Nearly 100,000 young people are in juvenile justice facilities of some sort on any given day, with more than 2 million arrested in a year. Of those in residential settings, 62 percent are minorities, 85 percent are boys, and many, if not most, lack adequate health insurance coverage. Youth in juvenile justice facilities – including detention centers, shelters, diagnostic centers, group homes, wilderness programs, residential treatment facilities and training schools (where most juveniles are committed) – suffer disproportionately from a host of mental and physical health problems. The presence and severity of health problems may help explain the behaviors that led to their involvement in the criminal justice system and make it critical they receive the appropriate medical services both in the system and upon their release. Most of those arrested do not end up at trial. Of those who are tried, about two-thirds are sentenced to probation after a trial, allowing a true opportunity for therapeutic intervention in the community. Given the preponderance of low-income youth involved with the juvenile justice system, it is likely that many who enter are enrolled in or eligible for Medicaid.
States and local governments face stiff challenges in organizing and funding services for troubled youth. One challenge is to make Medicaid work better for this population during those times an individual is not in a public institution. Another challenge is to ensure that quality and effective services are provided to individuals both during and after their involvement in the juvenile justice system. Medicaid presents unique limits and opportunities compared to state and local funding. Services provided to those involved in the juvenile justice system are impacted by these funding matters. This paper describes these limits and opportunities, and highlights a number of promising practices and service models in states.
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