With more than half of states expanding their Medicaid programs under the Affordable Care Act, Medicaid is growing in many ways. In contrast, recent articles highlight two places where Medicaid can’t reach: (1) juvenile justice residential facilities and (2) residential addiction treatment in community-based facilities with more than 16 beds.
An issue brief from the Kaiser Family Foundation explains that federal law prohibits the use of federal Medicaid funds to provide services to inmates in public institutions, with certain exceptions, a provision known as the inmate exclusion. The law allows youth already enrolled in Medicaid and entering juvenile justice residential facilities to remain enrolled, but Medicaid generally will not cover the cost of their care while they reside in the facility. The inmate exclusion also applies to adults in correctional facilities.
Federal law also generally prohibits Medicaid from covering care in adult residential mental health treatment facilities with more than 16 beds. This provision is known as the institutions for mental disease exclusion. According to this New York Times article, the law “was intended to prevent Medicaid funds from covering treatment in state psychiatric hospitals, which were far more common when it was written in 1965.” Today, as Medicaid expands to cover more people, this exclusion affects patient intake at larger facilities.
