5121 Consolidated Appropriations Act

This requirement applies to:

• Youth up to age 21 who are eligible for Medicaid or

• Young adults up to age 26 who qualify for Medicaid through the former foster care eligibility group

The requirement applies to individuals who are incarcerated after their court case is complete and are preparing for release back into the community.

Under Section 5121, states must make sure certain health services are available:

• Up to 30 days before release, while the youth is still incarcerated

• For at least 30 days after release, once they return to the community

These services include:

• Health screenings and assessments, including physical health, mental health, and substance use needs

• Care coordination and case management to help connect youth with doctors, counselors, medications, and other needed services after release

The intent is to reduce gaps in care, support a smoother transition back into the community, and help young people stay healthier and more stable during reentry.

States are required to have these services in place by January 1, 2025.

The state has also received State Plan Amendment (SPA) approval, which formally authorizes coverage of these services under Medicaid. Additional implementation details and guidance will be shared as they become available.

This page serves as a central landing site for information related to Section 5121 of the CAA. It will be updated as new information becomes available and will include:

• Plain-language explanations of the requirement

• State policies and guidance as they are developed

• Resources for partners, providers, and community organizations

• Updates on implementation and next steps

Please check back regularly for new policies, guidance documents, and resources related to the 5121 CAA requirement.

Purpose of the State Plan Amendment #25-0002-A

The amendment establishes Medicaid coverage for Targeted Case Management services to support eligible youth during the transition from incarceration back into the community. The intent is to improve continuity of care, reduce gaps in services, and support health and stability during reentry.

Eligible Population

Services apply to:

• Youth under age 21 who are eligible for any Medicaid eligibility group, and

• Young adults ages 18–26 who qualify under the former foster care Medicaid eligibility group

Eligibility applies to individuals who are incarcerated post-adjudication and are:

• Within 30 days prior to release, and

• For at least 30 days following release

Montana also elected to provide Targeted Case Management for up to 12 months post-release, with required reassessments at least every 90 days.

Covered Services

The approved SPA defines Targeted Case Management to include:

• Comprehensive assessments and periodic reassessments of medical, behavioral health, social, and educational needs

• Development and ongoing revision of an individualized, person-centered care plan

• Referrals and linkage to appropriate community-based services

• Monitoring and follow-up to ensure services are delivered and remain appropriate as needs change

• Warm handoffs to community providers or other case managers to ensure continuity of care after release

These services are designed to support reentry without delaying release or increasing justice system involvement.

Provider Qualifications and Approval

Targeted Case Management services must be provided by qualified and approved providers. Providers must:

• Be approved by the Behavioral Health and Developmental Disabilities Division (BHDD) as either:

  • a Substance Use Disorder (SUD) provider that is authorized to offer case management services, or

  • a licensed Mental Health Center authorized to provide case management services

• Employ case managers who:

  • Hold at least a bachelor’s degree in a human services–related field (or demonstrate equivalent skills)

  • Have experience working with justice-involved individuals

  • Receive appropriate clinical or programmatic supervision

  • Demonstrate cultural competence

  • Complete required background checks and ongoing training

Providers must also demonstrate the ability to collaborate with correctional facilities, community-based providers, and other stakeholders involved in the youth’s care.

Providers must collaborate with correctional facilities, community organizations, and other stakeholders involved in the youth’s care.

Approval and Authority

CMS approved the SPA under Title XIX of the Social Security Act and relevant federal regulations. The approval confirms that Montana has met federal requirements to implement Section 5121 mandatory youth reentry services statewide, retroactive to October 1, 2025.