Opportunities to Leverage Medicaid to Support Young People in Adult Corrections

What opportunities are available to adult correctional systems as a result of these changes to Medicaid and CHIP?

The 2018 SUPPORT Act and the 2023 CAA provide a framework that adult correctional systems can leverage to significantly improve outcomes for young people who are incarcerated. This framework includes opportunities to enhance mental health and substance use disorder treatment, access to physical health care services, and structured reentry support. By addressing the physical health, behavioral health, and health-related social needs of young people who are incarcerated, adult correctional leaders can improve the reentry process and reduce recidivism, leading to better long-term outcomes for young people impacted by the criminal justice system.

Behavioral Health Care Needs

Improved Access to Behavioral Health Care: Leaders in adult correctional systems can leverage screenings and diagnostic services to accurately assess the behavioral health needs of young people prior to their release, allowing for more targeted and effective treatments. Youth and young adults in correctional settings often have high rates of mental illness, SUD, and co-occurring disorders (CODs).¹ By identifying and addressing these challenges early on, correctional leaders can increase the likelihood that young people are able to successfully reintegrate into the community after incarceration.²

Improved Access to Medications for Substance Use Disorders and Psychiatric Needs: Continuity of Medicaid coverage means that young people can maintain access to psychiatric medications as they transition back into their communities. Timely access to medications for conditions like depression, bipolar disorder, and schizophrenia can be a critical part of maintaining stability for a person reentering the community. In addition, young people will also be able to maintain access to medications for SUDs (often referred to as MAT) during reentry, which have been shown to be particularly effective for people with opioid use disorders, decreasing the likelihood of overdose upon returning home.³

Improved Access to Peer Support Services: Leaders in adult correctional systems can also train, certify, and employ or partner with community-based peer recovery support specialists who have lived experience with mental health or substance use disorders to improve reentry outcomes for young people. Another option is to partner with external organizations led by people with lived experience. Peer support has been shown to increase engagement in treatment, reduce feelings of isolation, and improve long-term recovery outcomes for people with SUD.⁴

Physical Health Care Needs

Improved Access to Physical Health Care: With Medicaid coverage mandated for screening and diagnostic services, correctional leaders now can coordinate these services more effectively, identifying physical health conditions before release and ensuring that young people have access to ongoing treatment. Covered services will allow for the identification of chronic conditions and provide young people with immediate access to primary care, dental care, specialists, and necessary medications, reducing gaps in care that often lead to health complications. There is also an opportunity to provide preventive health services, such as vaccinations and health education.

Continuity of Care: Leaders in adult correctional systems can use Medicaid and CHIP coverage to facilitate continuity of care for young people returning to the community after incarceration. Establishing relationships with community health care providers while individuals are still incarcerated ensures that appointments and follow-ups are already in place upon release. This reduces the chances of health care disruptions that could negatively impact physical and behavioral health.

Improved Reentry Transitions from Pre- to Post-Release

Structured Reentry Support: Leaders in adult correctional systems now have an opportunity to partner with Medicaid-covered case managers to ensure that young people receive comprehensive case management services before and after release. These services can include referrals to health care providers, mental health services, substance use treatment, housing support, educational opportunities, employment services, and family services.

Warm Handoffs: The federal changes to Medicaid will make it easier for correctional leaders to ensure warm handoffs during the reentry process, where case management is transferred smoothly from pre-release correctional caseworkers to post-release community-based case managers. Warm handoffs ensure that physical health, behavioral health, and social services are aligned with the individual’s needs and that goals are clear for their transition back to their community. Correctional leaders can choose to contract with community caseworkers to manage both pre-release and post-release services or use an existing or different model in their state. Other opportunities include implementing face-to-face meetings between young people, their families, correctional staff, and community service providers to ensure continuity of care.

1. Establish partnerships with Medicaid agencies.

Partnerships with SMAs are essential for ensuring that Medicaid coverage is available to young people immediately before and after release. Partnerships should focus initially on producing strong state operational plans informed by the realities of corrections data, technology, and human resources.

Steps to Take:

• Initiate discussions with state Medicaid officials to collaborate on the state operational plan for handling suspension of Medicaid and CHIP eligibility during incarceration and reactivating benefits for young people 30 days before their release. If the SMA has written guidance on this topic, review that as a first step.
• Work together to develop an operational plan for pre-release enrollment and streamline processes to ensure all eligible young people are enrolled in Medicaid or CHIP before release. If possible, work to coordinate with other correctional leaders through Department of Corrections leadership and jail leaders’ associations such as the state’s sheriffs’ association.
• Align policies for case management and physical and behavioral health care access with Medicaid and CHIP benefits to ensure the operational plan addresses the full range of services needed by young people. This will require partnering with corrections staff, contracted physical and behavioral health providers, and community-based providers to ensure the new requirements are met.

2. Establish partnerships with physical and behavioral health providers.

Correctional leaders need to establish relationships with physical and behavioral health care providers and organizations to ensure ongoing care after release. These partners will be critical in providing collaborative comprehensive case management, treatment, and other support services.

