Testimony of Rachel White: Youth Leaving Justice System Deserve Comprehensive Healthcare

Hello Chairperson Henderson and members of the Committee on Health. Thank you for the opportunity to testify today regarding the Department of Healthcare Finance’s performance, and particularly the need to ensure access to services for youth exiting the justice system. My testimony will focus on the urgent need for streamlined Medicaid enrollment and behavioral health services for justice- involved youth as they transition back into the community.

Justice-involved youth face barriers to Medicaid access. 

Justice-involved youth experience significant challenges in re-establishing Medicaid coverage upon release from juvenile justice facilities. The newly enacted Consolidated Appropriations Act (CAA) requires Medicaid coverage for justice-involved youth to be reinstated 30 days before their release, and mandates case management support. However, it is unclear whether or how DC is implementing this law. 

• In 2021, fewer than one in five justice-involved youth ages 16 to 18 reported being enrolled in Medicaid upon release.
• Nearly two-thirds of justice-involved youth reported not having a primary healthcare provider.
• Nearly two-thirds of youth reported having physical health conditions, while approximately half reported substance use or mental health challenges.
• DC’s Medicaid enrollment backlog results in processing delays of over 45 days for nearly half of applications, leaving many youth without coverage when they need it most.

Medicaid access can be improved with automated enrollment and expanded case management.

1. Automate Medicaid Enrollment: 
   1. DC should use the provisions of the CAA to mandate that the Department of Youth Rehabilitation Services submits Medicaid re-enrollment applications 90 days before a youth’s release to prevent lapses in coverage.
   2. The CAA Medicaid provision appropriates grant funding to the Department of Health and Human Services.  Federal grants should be leveraged to create an automated system that streamlines Medicaid applications and renewals, improving information sharing between agencies.
2. Expand case management services: The Department of Behavioral Health and the Department of Health Care Finance must collaborate to ensure targeted case management is provided at least 30 days before young people are released, including providing referrals to care providers.
3. Enhance support for guardians and youth navigating enrollment: Some justice-involved youth may face challenges in navigating Medicaid enrollment independently. DC should establish dedicated navigators to assist both youth and their guardians in completing applications and accessing services. The Health Benefit Exchange has seen great outcomes through their use of health care enrollment navigators and this model should be replicated. 

Medicare access can change lives. 

Ensuring Medicaid access for justice-involved youth will provide them with vital physical and behavioral healthcare services, improve continuity of care, and reduce recidivism. By implementing these recommendations, DC can remove bureaucratic obstacles and support youth in successfully reintegrating into their communities.

I urge the Committee to prioritize these recommendations and hold the Department of HealthCare Finance accountable for implementing these solutions. Thank you for your time and commitment to improving health access for justice-involved youth.