Maintaining Health Insurance for Incarcerated Youths
By Smith, Kelly D | |
Proquest LLC |
Incarcerated youths are generally held in juvenile facilities that may be categorized as detention centers, or state-run correctional institutions for longer-term incarceration. Typically, detention facilities are administered by local governments and hold youths awaiting court decisions (i.e., preadjudicated). States generally run long-term institutions such as training schools or youth prisons. Some states also use private group homes.1 Once youths enter the corrections branch of the juvenile system, the state becomes their custodian and is responsible for ensuring that they receive timely, accessible and appropriate physical and mental health care.2 The federal government and court rulings have set minimal standards of care. Each state regulates the local facilities, and may conduct inspections with variable oversight.1 Nevertheless, juveniles held in custody are given - by law - access to health care that meets their clinical needs.
Many youths entering the juvenile justice system come from low socioeconomic backgrounds; have been wards of the state long enough to no longer have insurance covered by their families; or have been removed from insurance by their families, leaving the youths to be placed on
Covering the cost of health care and actually providing services has proven to be a daunting task for correctional health care staff and administrators in government agencies, because their funding streams are inconsistent, vulnerable to budget cuts and rely primarily on tax revenue funding for juvenile corrections. Correctional health care staff usually share the same budget sources that are intended to operate the juvenile correctional department or agency as a whole. Nonetheless, state and local governments have a legal and moral obligation to provide medical and mental health services that meet the community standard.*1 This dilemma is an injustice to juvenile justice agencies and to the youths entrusted into their care.
Juvenile Health Care and Treatment
Juvenile facilities release an estimated 88,000 youths each year.7 In 1999, an estimated 717,036 juveniles were incarcerated in the U.S. In 2001,
According to Forest et. al., when compared with civilian youths of the same age, incarcerated male youths had significantly worse health statuses as demonstrated by poorer health and functioning scores in perceived well-being; self-esteem; physical discomfort; acute, chronic and psychosocial disorders; family involvement; physical activity; interpersonal problem-solving; risky behaviors and academic performance.12 Three profile types - high-risks, high-risks/low resilience and worst health - accounted for patterns of health for 69.8 percent of incarcerated youths versus 37.3 percent of an age-matched school sample. Incarcerated male youths were significantly older; were more likely to participate in at least one of three welfare programs; were more likely to have a mother who was unemployed; and were nearly twice as likely to be from single parent families as boys in the civilian sample.
It is well-documented among researchers that adolescents entering correctional facilities may be at high-risk for pre-existing conditions such as mental health disorders, drug and sexual abuse, sexually transmitted diseases, poor dental health and other chronic health conditions that are often associated with their legal problems and/or parental neglect. These conditions have been found to occur at a greater rate in incarcerated youths compared to youths who are not incarcerated.13
Gupta et. al. outlined the policy issues and barriers to care for these youths in a 2005 pediatrics commentary. They cited the Social Security Act, which excludes federal financial participation in "care or services for any individual who is an inmate of a public institution" unless the individual is in a medical institution.14 As a result, most states terminate a youth's
Another factor to consider is release or discharge planning. Lack of
Suggestions for Improving Juvenile Health Care Coverage
Currently, several barriers and challenges exist in maintaining health insurance for incarcerated youths. States will need to carefully examine federal legislation for guidance on the provisions to identify opportunities to maximize
Possible improvements to the current system may include establishing health policies that seek to first determine a youth's
ENDNOTES
1 Morris, R.E. 2005. Policy forum health care for incarcerated adolescents: Significant needs with considerable obstacles. Virtual Mentor, 7(3): 1.
2 Gupta, R.A.,
3 Morris, R.E. 2005.
4
5 Burrell, S. and A.
6 Morris, R.E. 2005.
7 Golzari, M.,
8
9 Morris, R.E. 2005.
' Ibid.
1 Ibid.
2 Forrest, C.B.,
13 Gupta, R.A.,
1 Ibid.
' Ibid.
0 Golzari, M.,
17 Clark, K. and S. Gehshan. Meeting the health needs of youth involved in the juvenile justice system. Retrieved from http://www.ncchc.org/publications.
Kelly D. Smith, MN, APRN, CCN/M, is director of Health Services for the
Copyright: | (c) 2013 American Correctional Association, Incorporated |
Wordcount: | 1563 |
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