Enhancing Health Coverage for Juvenile Justice-Involved Youth

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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;

11. 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

12. 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