The Medicaid Programs Division works closely and in collaboration with federal and state agencies regarding Medicaid eligibility for juvenile justice youth. The Division provides technical assistance and training on our program initiatives as well as resource information on Medicaid eligibility for TJJD, juvenile probation departments, placement facilities, and other stakeholders.
The Division oversees the Juvenile Medicaid Tracker and Suspension and Reinstatement of Medicaid processes, as well as TJJD Community Partner sites.
Overview of Medicaid Eligibility for Youth in Our Care
Most youth placed in a facility are no longer eligible to remain on their family’s case. Many youth are eligible for Medicaid while residing in a non-secure facility by meeting the criteria as an Independent Child. Youth residing in secure facilities are considered inmates by federal standards and therefore not eligible for Medicaid benefits, with the exception of when an individual becomes an inpatient of a hospital or juvenile psychiatric facility.
Texas Juvenile Justice Medicaid Program
This process began in 1997 as an agreement between the former Texas Juvenile Probation Commission and the Department of Human Services to help expedite Medicaid coverage for eligible juvenile justice youth placed in non-secure out of home placements.
The process expanded in 2016 to include youth placed out of state.
Halfway House Medicaid
Youth residing in a halfway house had previously been ineligible for Medicaid. As per federal guidance provided in 2016, youth residing in a halfway house operated by the Texas Juvenile Justice Department or Juvenile Probation Department are now potentially eligible for Medicaid if the facility meets the following federally required criteria:
- the halfway house must operate in such a way that individuals living there have freedom of movement and association according to the following tenets;
- residents are not precluded from working outside the facility in employment available to individuals who are not under justice system supervision;
- residents can use community resources at will; and
- residents can seek health care treatment in the community to the same or similar extent as other Medicaid enrollees.
Medicaid applications for these independent youth are processed by staff at the HHSC Centralized Benefits Services (CBS) office located in Austin.
The Juvenile Medicaid Tracker (JMT) is the web-based application that was developed to meet the requirements of Sec. 531.02418 of the Government Code, which addresses the need for providing Medicaid or CHIP coverage in a timely manner for youth transitioning back into their homes from out-of-home placements. The Government Code instructs HHSC to ensure that each youth is assessed for eligibility for Medicaid and/or CHIP before being released from placement in a manner that will prevent gaps in coverage. It also holds TJJD and local juvenile probation departments subject to the requirements of the Memorandum of Understanding (MOU) executed between TJJD and HHSC.
HHSC Centralized Benefits Services (CBS) office staff located in Austin assess youth for eligibility. The JMT process went live in April 2010.
In an effort to improve continuity of health care coverage for youth residing in a juvenile facility
House Bill 839 passed during the 84th legislative session, added sections 62.106 and 62.107 to the Health and Safety Code, and sections 32.0264 and 32.0265 to the Human Resources Code. These new statutes resulted in changes concerning the suspension and automatic reinstatement of eligibility for children placed in and released from juvenile facilities and established a means by which the Texas Juvenile Justice Department (TJJD) and Juvenile Probation Departments (JPD) may determine whether a child placed in a facility is active on Medicaid or Children’s Health Insurance Program (CHIP).
Suspension: If a child is placed in a facility for 30 days, TJJD and/or JPD may notify HHSC of the placement of a child who receives health care coverage through Medicaid or CHIP. Upon notification, to the extent allowed under federal law, HHSC shall suspend the child's eligibility for Medicaid or CHIP during the period the child is placed in the facility.
Reinstatement: TJJD and/or JPD shall notify HHSC no later than 48 hours of the release of a child who, immediately before the child's placement in the facility, received Medicaid or CHIP. Within 48 hours of notification of release of a child whose benefits have been suspended under this section, HHSC shall reinstate the child’s eligibility. Reinstatement is facilitated via the Juvenile Medicaid Tracker (JMT).
This process does not apply to youth certified on a Supplemental Security Income (SSI) or Department of Family and Protective Services (DFPS) type Medicaid.
Designated staff at the HHSC Centralized Benefits Services (CBS) office located in Austin facilitate the processing of this information. The suspension and reinstatement process went live in September 2016.
The Community Partner Program (CPP) is a collaboration between HHSC and a statewide network of government, faith-based and community-based organizations, and other social service organizations called Community Partners (CP). The purpose of the CPP is to help people apply for and manage their HHSC Programs benefits (food, cash, and healthcare) online using YourTexasBenefits.com. It also strengthens HHSC's relationships with local communities and organizations across Texas. HHSC trains and certifies community partners to provide application assistance.
TJJD entered into an agreement with HHSC to become part of the CPP to initially facilitate submission of Medicaid applications for our halfway house residents. All our TJJD facilities and district offices are now designated CP sites, with staff available to assist families of youth transitioning to the community as part of the JMT process. The process has also recently expanded to include juvenile probation departments interested in becoming a CP site to assist youth and families residing in the community with submitting online applications for HHSC benefits as well as expedite processing of JMT related applications for youth returning from out of home placement.
The County Indigent Health Care Program (CIHCP) helps low-income Texas residents who don’t qualify for other state or federal health care programs have access to health care services. Benefits are limited to participating administrators who provide primary, preventative and some specialty services.
The program is available to anyone who:
- Lives in Texas.
- Has an income level at or below 21 percent of federal poverty guidelines.
- Has resources less than $2,000.
- Isn’t eligible for Medicaid.
Youth residing in secure facilities are considered inmates by federal standards and therefore not eligible for Medicaid benefits, with the exception of when an individual becomes an inpatient of a hospital or juvenile psychiatric facility. The CIHCP may be an option for assistance in covering some Medical expenses for these youth.