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How to Use This Provider Bulletin Template Per Section 5121 of the Consolidated Appropriations Act, 2023 (CAA), starting January 1, 2025, states are required to provide targeted case management, and screening and diagnostic services for children and youth who are incarcerated post-disposition (i.e., postconviction or adjudication) and enrolled in Medicaid or the Children's Health Insurance Program (CHIP).1 To prepare to implement this requirement, states have been conducting current state assessments to better understand how many youth are eligible for CAA services, in what facilities eligible youth are incarcerated, to what extent services are already being provided in correctional facilities, and what providers are available to deliver these services. During the course of states' engagement with correctional facilities, many have requested state Medicaid agency guidance on what is expected from the facilities and their implementation partners (e.g., managed care plans and community-based providers) as it relates to Medicaid/CHIP eligibility and enrollment, covered services, provider enrollment, and billing and reimbursement. The objective of this Correctional Facility and Implementation Partner Provider Bulletin Template is to outline specific guidance language that would be helpful for state Medicaid agencies to provide to correctional facilities and other partners as they are working towards implementation. This template is designed to be a starting point and should be modified to address specific state laws, regulations, policies and operational processes. Each section of the Correctional Facility and Implementation Partner Provider Bulletin Template includes a description of its purpose and provides example language that may be adapted to explain and operationalize certain aspects of Section 5121 of the CAA. Please note that this template does not constitute legal advice. Please consult with your state legal counsel, as needed, to assure that the provider bulletin's content is developed to comply with all applicable law and meets your specific state needs. |
1. Background
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Section Description: This section provides example text to describe the purpose of the Provider Bulletin, any intersection between the CAA and a state's Section 1115 Reentry Initiative Demonstration, as applicable, and the importance of meeting the CAA's requirements to support the disproportionate physical and behavioral health care needs of youth who are incarcerated. |
This bulletin provides information to correctional facilities and their implementation partners (e.g., managed care plans and community-based providers) about new requirements under the federal Consolidated Appropriations Act (CAA, 2023) (P.L. 117-328) (hereinafter CAA), which was enacted on December 29, 2023 and goes into effect January 1, 2025. Under Section 5121 of the CAA, all states, including [X State], must provide a targeted set of Medicaid-financed services to incarcerated youth who are post-disposition (e.g., youth who are incarcerated after conviction or disposition) in the periods immediately prior to and post-release. On July 23, 2024, the Centers for Medicare & Medicaid Services (CMS) issued implementation guidance, SHO# 24-004 RE: Provision of Medicaid and CHIP Services to Incarcerated Youth.1
Under Section 5121 of the CAA, [STATE AGENCY] is required to ensure the following services are provided to eligible justice-involved youth who are enrolled in Medicaid or CHIP and incarcerated post-disposition:
- Screening and diagnostic services in the 30 days prior to release (or no later than one-week post-release); and
- Targeted case management in the 30 days prior to release and for at least 30 days postrelease.
[INCLUDE PARAGRAPH IF APPLICABLE]: On [X DATE], [STATE AGENCY] submitted/received approval for a Reentry Initiative Section 1115 Demonstration [INSERT ANY RELEVANT LINKS TO WAIVER APPLICATION/APPROVAL], which will allow [STATE'S MEDICAID PROGRAM] to cover certain physical and behavioral health services in addition to case management for [ADULT AND YOUTH] justice-involved population(s) in the period immediately prior to the release to support successful reentry. The [STATE AGENCY] intends to implement the Reentry Initiative Demonstration over [INSERT IMPLEMENTATION PERIOD]. Because of the cross-over between the Reentry Initiative and the CAA, CMS has agreed that [STATE AGENCY] can subsume the CAA operational planning into the Reentry Initiative Section 1115 planning, meaning that [STATE AGENCY] does not need to submit a separate CAA operational plan to CMS. [INSERT SENTENCE, IF 1115 REENTRY INITIATIVE WAIVER DATE IS LATER THAN 1/1/25]: [STATE AGENCY] will start with CAA implementation on January 1, 2025, and implement 1115 on [X DATE].
[STATE AGENCY] recognizes the importance of meeting the CAA requirements, as justice-involved youth have generally experienced disproportionately higher rates of physical and behavioral health conditions, substance use disorder, trauma and poverty.2 Historically, under the Medicaid inmate exclusion policy, states have been prohibited from using Medicaid dollars to pay for services during the incarceration period (i.e., Medicaid coverage is typically suspended during incarceration), thereby limiting access to essential health care services for this high-risk population. The CAA and the Reentry Initiative [IF APPLICABLE] aim to modify these policies and lift the inmate exclusion for targeted services for a specific period of time prior to an individual's expected date of release. [STATE AGENCY] is committed to taking advantage of these federal opportunities to assist justice-involved youth successfully transition back into the community upon reentry with the health supports and services they need.
