ABOUT THE DEPARTMENT

The Health Care Authority works to ensure that all New Mexicans can attain optimal health and reach their full potential.

People leaving jail or prison often face numerous challenges accessing health care. Beyond costs, stigma, and long wait times, other barriers include gaps in Medicaid coverage, lack of provider awareness about their unique health needs, and difficulties in navigating health care systems.

They may need immediate access to primary care, mental health services, and substance use treatment, yet delays in care can lead to worsened health outcomes and higher rates of emergency room utilization.

JUST HEALTH PLUS (1115 WAIVER DEMONSTRATION PROJECT)

Providing Medicaid-covered services to adults and youth up to 90 days prior to release from incarceration or detention

What is JUST Health Plus?

Approved in July 2024 under the 1115 Waiver demonstration, JUST Health Plus will provide Medicaid-covered services to eligible incarcerated youth and adults 30-90 days prior to release from prison, jail and or detention centers.

Why is this initiative important?

Through this initiative, New Mexico Medicaid aims to:

•  Ensure Medicaid-eligible individuals receive re-entry services prior to release,
• Prepare people for a successful transition and reentry into their community and help them live their healthiest life,
•  Improve health outcomes and reduce recidivism (re-offense), emergency department visits, overdoses, and death,
•  Support substance use disorder and recovery and target infectious diseases like Hepatitis C before a person’s release, and
• Stabilize and treat other conditions before a person’s release so they can reenter their community as healthy as possible.

What services will the initiative provide?

Just Health Plus will support and fund the delivery of targeted pre-release services to Medicaid-eligible adults and youth in state prisons, jails, and youth carceral facilities. New Mexico Medicaid will require participating facilities to provide three mandatory services, and eight additional, optional services subject to state budget availability and facility readiness. The three mandatory services are:

• Case management
• Medication Assisted Treatment, and
•  30-day supply of medications and medical supplies at release.
• Additional, optional services (subject to state budget availability) include:
• Physical and behavioral clinical consultations,
• Medication and medication administration,
• Hepatitis C treatment,
•  Laboratory and radiology services,
• Services by community health workers (CHWs) with lived experience,
•  Peer Support services,
•  Family Planning services, and
•  Durable medical equipment and supplies.

Timeline for Implementation

New Mexico Medicaid has convened several targeted workgroups with state and county carceral facilities to prepare to enroll carceral facilities as providers and reimburse for Medicaid covered services beginning in summer 2025.

How to Learn More See the Community Presentations web page for upcoming public stakeholder meetings.

Other Resources

• MAD Justice Involved Public Meeting presentation (12/19/24)
• Medicaid.gov: What is an 1115 Demonstration?

CONSOLIDATED APPROPRIATIONS ACT (CAA) SERVICES FOR JUSTICE-INVOLVED YOUTH

A portion of the CAA law passed by Congress is specific to juveniles who are incarcerated. The aim is to expand access to Medicaid to improve pre-release planning with a specific focus on improving care coordination for the re-entry period.

Other Resources

• Medicaid.gov: SHO Letter (.pdf)

JUST HEALTH PROGRAM

In 2015, Governor Martinez signed Senate Bill 42 (SB42) into law, ensuring that individuals who are eligible or enrolled in Medicaid maintain that eligibility during incarceration, and can quickly be reinstated upon their release from jail or prison.

The JUST Health program ensures that:

• Being in jail or prison does not mean someone loses their Medicaid eligibility. Instead, their benefits are paused until they are released.
• If someone wasn’t on Medicaid before they were incarcerated, they can apply while they are in jail or prison.
• When an individual is released, their Medicaid benefits are restarted as long as they still qualify. This ensures access to medical care right away.
• Jails and prisons must inform the Medicaid agency when someone is sent to jail and when they are released.
• This law helps make sure people leaving jail or prison can get the medical care they need without delays.
• In 2018, Governor Martinez signed House Bill 19 (HB19) into law, which reinforced four key elements of SB42 and added new rules to help people in jail or prison get healthcare when they are released.
• HB19 added requirements that:
• The HCA and jails or prisons must help connect Medicaid members with care coordination before they are released, if allowed by federal rules.
• HCA and the Behavioral Health Services Division (BHSD) must provide a behavioral health screening tool to county facilities to help identify inmates who need support.

This law helps make sure people leaving jail or prison have better access to physical and behavioral health care services.

JUST Health is a partnership with the Medicaid managed care organizations (MCOs) and state and county correctional facilities. HCA receives daily electronic reports of members who enter or are scheduled for release from a carceral facility. Additionally, facilities and Presumptive Eligibility Determiners notify HCA and MCOs of incarceration dates and release dates for incarcerated individuals.

Presumptive Eligibility Determiners (trained and certified by the HCA) are located in jails and prisons to help incarcerated individuals apply for Medicaid.

When a Medicaid member enters incarceration, and is released within 30 days of entry, their Medicaid benefits are not suspended.

Under the JUST Health program, the Turquoise Care health plans each have a Justice Liaison as a single point of contact to support Medicaid members with transition of care planning as they return to their communities. Other contract requirements are included in the managed care contracts.

SHORT TERM MEDICAID FOR INCARCERATED INDIVIDUALS (STMII) PROGRAM

When a Medicaid member is incarcerated for more than 30 days, Medicaid benefits are suspended until they are released. The only Medicaid-covered service available to incarcerated members is inpatient hospital treatment (requiring a hospital admission of longer than 24 hours). These inpatient hospital services are generally covered services through the Medicaid Fee-for-Service (FFS) program if the facility has an agreement with HCA. Known as Short Term Medicaid for Incarcerated Individuals (STMII), Medicaid will only pay for STMII claims if the service is a Medicaid covered service.

To be eligible for STMII, an incarcerated member must be approved for Medicaid and have benefits suspended in order for STMII to pay for inpatient hospital stays of more than 24 hours. Inpatient hospital service must be a Medicaid covered service for Medicaid to pay for the inpatient hospital claim. A member may be eligible for STMII benefits multiple times a year.

STMII is only covered for correctional facilities who have a GSA contract with HCA.

How to Learn More

See the Community Presentations web page for upcoming  public stakeholder meetings.