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Position Statements
Health Care Funding for
Incarcerated Youth
Background
As reported by the AMA
Council on Scientific Affairs, Journal of American Medical
Association:
"Youth who are detained or
incarcerated in correctional facilities represent a medically
undeserved population that is at high risk for a variety of
medical and emotional disorders. These youth not only have
a substantial number of pre-existing health problems, they also
develop acute problems that are associated with their arrest and
with the environment of the correctional facility... Indicative
of both their personal behavior and their lack of adequate prior
health care services, youth in correctional institutions have a
greater than expected rate of selected physical and emotional
problems, such as substance abuse, sexually transmitted
diseases, unplanned pregnancies, and psychiatric
disorders." (JAMA, 1990) In the United States, the number
of juveniles (aged 10 to 17 years) in custody increased 25% from
80,091 to 99,846 from 1983 through 1989. (CDC, 1992). Annually,
more than 600,000 youth are admitted to public detention
facilities. These children are admitted with substantial
existing physical and emotional problem caused by a variety of
factors, including past physical and psychosocial insults,
life-style habits, and lack of prior health care. A
variety of studies reported through the Academy of Pediatrics,
the American Society of Adolescent Medicine, the American Public
Health Association, and the National Commission on Correctional
Health Care have shown that upon admission to the juvenile
facility, about 33% have a history of sexually transmitted
diseases; 20% report having parented a child, another 10% of the
girls are pregnant, and 10% have gonorrhea. In addition,
juveniles also have a high rate of alcohol and other drug abuse
including tobacco abuse. Prior to arrest and
incarceration, these children typically do not seek medical
assistance until their symptoms become extreme, and are usually
treated in an emergency room. They also lack a regular
source of coordinated health care prior to incarceration. Medicaid in Juvenile Detention
and Confinement Facilities
Young people
incarcerated in juvenile detention and confinement facilities
eventually return to their communities hopefully to live
productive, and healthy, lives. It is, therefore,
important to provide needed health care services, including
early diagnosis and treatment for communicable diseases, that
address their unique needs. The likelihood that needed
health care will be provided is, however, contingent upon the
availability of funding for these health services. Children who are placed in foster homes, private residential
facilities, or group homes remain eligible for Medicaid assuring
that the federal and local governments share in the cost of
required health care.
Until 1984, federal regulations
allowed correctional institutions to bill for health services
provided to incarcerated youth who were eligible for Medicaid
for the month of their arrest and the month of their discharge. After 1984, the regulations were changed to disallow any federal
reimbursement for health services to incarcerated individuals. This action shifted the responsibility for financing needed
health care entirely to local governments (e.g., states,
counties, cities) and, owing to a reduction in federal funding,
in many instances results in inequities in the quality of care
available to youth. Children in public, as compared to
private, facilities are mostly poor, minority, and from
dysfunctional families. They are, therefore, particularly
affected by their ineligibility while children in private
facilities continue to be eligible for Medicaid. Position Statement
America's future
depends on the health of all of our children. Incarcerated
youth represent an especially vulnerable population whose lives
are at high risk for illness and disability. Early
diagnosis and treatment is essential. The National
Commission urges equality in access and funding for health care
and, therefore, recommends that all youth in public and private
confinement and detention facilities remain eligible for all
public (e.g., Medicaid) and private health care coverage
consistent with state and local eligibility requirements. All of America's youth deserve
the opportunity for equal access to health care regardless of
placement in public or private facilities. Adopted by the
National Commission on Correctional Health Care
Board of Directors
March 21, 1993 References
AMA Council on
Scientific Affairs, Journal of the American Medical Association,
February, 1990, pp. 987-88. Centers for Disease Control and
Prevention, MMWR, June 5, 1990, p. 22.
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