2. State Plan Authority
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Section Description: This section provides example text to describe the required CAA State Plan Authority and whether the state will pursue a new Targeted Case Management State Plan, amend an existing one, or pursue another legal authority to provide targeted case management. Please select the text most relevant to reflect your state's situation and modify as appropriate. |
- Section 5121 State Plan Amendment
[STATE AGENCY] will use the CMS CAA 5121 State Plan Amendment Template to attest that it has an operational plan and, in accordance with that operational plan, will provide eligible populations under the CAA with the requisite screening and diagnostic services in the 30 days prior to release, as well as targeted case management services in the 30 days prior to release and for at least 30 days following release. - Targeted Case Management State Plan
The State intends to [INSERT AMEND OR SUBMIT NEW] a Targeted Case Management State Plan to secure the necessary legal authority to provide such services to eligible youth, consistent with the CAA requirements. [OR INSERT DESCRIPTION OF CURRENT TARGETED CASE MANAGEMENT STATE PLAN AUTHORITY OR MANAGED CARE AUTHORITY.]
3. Eligible Populations
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Section Description: The section provides example text to describe the eligible populations for whom CAA, Section 5121 applies. |
Under the CAA, eligible populations include youth who are:
- Enrolled in Medicaid or separate CHIP;
- Under 21 years of age or between the ages of 18 and 26 under the mandatory former foster care eligibility group; and,
- Being held in a correctional facility post-adjudication (e.g., youth who are incarcerated after conviction or disposition).
4. Eligible Correctional Facilities
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Section Description: This section provides example text to describe the facilities in which the CAA applies and provides an example table if the state wishes to provide specific names of the facilities subject to the CAA requirements. Please adapt this language to describe specific carceral facilities in your state. |
All facilities that house eligible post-disposition youth are subject to CAA, Section 5121 requirements. These include all the following facilities if they house eligible post-disposition youth:
- Facilities that exclusively house youth, including juvenile detention and youth correctional facilities; and
- Facilities with populations that include CAA-eligible youth (e.g., former foster care youth between ages 18 and 26), including, state prisons, local jails, tribal jails and prisons.
Table 1: Eligible CAA Facilities
| Facility Type | Number of Facilities | Facility Names |
| Juvenile detention and youth correctional facilities | ||
| State prison | ||
| Local jails | ||
| Tribal jails and prisons |
5. Screening and Diagnostic Services: Definitions and Eligible Providers
- Definitions of Screening and Diagnostic Services
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Section Description: This section provides example text for defining screening and diagnostic services. Per SHO #24-004,
The section below is written to meet the minimum standard requirements as outlined in SHO #24-004. States may develop additional standards for medical and dental screening and diagnostic services to be furnished to the post-adjudication eligible youth population during the statutory pre- and post-release period. However, because states have already established standards for EPSDT medical and dental screening and diagnostic services, states may use their already established standards rather than developing additional standards. |
In the 30 days prior to release (or no later than one week, or as soon as practicable after release from the facility) providers must furnish the following screening and diagnostic services. [STATE AGENCY] will cover screening and diagnostic services for eligible youth under the age of 21 in the same manner as for youth who are not incarcerated, but will not cover EPSDT treatment services.
Table 2: Screening and Diagnostic Service Definitions
| Covered Service | Medicaid Eligible Youth Under the Age of 21 | CHIP Eligible Youth Under the Age of 21 | Eligible Youth Ages 21 and Over |
| Screening |
Screening services must include:
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[INSERT STATE AGENCY DEFINITION OF CHIP SCREENING AND DIAGNOSTIC SERVICES IF DIFFERENT THAN MEDICAID] |
Screening services must include:
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| Diagnosis |
Diagnostic services must be rendered:
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Footnotes
1 CMS is responsible for implementing laws passed by Congress related to Medicaid and CHIP. CMS issues regulations and sub-regulatory guidance to states that lay out minimum expectations, guardrails and state options with operationalizing the statutory requirements.
2 Centers for Medicare & Medicaid Services, SHO# 24-004 "RE: Provision of Medicaid and CHIP Services to Incarcerated Youth," July 23, 2024.
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