The law went into effect Jan. 1 and says youth up to 21 or foster youth up to 26 should be connected to health care before or soon after they leave prisons, detention centers or jail.
Oona Zenda/KFF Health News
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Oona Zenda/KFF Health News
If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline.
Valentino Valdez knows all too well the challenges of life after incarceration. Released from a Texas prison in 2019 at 21, Valdez was given basic documents but lacked health insurance, mental health medications, and access to a doctor. His life took a turn for the worse a few years later when he entered an inpatient hospital due to suicidal thoughts. Valdez, who has cycled through juvenile detention, foster care placements, and state prisons, now realizes that adequate mental health care during those critical years could have profoundly changed his trajectory.
“It’s not until you’re put in, like, everyday situations and you respond adversely and maladaptive,” he said. “You kind of realize that what you went through had an effect on you.”
At 27, Valdez is still grappling with the mental health issues stemming from his upbringing and incarceration. Statements like these highlight the urgent need for effective reentry policies that address the health needs of incarcerated youth and young adults.
Lapses that Lead Back to Jail
Former inmates often face significant challenges in accessing healthcare, which can lead to reoffending. This is particularly true for youth and young adults who are already at a disadvantage due to their past involvement in the criminal justice system. A recent federal law seeks to address this issue by requiring Medicaid and CHIP eligibility screening for incarcerated children and young adults up to 21, or 26 for those in foster care.
“This new law could dramatically alter the course of their lives,” said Alycia Castillo, associate director of policy for the Texas Civil Rights Project. “Without access to necessary health services, many young people leaving custody struggle to reintegrate into society, become dysregulated, and end up back in detention facilities.”
The new legislation mandates medical and dental screenings for eligible individuals 30 days prior to or immediately after their release, ensuring timely access to healthcare. Additionally, it requires the provision of case management services for the first 30 days in the community. More than 60% of incarcerated youth are eligible for Medicaid or CHIP, according to a recent report from the Center for Health Care Strategies.
A Challenge for States, Building on a Trump 1.0 Law
Implementing this law will require significant changes to the healthcare systems in correctional facilities across the country. While this new legislation builds on a similar law enacted under the Trump administration, compliance will not be straightforward. States will need to overhaul multiple systems to identify eligible individuals, connect them with healthcare providers who accept Medicaid, and ensure seamless data transfer and billing.
“It’s not going to be flipping a switch,” stated Vikki Wachino, founder and executive director of the Health and Reentry Project. “These connection points have never been made before.”
The federal Center for Medicare & Medicaid Services (CMS) has allocated approximately $100 million in grants to assist states in making these changes, including the necessary technological upgrades. However, challenges remain, particularly for states with limited resources or outdated systems.
For example, in Georgia, the state juvenile justice system is currently unable to bill Medicaid. Similarly, South Dakota faces difficulties in suspending a person’s Medicaid or CHIP coverage during incarceration rather than terminating it. These are complex issues that require careful planning and implementation.
A ‘Neglected Part of the Health System’
The federal Bureau of Justice Statistics reports that approximately 20% of the U.S. prison population has a history of foster care. Additionally, Black youths are nearly five times more likely than white youths to be placed in juvenile facilities, according to the Sentencing Project. Addressing these disparities is crucial for the successful reintegration of incarcerated youth.
Studies have shown that providing healthcare for youth after release can significantly reduce the likelihood of reentering the juvenile justice system. “We frequently see unfounded needs pulling children and families into these systems,” said Joseph Ribsam, director of child welfare and juvenile justice policy at the Annie E. Casey Foundation. “It makes more sense for children to have their healthcare tied to a healthcare system, rather than a carceral system.”
Despite these findings, integrating healthcare into correctional facilities and ensuring continuity post-release pose significant challenges. States will need to develop robust systems to enroll eligible individuals in Medicaid or CHIP, find healthcare providers willing to accept these insurance plans, and manage the data exchange between correctional facilities and health agencies.