approved CHIP state plan, including behavioral health screenings or diagnostic services, must be provided 30 days prior to scheduled release or as soon as practicable after release.
- Targeted Case Management: Medicaid-defined Targeted Case Management, including assessment, referrals, development of a care plan, monitoring, and follow-up for appropriate care and services in the home and community, must be provided 30 days prior to release and continue for at least 30 days after release.
- Youth Pending Disposition (Section 5122): States have the option to provide Medicaid or CHIP coverage for eligible young people pending disposition of charges in correctional institutions.
- Changes go into effect January 1, 2025.
- Suspension, Not Termination: States must suspend rather than terminate Medicaid eligibility when individuals become incarcerated. This provision mandates that states redetermine eligibility prior to release without requiring a new application. Similarly, states may suspend rather than terminate CHIP coverage for pregnant individuals. This ensures faster reinstatement of coverage upon release for eligible individuals.
- Effective January 1, 2026, for all people who are incarcerated.
- Provision of Medicaid and CHIP Services to Incarcerated Youth, CMS, July 23, 2024
- Letter to state health officials outlining guidance on provisions in the CAA impacting the availability of Medicaid-covered services for youth who are incarcerated and CHIP eligibility requirements for children who become incarcerated.
- Policy Cheat Sheet: Medicaid Opportunities to Support Youth Transitioning from Incarceration, Center for Health Care Strategies, April 2024
- Outlines opportunities under the CAA for states to use Medicaid to support youth transitioning from incarceration, including screenings, case management, and continuous Medicaid coverage.
- Outlines opportunities under the CAA for states to use Medicaid to support youth transitioning from incarceration, including screenings, case management, and continuous Medicaid coverage.
- Medicaid’s New Role in Advancing Reentry: Key Policy Changes, Health and Reentry Project, March 2024
- Provides overview of recent policy changes that expand Medicaid’s role in supporting individuals transitioning from incarceration to the community.
- Report: Changes to Medicaid and Children’s Health Insurance Program (CHIP) Eligibility for Justice-Involved Youth, Center for Community Solutions, December 18, 2023
- Explains changes to Medicaid and CHIP eligibility for youth involved in the justice system, including pre-release mandates and the option for pretrial coverage for youth pending disposition of charges.
- FAQs about the New Statutory Changes, Community Oriented Correctional Health Services, September 2023
- Addresses frequently asked questions about how the recent statutory changes impact Medicaid coverage and services for people involved in the justice system.
- Issue Brief: Consolidated Appropriations Act, 2023: Medicaid and CHIP Provisions Explained, Georgetown University McCourt School of Public Policy Center for Children and Families, January 5, 2023
- Discusses mental health-related improvements to Medicaid and CHIP, including new required services and optional coverage for young people involved in the justice system.
- Discusses mental health-related improvements to Medicaid and CHIP, including new required services and optional coverage for young people involved in the justice system.
- Children’s Health Insurance Program (CHIP), Medicaid.gov
- Provides an index of resources related to CHIP policy and program implementation, including eligibility standards, cost sharing, and CHIP state program information.
- Discussion Panel: Medicaid and Reentry: New Policy Advances to Improve Public Health and Public Safety, Council on Criminal Justice, March 2024
- Discusses implications of the recent policy changes to enhance Medicaid services for people returning to the community after incarceration.
- Medicaid and the Criminal-Legal System: Jails, Community Oriented Correctional Health Services, March 2023
- Explores how Medicaid can be leveraged within jail settings to improve health outcomes for people who are incarcerated, detailing the challenges and opportunities associated with implementing Medicaid services in jails.
- Medicaid and the Criminal-Legal System: Community Corrections, Community Oriented Correctional Health Services, March 2023
- Discusses the role of Medicaid in community corrections and how services can support people under community supervision, including probation and parole.
- Opportunities for Health Providers to Partner with Justice Systems, Community Oriented Correctional Health Services, March 2023
- Discusses how health care providers can collaborate with justice systems to deliver Medicaid-funded services, improve health outcomes for people involved in the justice system, and support successful reentry into the community.
- The CMS Medicaid Targeted Case Management Rule: Implications for Special Needs Service Providers and Programs, CHCS, April 2008
- Examines the CMS targeted case management rule in the context of people with complex health needs who receive services from programs that specialize in community-based care management.