Valentino Valdez was handed a few basic items—a birth certificate, a Social Security card, a T-shirt, and khaki pants—when he walked out of a Texas prison at 21 years old in 2019. What he didn’t receive was access to health insurance, mental health medications, or a doctor. Three years later, Valdez found himself in an inpatient hospital after sharing suicidal thoughts, a consequence of enduring years of juvenile detention, foster care placements, and state prisons without adequate mental health treatment.
Reflecting on his experiences, Valdez now recognizes the critical role that mental health support could have played in easing his transition to life outside the system. “It’s not until you’re put in, like, everyday situations and you respond adversely and maladaptive,” he explained. “You kind of realize that what you went through had an effect on you.”
At the age of 27, Valdez opened up about his struggles with mental health, a problem shared by many who are released from carceral facilities. Despite facing high rates of mental health issues and substance use disorders, these individuals often return to their communities without health insurance coverage, leading to increased risks of mortality or re-incarceration.
In an effort to address these challenges, a groundbreaking federal law was signed by President Joe Biden in 2022 to facilitate better access to health care services for incarcerated children and young adults eligible for Medicaid or the Children’s Health Insurance Program (CHIP). This law, which took effect on January 1 of this year, mandates that all states provide medical and dental screenings to eligible youths before or immediately after their release from correctional facilities. Additionally, these individuals must receive case management services for 30 days post-release.
This legislation represents a significant shift in the healthcare landscape for incarcerated populations, as historical restrictions have barred Medicaid from funding health services for people in custody. Consequently, jails, prisons, and detention centers have operated independent health care systems funded by state and local budgets, separate from public or private health services. The new law marks the first adjustment to this prohibition since the inception of the Medicare and Medicaid Act in 1965.
Implications of the New Law
The impact of this legislation cannot be understated, according to Alycia Castillo, the associate director of policy at the Texas Civil Rights Project. By providing essential health services to young individuals transitioning out of custody, the law aims to prevent health crises, facilitate successful reintegration into society, and reduce the cycle of detention and recidivism.
Notably, over 60% of youth in custody are eligible for Medicaid or CHIP, underscoring the broad reach and potential benefits of the law. This critical support extends to children and young adults up to 21 years old, or 26 for those who, like Valdez, have been in foster care.
However, the practical implementation of this law poses significant challenges for correctional facilities across the country. Vikki Wachino, founder of the Health and Reentry Project, emphasized that establishing the necessary connections between facilities and health care providers will require substantial time and resources. Despite the federal government’s allocation of approximately $100 million in grants to support this transition, states must navigate complex logistical and technological hurdles to ensure compliance with the law.
Personal Perspectives on the Law
Valdez’s story provides a poignant illustration of the failures in the current system. Placed in state custody at 8 years old due to his mother’s health issues, Valdez encountered a series of traumatic experiences in foster care and juvenile justice facilities. His mental health deteriorated over time, exacerbated by a lack of consistent care, abrupt medication changes, and harsh treatment.
These challenges are not unique to Valdez. Elizabeth Henneke, founder of the Lone Star Justice Alliance, highlighted the systemic issues that perpetuate cycles of trauma and recidivism among justice-involved individuals. The failure to provide adequate mental health services and continuity of care ultimately undermines the well-being of those reintegrating into society.
In Valdez’s case, a breakdown in 2022 led to a diagnosis of post-traumatic stress disorder and the initiation of appropriate treatment. Reflecting on this turning point, Valdez expressed gratitude for the support he finally received. “It helped me understand that I wasn’t going crazy and that there was a reason,” he shared. “Ever since then, I’m not going to say it’s been easy, but it’s definitely been a bit more manageable.”
As states grapple with the practical implications of implementing the new law, individuals like Valdez offer a powerful reminder of the urgent need to prioritize mental health services for justice-involved youth. By bridging the gap between the criminal justice and healthcare systems, policymakers have a unique opportunity to transform the lives of vulnerable populations and break the cycle of incarceration and untreated mental illness.
