Close Care Gap for Children

TMA Testimony by Ryan Van Ramshorst, MD

House Public Health Committee
HB 839 – Presumptive Eligibility in Medicaid for Certain Children

April 7, 2015

Submitted on behalf of:
Texas Medical Association
Texas Pediatric Society 

Good morning, Chair Crownover and committee members. I am Ryan Van Ramshorst, a practicing pediatrician from San Antonio, testifying today on behalf of the Texas Medical Association and the Texas Pediatric Society in favor of House Bill 839, which will help improve the continuity of medical care provided to some of our most vulnerable children – youth leaving a juvenile detention center to return to the community.

Each year, hundreds of youth exit placement, commitment or detention from a juvenile detention facility. Just like any child these youth should have access to health care coverage and a primary care medical home to care for their needs and to monitor their ongoing development into adulthood. In addition to needing access to basic primary care, detained youth are more likely to have acute medical and psychiatric needs. Unfortunately, when transitioning from a facility back to the community, many of these youth experience a gap in coverage, despite being Medicaid eligible at the time of their release. That is because the Medicaid application process cannot begin while still in a juvenile justice facility. By authorizing these facilities to provide presumptive eligibility, Texas can maintain continuity of care for youth leaving Texas Juvenile Justice Department (TJJD), which will vastly improve their medical care. 

A gap in coverage is problematic for any child, but it poses particular challenges for this population because of the extent of their physical and behavioral health needs. Among incarcerated youth, national studies indicate higher rates of acute illnesses such as chronic liver problems, sexually transmitted diseases, unplanned pregnancies and a history of hospitalization for a medical or surgical reason. Chronic needs are also of concern for detained youth including dental, dermatological and respiratory problems and substance abuse and psychiatric disorders.[1] As an example, of the 782 youth admitted to TJJD facilities in 2014, 82% had a need for alcohol and other drug treatment and 54% presented with at least one psychiatric diagnosis, indicating need for mental health care. [2]


[ 1 ] Gupta, R.A., et al. (2005). Delingquent Youth in Corrections: Medicaid and Reentry into the Community. Pediatrics.

[ 2 ]Texas Juvenile Justice Department. (Dec 2014). The Annual Review of Treatment Effectiveness. Retrieved from: 

84th Texas Legislature Testimonies and Letters

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Last Updated On

April 10, 2015

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