The Bernalillo County Experience

Medicaid is a critical funding source for an onsite mental health clinic at the Bernalillo County (NM) Juvenile Detention and Youth Services Center, where rates of recidivism a year after release among youth in need of mental health treatment fell from 88 percent to 22 percent.

In 2000, the detention center convinced the state Medicaid office to interpret detention as a temporary period of custody pending other arrangements, so that juveniles in detention are not considered inmates of a government institution. With this change, the detention center can keep youths covered under Medicaid for up to 60 days – which is longer than most juveniles are in detention.

At booking, detention center staff verify juveniles’ Medicaid status and enroll those juveniles who are eligible but not yet enrolled. The detention center bills Medicaid roughly $370,000 a year for health care services provided to youth in detention.

The mental health clinic opened in 2000, drawing on several funding sources, including Medicaid revenues, and became fully functional around 2004. Today, youth brought to detention are screened for mental health problems at booking so that they can get treatment immediately upon entering detention if they need it. After release, they can continue receiving treatment at the mental health clinic.

Meanwhile, the detention center closed several residential units in response to a drop in its population. Staff members affected by the closures were trained as case managers for juveniles, acting as liaisons between the juvenile court, the probation office, and the mental health clinic. These case managers also work with youth in the community after they are released from the detention center. The reduction in recidivism occurred after this new case management program was implemented.

An April 2008 article in Youth Today describes in detail how Bernalillo County accomplished this and the implications for other states and counties.

As Bernalillo County’s experience shows, building health care connectivity for juveniles makes financial sense and is feasible. Even in times of severe economic constraints, there is money available to better serve juveniles brought to detention and achieve the rehabilitative goals of detention. In this case, a change in state policy enabled the county to tap into Medicaid funds to develop revenue streams to provide health care for youth brought to detention.

If other jurisdictions adopted a similar approach to Medicaid participation, they might be able to expand needed health care services for juveniles brought to detention centers. In that way, more juveniles could receive rehabilitative services that will help them overcome health care obstacles to achieving their personal potential and participating in society. In addition, recidivism and related public safety costs for counties and states may be reduced.