MARCH2002

Does Medicaid, Title XIX, pay for services to delinquent youth? Why doesn't Medicaid pay for the same services in every state?

The answer to this question will vary from state to state, since individual states determine who is eligible for Medicaid and the type, duration and scope of services that are provided under Medicaid. States have broad discretion to determine the specific population their programs will cover. Since poor children are the largest population served by Medicaid, many youth in the juvenile justice system will and do qualify for services under Medicaid.

Medicaid, Title XIX of the Social Security Act, is a cooperative venture between the Federal Government and State Governments to provide medical assistance to persons with low income and resources. In 1999, it was estimated that Medicaid served 41 million children. The Federal Government provides broad general guidelines, but States administer their programs as they themselves have designed them, with a few exceptions. The Federal Government requires all states to provide Medicaid coverage for certain individuals receiving federal assisted income maintenance, as well as to groups of individuals receiving government support but who do not receive cash payments, poor children, the aged, and the blind and/or disabled.

Since all poor children born since 1983 and under age 19 who are receiving adoption and foster care assistance, who are TANF eligible (who were eligible under the old AFDC regulations), who are SSI recipients, or who are medically needy are covered by the broad federal guidelines, many youth in the juvenile justice system should have services funded by Medicaid.

Examples include the youth in secure detention in Pennsylvania and youth in Milwaukee, WI in the Wraparound Milwaukee program. In both instances, the states determined that those populations would be served for specific period of time and in specific circumstances.

It is very common for a person who is eligible for Medicaid in one state NOT to be eligible in another state or even a neighboring state. It is equally as common for a service provided by Medicaid in one state NOT to be provided in a neighboring state or any other state. This goes back to the cooperative relationship between the Federal Government and the states that says that states will determine eligibility, scope and duration of services to Medicaid recipients.

For specific information on eligibility and what services are rendered in your state, go to the web site of the Association of Public Human Service Administrators at http://www.aphsa.org/members.htm. If you know the Director of Medicaid Service, please call that office first.

Contacting the Director of Medicaid Services in your state directly has added benefits. By contacting the Director of Medicaid Services in your State, you can find out: 

• Who is eligible for Medicaid

• How long one can receive services

• Under what circumstances, if any, services rendered in a secure detention center or training school can be paid for by Medicaid

• How to get a waiver for a specific service or class of citizens

• Why your state decided not to cover certain services 

Tremendous work is needed in this area. Making contact with your state's Director of Medicaid Services will be a first step toward building a relationship that will benefit you and others in advocating for appropriate and timely services to youth and their families.