State Progress in Providing Pre-Release Targeted Case Management (TCM) and EPSDT Services to Incarcerated Youth
Since the beginning of 2025, states have been required to ensure that eligible juveniles who are within 30 days of release from incarceration receive the following services:
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- During the 30 days prior to release, medically necessary screening and diagnostic services, including behavioral health screenings and diagnostic services consistent with Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements.
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- During the 30 days prior to release and for at least 30 days after release, Targeted Case Management (TCM) services, including referrals to appropriate and available care and services.
This article provides an update on states’ progress to provide TCM and EPSDT services pre-release and an overview of the additional steps states must take in order to continue providing the services pre- and post-release to incarcerated youth.
To date, 26 states have submitted and received approval of State Plan Amendments (SPAs) authorizing the provision of TCM services. However, 16 of these approvals are time‑limited through December 31, 2026. For those states, CMS has identified specific implementation actions that must be completed in order to fully operationalize mandatory coverage. States must complete these actions by the end of 2026 to maintain ongoing authority under their State Plans.
Standardizing Eligibility, Enrollment, and Coverage Continuity
CMS is requiring several states to work toward standardized, system-supported Medicaid eligibility and enrollment processes within carceral settings, including preventing termination during incarceration, supporting coverage suspension and reactivation, and ensuring pre-release eligibility determination. Operationally, these states are implementing bi-directional data sharing, allowing Medicaid agencies to receive incarceration and release information in real time. States are also updating eligibility and claims systems so coverage includes authorized pre-release services only and developing special processes to identify former foster youth up to age 26.
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- Massachusetts and Nevada are implementing standardized, statewide eligibility and enrollment processes across all correctional facilities.
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- Vermont is embedding eligibility screening and application at entry and ensuring coverage is suspended rather than terminated.
Stakeholder Engagement and Cross-Agency Coordination
CMS is also requiring states to facilitate better coordination across Medicaid agencies, corrections, juvenile justice, courts, and providers. Such work includes standing up regular stakeholder meetings or workgroups, conducting interagency planning and gap analyses, synchronizing across courts, probation, child welfare, and behavioral health agencies, and ongoing outreach to county-run facilities to assess interest and feasibility.
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- Georgia is using quarterly multi-agency meetings to troubleshoot youth eligibility and service access.
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- New Hampshire is holding one-on-one county meetings to assess county-specific implementation readiness.
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- Wisconsin is focusing on ongoing facility-level outreach and engagement, documenting readiness to enroll in Medicaid, furnish services without enrolling in Medicaid, and those facilities for whom service provision is not yet feasible.
Provider Enrollment, New Provider Types, and Facility Onboarding
Other states are required to support creation of new Medicaid provider types or enrollment pathways so carceral facilities, and in some cases juvenile justice agencies, can legally deliver and bill for TCM services. This includes creating “correctional facility” or “section 5121 specialty” provider types, enrolling juvenile justice agencies or state corrections entities as Medicaid providers, providing technical assistance and enrollment guidance, and using phased onboarding based on facility readiness.
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- Colorado and Massachusetts created new provider enrollment types tailored to correctional settings.
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- New Jersey is enrolling both its Youth Justice Commission and community TCM providers under a new section 5121 provider type.
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- Kentucky and North Carolina are onboarding facilities iteratively based on preparedness assessments.
Data Sharing, Systems, and Technology Integration
Many states need to build or enhance IT infrastructure to support eligibility, service tracking, billing, and coordination across entities. States are executing data use agreements (DUAs) or memoranda of understanding (MOUs) between Medicaid and corrections, building automated incarceration and release notification systems, updating Medicaid Management Information Systems (MMIS) and eligibility systems to restrict services to authorized periods, enhancing interfaces with MCOs and correctional IT systems, and exploring or implementing electronic medical records (EMRs) in juvenile justice settings.
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- Nevada is implementing MMIS benefit plans specific to incarcerated populations.
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- North Carolina is deploying daily roster files to automate incarceration status reporting.
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- Georgia is pursuing a statewide EMR and health information exchange integration.
Billing, Claiming, and Provider Guidance
Several states are still in the process of making billing operationally feasible for entities that have not historically billed Medicaid while also ensuring compliance with federal rules, including developing billing guides and provider manuals and configuring MMIS to limit claims to allowable services and timeframes. To support this process, some states are providing hands-on technical assistance to facilities with limited billing capacity and piloting informal billing processes before scaling.
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- Massachusetts is gradually standardizing billing practices across facilities, with plans to scale formal claims processing across facilities in time.
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- Vermont is folding pre-release TCM billing into its 1115 Reentry Demonstration Waiver.
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- Virginia is implementing system changes, outreach, training, and technical assistance to ensure carceral system providers can enroll and bill Medicaid for pre-release services. The state is also establishing a new 5121 TCM service to be delivered by community providers pre- and post-release.
Training, Technical Assistance, and Educational Materials
Some states are supporting implementation through continuous training and education, developing training modules and recorded materials and training correctional, Medicaid, and provider staff on eligibility, billing, and services. States are also offering continuous technical assistance post-service launch and producing public-facing educational materials for beneficiaries and families.
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- Massachusetts and Nevada are providing facility-specific technical assistance.
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- North Carolina is conducting recurrent trainings with Youth Development Committees, health centers, and MCOs.
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- Ohio is creating various materials to support implementation, including provider agreement language, TA, training materials for external stakeholders, and communication materials for eligible juveniles.
Readiness, Feasibility, and Phased Implementation
Most states are still in the process of supporting incremental, readiness-driven implementation by conducting readiness and feasibility assessments, categorizing facilities as ready, ready with remediation, or not ready. Some states are also documenting non-participation or incapacity to participate, while others are using pilots and early adopters to inform statewide expansion.
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- New Hampshire’s readiness assessments cover operations, staffing, technology, and telehealth.
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- Nevada requires formal facility attestations confirming they are providing required services to eligible juveniles pre-release.
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- Kentucky and North Carolina are assessing feasibility in local jails, which often lag behind state facilities.
Once states complete all actions required by CMS, they must submit an additional SPA acknowledging compliance with Section 5121 of the Consolidated Appropriations Act in order to remove the sunset date. Wyoming recently did just that, receiving approval from CMS in February 2026.