Steps to Take:

• Identify providers, including Federally Qualified Health Centers (FQHCs), Certified Community Behavioral Health Clinics (CCBHCs), hospitals, and local health care organizations, who can provide services such as primary care, mental health services, and substance use treatment, including opioid treatment programs and telehealth services.
• Establish agreements with service providers to ensure access to mental health counseling, psychiatric services, peer support, and other key services.
• Coordinate with providers to develop continuity-of-care plans for young people transitioning out of correctional settings. This may include working jointly on existing reentry case plans or developing a new tool to assist with coordination.

3. Establish partnerships to confirm former foster youth status.

Correctional leaders need to coordinate with their state or local Medicaid partners to understand former foster youth status for individuals up to age 26 who turned 18 while in foster care. This is essential for ensuring these young people remain enrolled in Medicaid or CHIP and receive covered services prior to release.

Steps to Take:

• Set up data-sharing agreements that align with the state operational plan to facilitate data exchanges between relevant social service entities and correctional systems.
• Develop a process for cross-referencing foster care records with young people who are incarcerated to identify who qualifies for Medicaid under the extended eligibility for former foster youth.
• Create a referral system to link these young people to the necessary services as they prepare for reentry.

4. Develop relevant data-sharing memoranda and agreements.

To coordinate services effectively and efficiently, correctional leaders must have agreements in place to share data with key partners, including Medicaid agencies, physical and behavioral health care providers, and the foster care system, and ensure that these are fully integrated into the state operational plan.

Steps to Take:

• Develop a secure data-sharing system that complies with federal and state privacy regulations (such as HIPAA and 42 CFR Part 2) to share critical physical and behavioral health and eligibility information with Medicaid and other service providers.
• Create data-sharing agreements that allow for the smooth transfer of information between agencies, in collaboration with community-based health care organizations and foster care systems.
• Include provisions in data-sharing agreements for tracking Medicaid and CHIP enrollment, health care services provided, and outcomes during reentry.

5. Develop internal protocols.

Correctional leaders need standardized processes for pre-release Medicaid and CHIP enrollment, reactivation of benefits, and documentation management to ensure compliance with the new requirements. These protocols should align with and support the broader strategies outlined in the state operational plan.

Steps to Take:

• Create internal workflows for identifying eligible young people 90 days before release, for Medicaid or CHIP enrollment and reactivation processes, and for billing processes for Medicaid-covered services.
• Standardize protocols for collecting and transferring medical records from correctional facilities to community health care providers to ensure continuity of care.
• Implement a system to document case management and other services provided before release to ensure continuity of services.

6. Establish a process for monitoring and evaluation.

Monitoring and evaluating the impact of these changes will be essential to ensure that the implementation of the new Medicaid requirements is effective and that young people are adequately supported in their reentry process. Correctional leaders should work closely with Medicaid agencies to ensure that the state operational plan includes strong provisions for ongoing monitoring and data collection.

Steps to Take:

• Establish collaborative research partnerships to support program monitoring and evaluation.
• Develop a monitoring system to track key metrics, such as the number of Medicaid and CHIP enrollments completed before release, services provided, and recidivism rates among reentering young people.
• Conduct regular evaluations to assess how well partnerships with Medicaid agencies, health care providers, and community organizations are functioning.
• Use evaluation data to make ongoing improvements to reentry planning, service coordination, and health outcomes for young people who are incarcerated.

7. Train correctional staff.

Staff must be prepared to support reentry, including understanding the role of Medicaid, the eligibility and enrollment processes, and how to support the reentry needs of young people who are incarcerated. Many of these trainings are offered for free, such as those found at the Justice Community Opioid Innovation Network (JCOIN) Training and Engagement Center.

Steps to Take:

• Implement training programs that educate staff on the Medicaid reactivation and enrollment processes, eligibility requirements, and the importance of maintaining continuity of care during reentry for young people.
• Provide specialized training on developmentally appropriate care for young people, focusing on mental health and substance use needs and trauma-informed care.
• Clarify roles and responsibilities for correctional staff, case managers, and correctional and community-based health care providers to ensure a cohesive approach to service delivery and Medicaid coordination.

Why is it important to act now and what does the future hold?

The new Medicaid and CHIP requirements began to take effect on January 1, 2025. As a result, correctional leaders need to ensure that Medicaid eligibility processes, data-sharing protocols, and partnerships with physical and behavioral health care and social service providers are in place in alignment with the SPA as soon as possible.

While these changes bring many benefits, there will also be challenges in developing infrastructure, establishing new policies and procedures, and training staff to meet the new requirements. Correctional systems will need to balance operational needs with the demand for expanded services. However, these challenges also provide an opportunity for increased access to Medicaid-reimbursable services, integration with community-based services, expanded correctional health care options, and improved outcomes for young people involved in the criminal justice system.

Correctional systems will increasingly coordinate care with community providers, creating new opportunities for integrated health services that address physical and behavioral health needs during and after incarceration. Telehealth may also play a larger role, especially in rural or underserved areas, to meet the health care needs of young people transitioning back into the community. By building these partnerships and systems early, correctional leaders will set the stage for better health care, improved reentry outcomes, and a reduction in recidivism for young people impacted by the criminal justice system.