CMS Works with States on Medicaid and CHIP Coverage for Eligible Incarcerated Individuals

Last week, the Centers for Medicare and Medicaid Services (CMS) took significant steps to expand Medicaid and Children’s Health Insurance Program (CHIP) coverage for eligible incarcerated individuals. This expansion mandates coverage for targeted case management 30 days before and after release, which includes hearing screenings and other diagnostic services under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements.

To facilitate this expansion, CMS approved seven new reentry section 1115 demonstrations. These approvals enable Medicaid programs to offer services to imprisoned individuals transitioning back into society. The initiative aims to address the higher health risks faced by formerly incarcerated individuals, improve health outcomes, and reduce reincarceration rates.

Additionally, CMS issued a guidance letter to state health officials on implementing Medicaid and CHIP services for incarcerated youth. This guidance aligns with statutory requirements from the Consolidated Appropriations Act of 2023, which affects the availability of Medicaid services for these individuals, and modifies CHIP eligibility for children who become incarcerated.