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 2

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 3

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 4

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 5

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 6

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 7

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 8

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 9

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; 10

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 11

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 12