Legislators Look for Solutions for Previously Incarcerated Youth Health Care


ANNAPOLIS (March 19, 2010)—Advocates of a bill that would guarantee continuous medical assistance for recently incarcerated youth reentering their communities say their legislation would help minors and save the state money.

Currently, incarcerated youth who use Medicaid or the Maryland Children's Health Program before being sentenced lose their enrollment upon entering juvenile services. Once released from inmate facilities, minors may reapply for the medical services but can go months until they are reaccepted and regain coverage.

Offering the minors access to medications as soon as they are released would lower rates of second-time offenders and save the state money in future medical costs, main bill sponsor Delegate Victor Ramirez, D-Prince George's, said.

The state agencies affected by the bill agree with its intent, but say the legislation is too expensive.

The departments of Juvenile Services, Health and Mental Hygiene, and Human Resources will meet with Ramirez soon to see if they can find a more agreeable solution to guarantee continuous coverage for released youth.

Ramirez's legislation, which would create a new "inactive" or "suspended" status in the state's computer systems for Medicaid and Maryland Children's Health Program (MCHP), was presented to the House Health and Government Operations committee Tuesday.

The new status would eliminate the need for juveniles to reapply for those programs, thereby allowing minors to reenter their homes with the health coverage they had before they were incarcerated.

"The key advantage of keeping individuals enrolled in Medicaid is that the youth's eligibility for services can be restored immediately upon release, translating to immediate access to mental health services, substance abuse treatment, and necessary medications," a study prepared by the national Youth Reentry Task Force of the Juvenile Justice and Delinquency Prevention Coalition stated. "This eases the transition back to the community and increases the youth's chance for success."

It is against the law to use federal funds to support inmates in public systems, so the 1,456 juveniles serving sentences in programs like the Thomas J.S. Waxter Center are funded through the Department of Juvenile Services.

The 722 minors serving sentences in private institutions, such as group therapy homes that the government contracts with, can keep their Medicaid and the Maryland Children's Health Program without interruption.

In its report, the task force recommended that all states suspend rather than terminate health benefits. Forty-six states currently terminate Medicaid when a youth is sent to jail, according to the study published in November.

Currently when a ward of the state exits any public treatment program and reenters the community, the Department of Juvenile Services will notify the Department of Social Services case worker for that area and it becomes the case worker's responsibility to resubmit the minor's medical assistance application.

If the child is returning home it becomes the parent or guardian's responsibility to resubmit the minor's application to Medicaid. In certain cases, the Department of Juvenile Services case worker will assist the family in the reapplication process.

Either way the processing of applications can take more than 90 days.

"(The minors) are leaving our juvenile jails ... and they're not getting their proper medication. And they're going to act out again. Then they'll be in our system again and that's where it costs more to incarcerate someone than treat them," said Ramirez. "When you don't get the proper treatment, sometimes you don't know right from wrong."

Ramirez said that medical costs would be lower, too. By making sure children have access to Medicaid immediately and do not miss any medications or other treatments they might need, they would be less likely to need emergency hospital visits for those issues.

"Especially because of the overlap between mental illness, substance abuse, and criminality, the period of transition from secure custody to the community is a critical time where necessary supports should be in place to provide appropriate medical attention," the task force says in the report.

Nationally, 60 percent of youth in the juvenile system were diagnosed with at least three mental disorders, the task force found.

Delegates questioned how realistic $461,250 was as a budget to accomplish revamping the youth Medicaid computer system, though. This amount would cover the immediate change in the Department of Health and Mental Hygiene's Medicaid Management Information Systems.

Kevin McGuire, executive director of the Family Investment Administration within the Department of Human Resources, testified that it would cost more than $600,000 for his department alone.

"We support the aim of the bill but we're opposed to the cost attached to it," said Connie Tolbert, a spokeswoman for the Department of Human Resources.

Secretary of the Department of Health and Mental Hygiene John Colmers said there are limited resources, money and people, to make this bill work. He indicated that the bill would divert essential resources from another project which would cost the state federal funding.

But advocates say medical care is a right, not a choice.

"We understand the statement the state officials made regarding the bill. It's our belief that it's a policy choice ... to fund the necessary services," said Nicole Porter, the state advocacy coordinator for The Sentencing Project research and advocacy organization. "While someone is incarcerated, systems should be in place at the state level that maintain that child's access to Medicaid. It's what they are entitled to under the law."

Capital News Service contributed to this report.

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