Low-income

Juvenile justice agencies face a significant challenge meeting the health needs of the youth in their systems. Medicaid, which provides health coverage to more than half of all low-income children in this country, can be a vital partner in juvenile justice reform efforts. However, coordination between juvenile justice systems and state Medicaid programs can be much improved. It may help many juvenile justice officials to learn more about Medicaid and how it can be used to improve their programs and the lives of the young people they work with. The purpose of this State Health Policy Briefing is to provide those who work with system-involved youth with an introduction to Medicaid and its key concepts, as they pertain to the juvenile justice system.

Since the mid-1990s, 26 states have implemented Medicaid Section 1115 family planning demonstration waivers to help low-income women avoid unintended pregnancy and improve child and maternal health outcomes. These waivers have saved states millions of dollars. The waiver programs, which require approval from the Centers for Medicare and Medicaid Services (CMS), provide access to family planning services for individuals not otherwise eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP). This State Health Policy Briefing is the third is a NASHP series examining Medicaid family planning demonstration waivers. It explores some of the design choices states face when applying for and implementing a waiver – choices about whom the program should cover, how it should cover them, and how states can ensure that clients receive the services they need.

Nearly 100,000 young people are in juvenile justice facilities of some sort on any given day, with more than 2 million arrested in a year. Of those in residential settings, 62 percent are minorities, 85 percent are boys, and many, if not most, lack adequate health insurance coverage. Youth in juvenile justice facilities – including detention centers, shelters, diagnostic centers, group homes, wilderness programs, residential treatment facilities and training schools (where most juveniles are committed) – suffer disproportionately from a host of mental and physical health problems. The presence and severity of health problems may help explain the behaviors that led to their involvement in the criminal justice system and make it critical they receive the appropriate medical services both in the system and upon their release. Most of those arrested do not end up at trial.

This report identifies numerous opportunities for strengthening the Medicaid program and enabling it to continue to play a critical role in the country’s health care system. The report draws upon the work of a group of experts with a broad range of experience in the Medicaid program. The report’s detailed recommendations identify opportunities for improvement in all areas of the Medicaid program and include calls for simplifying and expanding eligibility; increasing program flexibility for optional populations; improving coordination and integration with the Medicare program and private insurance; adjusting current financing mechanisms; and providing states with tools to manage the long-term care system and, in the process, rebalance the institutional and home and community-based care systems.