The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #59608

Laura R. Meraz, BA¹, Jennifer A Rolls, MPH¹, and Kelly J. Kelleher, MD, MPH². (1) Child and Adolescent Services Research Center, Children's Hospital and Health Center, San Diego, 3020 Children's Way, MC 5033, San Diego, CA 92123, 858-966-7703 x7143, lmeraz@casrc.org, (2) Office of Clinical Sciences, Columbus Children's Research Institute, 700 Children's Drive, Room J1415, Columbus, OH 43205

Many, if not most, youth entering detention facilities meet the criteria for mental disorders, and as such, need appropriate care during detention, as well as upon release. While state and local facilities increasingly offer treatment while the juvenile is detained, transition to community services may be difficult because of a lack of continuity of services, transportation issues and most importantly, affordability. While many youth in the detention system enter with Medicaid coverage, some facilities engage in the systematic practice of disenrolling such youth because of the ‘Inmate Exception Rule’ which forbids federal participation for services provided to inmates through Medicaid. In order to prevent duplicate billing and administrative errors, some localities or states have chosen to terminate benefits upon admission to a detention facility, ignoring the consequences that may follow. However, the mechanisms, processes and success of such disenrollment policies and their impact on youth have not been examined. It is not clear how often or at what point after detainment the termination of benefits occurs, if at all. The Adolescent Detainees and Medicaid (ADAM) study explored Medicaid coverage and termination of enrollment for juveniles in detention centers and the possible effects upon release. In addition, ADAM identified detention facilities that use innovative methods for maintaining or re-instating Medicaid coverage for detained youth. Under funding from the MacArthur Foundation, the study is collecting systems level data through the use of key informant interviews with county and state Juvenile Justice and Medicaid officials from approximately 100 counties and all 50 states. The typical informant for the Juvenile Justice interviews was a detention center administrator or health officer; the informant for the Medicaid interviews was typically a supervisor. The county and state interview rates were high and the interviews were well received by the informants; several commented that the study was examining an important and worthwhile issue. Preliminary results show that there is a disconnect in communication between Medicaid and the juvenile detention centers in terms of appropriate use of Medicaid for detained youth. Data analysis is ongoing and final results will be available in the summer of 2003. The data collected through ADAM will be used to determine variation in local policy on termination of Medicaid enrollment upon detention, describe the health services being offered to juveniles in detention facilities, and to identify the specific localities capable of participating in a longitudinal study.

Learning Objectives:

• 3. Describe health services available in juvenile detention centers.
  7. Describe variations in local and state Medicaid policies for detained youth.
  11. Discuss effects of disenrollment from Medicaid for youth upon release from detention.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.