Valentino Valdez received his birth certificate, Social Security card, a t-shirt, and khaki pants when he was released from a Texas prison in 2019 at the age of 21. However, he did not have health insurance, medications for his mental health conditions, or access to a doctor, he said.
Three years later, he ended up hospitalized after expressing suicidal thoughts.
After more than a decade of going through juvenile detention centers, foster homes, and state prisons, Valdez now realizes that receiving treatment for his mental health issues would have made life much easier.
“I was struggling with many mental health issues,” said Valdez, who is now 27.
For years, individuals like Valdez have often had to fend for themselves when seeking healthcare services after being released from jail, prison, or other correctional facilities.
Despite the high rate of mental health problems and substance abuse disorders in this population, they often return to their communities without coverage, increasing their chances of dying or experiencing a relapse that leads them back to jail.
A new federal law aims to better connect incarcerated minors and young adults who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) with services before their release.
The goal is to help prevent them from developing a health crisis or recidivating while in the process of reintegrating into society.
“This could change the trajectory of their lives,” said Alycia Castillo, associate policy director at the Texas Civil Rights Project. She added that without that treatment, many young people leaving the system struggle to reintegrate into schools or jobs, do not follow rules, and end up going in and out of detention centers.
Historically, Medicaid has been prohibited from paying for the health services of incarcerated individuals. Therefore, jails, prisons, and detention centers across the country have their own healthcare delivery systems, usually funded with state and local budgets, not integrated with a public or private healthcare system.
The new law is the first change to that prohibition since the creation of the Medicare and Medicaid Act in 1965, and is part of a spending bill signed by President Joe Biden in 2022. It went into effect on January 1 of this year and requires all states to provide medical and dental exams to young people eligible for Medicaid and CHIP, thirty days before or immediately after they leave a correctional facility. The youth must continue to receive case management services for 30 days after their release.
More than 60% of incarcerated youth are eligible for Medicaid or CHIP, according to a September 2024 report from the Center for Health Care Strategies. The new law applies to minors and young adults up to 21 years old, or 26 for those who, like Valdez, were in foster care.
However, implementing the law will require significant changes in how the thousands of correctional facilities across the country provide healthcare to individuals returning to communities, and it could take months or even years for facilities to fully comply.
“It’s not a matter of flipping a switch,” said Vikki Wachino, founder and executive director of the Health and Reentry Project, which has been helping states implement the law. “These connection points have never been made before,” said Wachino, former deputy administrator of the Centers for Medicare and Medicaid Services (CMS).
The CMS has not stated how they plan to enforce the law.
It is also unclear if the Trump administration will compel states to implement it. In 2018, President Donald Trump signed a law requiring states to enroll eligible youth in Medicaid when they were released from prison, so they did not experience a gap in health coverage.
The law signed by Biden was based on that change by requiring facilities to provide health exams and services to those youth, as well as those eligible for CHIP.
Although the number of incarcerated youth in the country has significantly decreased in the past two decades, more than 64,000 minors and young adults aged 20 or younger are in state prisons, local jails, tribal facilities, and youth facilities, according to estimates provided to KFF Health News by the Prison Policy Initiative, a nonprofit organization that researches the harm of mass incarceration.
An “overlooked part of the healthcare system”
The Federal Bureau of Justice Statistics estimates that approximately one-fifth of the country’s prison population spent time in foster care. Non-Hispanic Black youth are nearly five times more likely than non-Hispanic white youth to be placed in juvenile facilities, according to The Sentencing Project, a nonprofit organization advocating for reducing prison and jail populations.
Studies show that minors who receive treatment for their health needs after release are less likely to reenter the juvenile justice system.
“Often, what leads minors and families to these systems are unmet needs,” said Joseph Ribsam, director of child welfare and juvenile justice policy at the Annie E. Casey Foundation and former state official for youth services. “It makes more sense for children to have their healthcare linked to a healthcare system, not a correctional system.”
However, the new law will require many changes. Facilities and agencies must first create systems to identify eligible youth, find healthcare providers who accept Medicaid, bill the federal government, and share records and data, according to state Medicaid officials, correctional officers, and researchers following the changes.
In January, the federal government began distributing around $100 million in grants to help states implement the law, including updating technology.
Some state officials are pointing out potential complications.
For example, in Georgia, the state’s juvenile justice system has no way to bill Medicaid, said Michelle Staples-Horne, medical director of the state’s Department of Juvenile Justice.
In South Dakota, suspending Medicaid or CHIP coverage for a person while in prison instead of simply terminating it is a challenge, said Kellie Wasko, secretary of the state’s correctional system, in a webinar in November about the new law. That is a technical change that is difficult to implement, she noted.
State Medicaid officials also acknowledged that they cannot force local officials to comply.
“We can build a baseball field, but we can’t make people come play ball,” said Patrick Beatty, deputy director and policy director of the Ohio Medicaid Department.
States should see the law as a way to address an “overlooked part of the healthcare system,” said Wachino, the former CMS official. By improving care for individuals leaving prison, states can spend less money on emergency care and corrections facilities, she said.
“Any state that is delaying the process is missing an opportunity,” she added.
“Our system is making people worse”
The Texas Department of Family Services took custody of Valdez when he was 8 years old because his mother’s history of seizures made her unable to care for him, according to records. Valdez said he ran away from foster homes due to abuse or neglect.
A few years later, he entered the Texas juvenile justice system for the first time.
Officials there did not comment on his case. But Valdez said that as he was transferred from one facility to another, his antidepressants and antipsychotic medications were abruptly discontinued and his records were rarely transferred. He never received therapy or other support to cope with his childhood experiences, which included sexual abuse, according to his medical records.
Valdez said his mental health deteriorated while in detention, because he was isolated for long periods, treated roughly by staff, feared violence from other children, and received inadequate medical care.
“I felt like an animal,” said Valdez.
In August, the U.S. Department of Justice released a report stating that the state exposes detained children to excessive force and prolonged isolation, does not protect them from sexual abuse, and does not provide adequate mental health services.
The Texas Juvenile Justice Department has said it is taking steps to improve safety in its facilities.
In 2024, 100% of minors in Texas Juvenile Justice Department facilities needed specialized treatment, including for mental health issues, addictions, or violent behavior, according to the agency.
Too often, “our system is making people worse and not offering them the continuity of care they need,” said Elizabeth Henneke, founder and executive director of the Lone Star Justice Alliance, a nonprofit law firm in Texas.
Valdez said that the trauma of state custody overshadowed his life after his release. He easily became angry and violent and often felt despair. He was incarcerated again before experiencing a crisis that led to hospitalization in 2022. He was diagnosed with post-traumatic stress disorder and prescribed medications, according to his medical history.
“It helped me understand that I wasn’t going crazy and that there was a reason,” he said. “Since then, I’m not going to say it’s been easy, but it has definitely been a bit more manageable.”
