New York City is moving closer to closing Rikers Island with part of that plan being the opening of a Therapeutic Housing Unit at Bellevue Hospital, which would provide medical care for incarcerated adults with serious health conditions outside of jail. This is an encouraging step toward what many New Yorkers have long demanded.
Many of us remember Kalief Browder, who was 16 when he was sent to Rikers and spent three years incarcerated — including two in solitary confinement — without trial. After release, he struggled with severe depression and trauma and died by suicide in 2015 at age 22. His life galvanized the movement to close Rikers and exposed the deep health harms of incarceration, especially for young people.
As a nurse scientist, I’ve seen these harms firsthand. I’ve cared for patients in mental health crises after leaving jail due to trauma and lack of follow-up care. In my research, people describe how being incarcerated at a young age leaves lasting impacts on mental health and help-seeking.
On any given day, nearly 32,000 children and adolescents are held in U.S. juvenile facilities. Most have mental health conditions and have experienced significant trauma before and during incarceration. Nearly all will eventually come home.
A federal law passed in 2023 offers an important opportunity to meet their health needs — but only if states implement it correctly. Effective January 2025, this law requires states to ensure incarcerated youth (up to age 21, or 26 for former foster youth) are enrolled in Medicaid and connected to services like case management and behavioral health screening, starting 30 days before release and continuing at least 30 days after.
This policy addresses a longstanding barrier. For years, many states terminated or suspended Medicaid upon incarceration, leaving people to reapply and find providers after release. Navigating insurance and appointments is hard enough. For a teen or young adult facing housing instability, disrupted schooling, or family stress, that process is often impossible, leading to gaps in medication, untreated trauma, and preventable crises.
The health needs of these young people are significant. About two-thirds of boys and nearly three-quarters of girls in detention meet criteria for at least one psychiatric disorder — depression, PTSD, ADHD, and substance use disorders are common. More than half have had suicidal thoughts, and roughly one-third report a prior suicide attempt, rates far higher than those in the general population.
But good policy on paper does not guarantee good outcomes. Coverage alone does not always ensure care — as seen with past efforts to boost Medicaid enrollment for people leaving incarceration. Young people face competing priorities like school or family issues. Clinics may have long waits. Providers may lack trauma-informed training. Community organizations may be asked to do more without additional funding.
Well-intentioned reforms can also be implemented inequitably. Over 25 years, youth incarceration rates have declined overall, yet racial disparities have widened. Research on diversion programs shows Black, Latino, and Indigenous youth are less likely to be diverted and more likely to face formal charges than white youth for the same behaviors. And though youth transfers to adult courts have been cut in half since 2005, Black youth remain more likely to be transferred. A policy that appears progressive can still reproduce injustice if equity isn’t embedded from the start. To ensure this Medicaid change delivers on its promise, three things are essential:
First, invest in the right partners — community organizations with trusted ties in neighborhoods, offering trauma-informed, culturally responsive care.
Second, embed people with lived experience of incarceration — those who were incarcerated when they were young and their families. They know the barriers firsthand.
Third, build in equity-focused accountability. Beyond knowing how many people enroll, we need to know who actually gets care and whether their health improves. Data should be broken down by race, ethnicity, income, foster care status, and other factors to identify and correct disparities early.
This policy arrives amid broader uncertainty for Medicaid. Proposed federal changes — including work requirements and other restrictions — could limit coverage and create new barriers to care. State leaders are navigating sometimes contradictory policy proposals.
These young people are part of our communities. This policy is a real opportunity to improve their health and wellbeing, but only if we get it right through sustained investments, meaningful inclusion, and clear accountability.
Helena Addison Ph.D., RN, is a nurse scientist and postdoctoral fellow in the National Clinician Scholars Program at Yale University and a Public Voices Fellow of the Op-Ed Project in partnership with Yale University.