CDC Update on New Medicaid Rules for Incarcerated Youth Services

Effective January 1, 2025, Medicaid and Children’s Health Insurance Program (CHIP) are required to provide select services to certain eligible youth, including some youth under 21 years of age or under 26 years of age with a history of foster care, who are incarcerated and within 30 days of their scheduled release date following adjudication. The new coverage requirements include screening, diagnostic, and case management services, as outlined in CMS guidance.

For the first time through this policy change, all state Medicaid and CHIP programs have the opportunity to provide several services recommended by CDC for eligible youth who are incarcerated. This includes screening for HIV, hepatitis B and C, sexually transmitted infections (STIs), and tuberculosis.

In addition to this mandatory coverage, states will have the option to provide Medicaid coverage to eligible youth who are incarcerated pending disposition of charges and/or to consider children who are pending disposition of charges as eligible for CHIP during that time. Adopting the optional coverage to expand coverage to all Medicaid and CHIP services to youth who are detained pending disposition of charges could facilitate coverage of additional CDC treatment and prevention recommendations.

Leadership, providers, and staff in a correctional/detention facility or criminal justice system can:

• Review the CDC Recommendations for Correctional Settings for HIV, viral hepatitis, STIs and TB to identify existing services and gaps in services that could be covered.
• Connect with and discuss potential correctional policy and operations changes for inclusion of services with your leadership and other representatives.
• Coordinate leadership and implementation with state Medicaid and CHIP Agency partners.

State Medicaid and CHIP officials or public health organizations can: 

• Review the CDC Recommendations for Correctional Settings for HIV, viral hepatitis, STIs and TB and consider how they may be supportive when developing the new coverage policies.
• Connect with the representative(s) including leadership, providers, and staff in correctional/detention facilities and criminal justice systems who are involved in the Medicaid and CHIP policy and operational changes and discuss current and potential implementation of services, including those in the CDC Recommendations for Correctional Settings.

Please consider these CDC recommendations when implementing the new Medicaid and CHIP requirements as part of your state plan and Section 1115 Medicaid demonstration implementations, and how they could contribute to essential and equitable health care provision and support improved post-release infectious disease health outcomes.