Youth in the juvenile justice and foster care systems often share many traits: a history of abuse or neglect, mental health and substance abuse needs, low incomes, and likely eligibility for public insurance programs. For both populations, custody transitions provide an opportunity to screen youth for Medicaid and State Children’s Health Insurance Program (SCHIP) eligibility. This paper describes ways for states to expand Medicaid and SCHIP eligibility to youth in the juvenile justice and foster care systems; key transition points for these youth; and opportunities to better enroll and keep them in programs that encourage healthy growth and development.
Many options exist for states to expand eligibility to better cover transitional youth. Most of these youth who are younger than 18 are income-eligible for Medicaid. However, they are likely to age out of children’s eligibility categories when they turn 19 unless their state has enacted a Medicaid option to extend coverage through age 20.
The federal Medicaid statute preventing states from receiving a federal match for services provided to “inmates of a public institution” is a major challenge in covering youth in the juvenile justice system. However, states have the opportunity to provide Medicaid coverage to children in the process of entering or leaving the juvenile justice system. For example, many such youth are placed in community-based programs – ncluding small-group homes, treatment foster care, and day treatment – that allow youth to receive services financed by Medicaid.
Youth in the foster care system also tend to face gaps in coverage between the time they are placed in state custody and the time they are reunified with their family, emancipated, or adopted. These gaps in coverage often lead to gaps in treatment.
Given these challenges, this paper focuses on three ways to improve states’ ability to keep youth enrolled in Medicaid and SCHIP:
1) Simplify enrollment,
2) Enhance retention through the transitions, and
3) Better integrate and coordinate services with partners.
The transition from adolescence to adulthood is a difficult time for many youth. Involvement with the juvenile justice and foster care systems adds additional complexity to the lives of youth as they transition between custody arrangements. Medicaid and SCHIP play an important role in providing supportive services for these youth, but only if they enter the programs and stay enrolled.