New CMS Guidance on Compliance Requirements for Provision of Medicaid/CHIP Services to Incarcerated Youth

Christopher Cantrell and Gini Morgan, Manatt Health

On December 19, the Centers for Medicare and Medicaid Services (CMS) released State Health Official (SHO) letter 24-006, “Provision of Medicaid and CHIP Services to Incarcerated Youth – FAQs,” which provides several clarifications for states on compliance expectations for implementing section 5121 of the Consolidated Appropriations Act (CAA) of 2023. Key clarifications addressed in the SHO letter include:

1. Are states required to provide pre-release services for incarcerated children and youth in federal custody, including federal prisons?
   1. CMS clarified that the Federal Bureau of Prisons (BOP) will not participate in Medicaid or the Children’s Health Insurance Program (CHIP) because BOP is responsible for individuals’ healthcare while incarcerated. However, CMS does expect states to coordinate with federal carceral facilities to provide access to screening and diagnostic services in the first week post-release (or as soon as practical after release), as well as linkages to targeted case management in the 30 days after release. CMS does not expect states to provide access to these services prior to release given that BOP will not participate.
2. What if a carceral facility is unable to or refuses to participate or engage with state Medicaid/CHIP programs?
   1. CMS reinforced that states should work to engage impacted carceral facilities, but recognizes that it may not always be feasible to secure facility participation and/or implement services prior to release. In these cases, CMS encourages states to maintain clear documentation when a state determines it is not feasible to provide services prior to release (e.g., document in the state’s operational plan, appendix of Reentry Implementation Plan), and work to ensure that individuals have access to required services as soon as possible after release.
3. Will a facility still be in compliance if they provide required pre-release services, but do not enroll in and bill Medicaid and CHIP for those services?
   1. Yes, CMS clarified that CAA requirements may be met even if a carceral facility does not bill Medicaid or CHIP for providing required services. However, CMS strongly encourages states to carefully consider the potential impact of not billing Medicaid/CHIP for pre-release services, such as limitations on billing Medicaid in the post-release for services ordered or prescribed by pre-release providers who are not enrolled in Medicaid.