Delinquent Youth in Corrections: Medicaid and Reentry Into the Community

In general, states and public agencies acting as custodians for youth in the corrections branch of the juvenile justice system are responsible for ensuring that such youth receive access to timely and appropriate physical and mental health care. However, to date, health care for youth in the juvenile justice system has generally been considered inadequate. Note that in this article “health care” refers to the treatment of both physical and mental health problems. The American Academy of Pediatrics and others have issued policy statements in the past 2 decades that stress the need for better health care for juvenile offenders in correctional facilities.^1–4 In response, correctional facilities have put in place enhanced acute care services for children and adolescents in juvenile justice.

Although such services are almost certainly needed, these efforts are likely to be deficient on at least 2 counts. First, many of these youth suffer not only from acute medical and psychiatric problems but also chronic ones including substance abuse and other psychiatric disorders. Second, with an estimated 88000 youth being released from juvenile commitment facilities each year,⁵ the need for ongoing medical treatment after parole and reentry into the community is high. However, care often stops when the juveniles leave the system, with little or no reintroduction to community services.⁶ Pediatricians and other primary care clinicians have a central role to play in establishing a medical home for these youth and expediting access to critical medical and behavioral services.

This review will provide an overview of the juvenile justice system, present the extant literature on the chronic health problems found in incarcerated youth, and discuss how the absence of care after release from the juvenile justice system impacts public health and society. We argue that Medicaid financing could be used as an …

Reprint requests to (K.K.) Office of Clinical Sciences, Columbus Children’s Research Institute, 700 Children’s Dr, Suite J1401, Columbus, OH 43205. E-mail: kellehek{at}pediatrics.ohio-state.edu