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    OpenPayerPolicy UpdatesClinical/Medical PolicyUtah Medicaid Juvenile Transition Coverage | OpenP…
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    CurrentUtah MedicaidPolicy 25-0004

    Mandatory Coverage for Eligible Juveniles who are Inmates of a Public Institution Post Adjudication of Charges

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    This policy governs Medicaid coverage and transitional services for eligible juveniles who are inmates of public institutions following adjudication of charges and approaching release. It requires screenings, diagnostic services, behavioral health services, and targeted case management before and after release.

    Policy Summary
    PayerUtah Medicaid
    PolicyMandatory Coverage for Eligible Juveniles who are Inmates of a Public Institution Post Adjudication of Charges
    Policy CodePolicy 25-0004
    Change TypeNew policy
    Effective DateJan 1, 2025
    Next Review DateN/A
    Key ActionCoordinate medically necessary screenings, diagnostic services, behavioral health services, and targeted case management with the public institution before and after release.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Under 21Age eligibility
    30 daysPre-release service period
    30+ daysPost-release case management
    4Covered facility types
    Policy Summary
    PayerUtah Medicaid
    PolicyMandatory Coverage for Eligible Juveniles who are Inmates of a Public Institution Post Adjudication of Charges
    Policy CodePolicy 25-0004
    Change TypeNew policy
    Effective DateJan 1, 2025
    Next Review DateN/A
    Key ActionCoordinate medically necessary screenings, diagnostic services, behavioral health services, and targeted case management with the public institution before and after release.
    SourceLink
    On This Page
    Eligible Juvenile Transition CoverageOperational Plan DocumentationKey Policy Definitions

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    AvailablePost-release fallback

    Eligible Juvenile Transition Coverage

    Eligible juvenile transition coverage

    Coverage applies when all eligibility and timing requirements are met:

    Eligible juvenile approaching release

    • Medicaid eligibility pathway: The individual is under 21 years of age and was determined eligible for any Medicaid eligibility group immediately before becoming an inmate of a public institution or while an inmate; or the individual is eligible for the mandatory former foster care children eligibility group from age 18 up to age 26 under the same circumstances.Under 21, or former foster care eligibility from age 18 up to age 26
    • Required covered services: The required services include screenings and diagnostic services meeting reasonable standards of medical and dental practice or otherwise medically necessary under Early and Periodic Screening, Diagnostic, and Treatment requirements, including behavioral health screening or diagnostic services, and targeted case management with referrals to appropriate care and services when feasible.Screening and diagnostic services during the transition; targeted case management during the 30 days before and at least 30 days after release

      Services are coordinated with the public institution.

    Service timing and feasibility

    Required services must be furnished during the pre-release period unless the state determines that delivery is infeasible for a documented facility or circumstance:

    Service delivery timing

    • Feasible pre-release delivery: The facility and circumstances permit delivery of the required services before release in coordination with the public institution.Within 30 days before release

      Required services may be furnished before release without the facility enrolling in or billing Medicaid, as addressed in the state's operational plan.

    • Infeasible pre-release delivery: The state has identified and documented a facility or circumstance where pre-release delivery is not feasible, and the required screening, diagnostic, behavioral health, and targeted case management services are provided after release.Post-release delivery required

      Examples include an unexpected release or short-term stay. Post-release services include the mandatory 30 days of targeted case management.

    Operational Plan Documentation

    Documentation Required

    Maintain operational plan documentation

    Maintain clear documentation in the internal operational plan identifying each facility or circumstance where pre-release services are not feasible, such as an unexpected release or short-term stay. Also identify facilities that furnish required services before release without enrolling in or billing Medicaid; this documentation must be available to CMS upon request.

    • Document facilities or circumstances where required pre-release services cannot be provided.
    • Document facilities furnishing required services before release without enrolling in or billing Medicaid.
    • Make the operational-plan documentation available to CMS upon request.

    Key Policy Definitions

    Eligible juvenile
    AgeUnder 21 years of age
    Medicaid eligibilityDetermined eligible for any Medicaid eligibility group immediately before becoming an inmate of a public institution or while an inmate; this also includes the mandatory former foster care children eligibility group for individuals ages 18 up to 26.
    Institutional statusAn inmate of a public institution following adjudication of charges and within 30 days of the scheduled release date.
    Public institution
    SettingA correctional or penal setting considered a public institution.
    Covered examplesPrisons, jails, and detention facilities.
    Other examples
    Boot camps, wilderness camps, or other similar penal settings.
    Screening and diagnostic services
    ScreeningsScreening services that meet reasonable standards of medical and dental practice, as determined by the state, or are otherwise medically necessary under Early and Periodic Screening, Diagnostic, and Treatment requirements.
    Diagnostic servicesDiagnostic services meeting reasonable standards of medical and dental practice or otherwise medically necessary under Early and Periodic Screening, Diagnostic, and Treatment requirements.
    Behavioral healthBehavioral health screening or diagnostic services included among the required services.