Just Healthcare

An Overview and Analysis of Healthcare Delivery in the Massachusetts Juvenile Justice System

april 2025

CfJJ’s report Just Healthcare: An Overview and Analysis of Healthcare Delivery in the Massachusetts Juvenile Justice System examines healthcare policies and practices affecting incarcerated youth and emerging adults in Massachusetts, with a focus on the need for a community standard of care. The report evaluates the structure of healthcare delivery within the Department of Youth Services (DYS), identifying systemic barriers to access and the quality of care provided. Additionally, recent changes to federal Medicaid coverage are discussed, as they present unique opportunities related to pre-release and post-release transitional health services for all incarcerated individuals in the Commonwealth. Lastly, the report explores the impact of policy decisions on health outcomes and provides targeted recommendations for improving healthcare access and quality for incarcerated youth and young adults. Key stakeholders, including the state legislature, have critical roles in reforming the system to align with ethical medical practices and ensuring continuity of care.

Key Findings

  • DYS lacks a codified community standard of care: While DYS follows a strong standard of care outlined in its contracting process, this standard is not codified in the agency’s legislative, regulatory, or policy framework

  • DYS funds healthcare for youth in secure facilities, and youth remain on MassHealth: Healthcare provided to this population of youth is paid for through a combination DYS funding for those within facilities and by MassHealth for some care provided in hospital settings.

  • The DYS continuum of care aims to ensure comprehensive health services: DYS aims to provide high-quality, integrated healthcare for youth, adjusting services based on custodial status and length of stay. Pre-trial detainees receive urgent and stabilization care, while committed youth receive comprehensive assessments, chronic disease management, and preventive care. DYS also provides substance use treatment and does its best to facilitate continuity of care post-release.

  • DYS policies and practices differ from those adopted by DOC: The DYS health service provides structurally better healthcare than present in the adult system, with several differences standing out: 1) DYS does not use a capitated model, 2) DYS youth remain on MassHealth, 3) DYS contracts with non-profit providers, and 4) DYS’s definitions of “community standard of care” is much stronger.

  • DYS routinely shackles youth in clinical/hospital settings: DYS policy mandates shackling of youth during medical transport and often throughout clinical visits; DYS is reportedly considering policy updates to address shackling concerns

  • Recent changes to federal Medicaid impact carceral health practices: Two recent federal policy changes—the Consolidated Appropriations Act of 2023 (CAA) and the Section 1115 Demonstration Waiver—impact healthcare coverage for incarcerated juveniles, including those in DYS custody. These changes aim to improve continuity of care and access to re-entry services by extending Medicaid coverage to eligible youth, with changes in how services are reimbursed and coordinated across agencies.

Recommendations to policy makers

State Legislature

  • Codify the robust “community standard of care” at DYS into law to prevent future administrative rollbacks.' approach.

  • Raise the age of juvenile jurisdiction to include 18- to 20-year-olds in the Juvenile Court system, improving healthcare access for this population

  • Remove correctional control over healthcare services to ensure medical decisions are made based on ethical care standards rather than punitive policies.

Department of Youth Services

  • Codify the “community standard of care” language into the regulatory and policy frameworks.

  • Continue to work collaboratively with MassHealth to fully implement the CAA 2023 and the Section 1115 Waiver.

  • End the practice of shackling youth in healthcare settings.

  • Improve data collection and incorporate the lived experiences of youth in healthcare policy development, with a particular focus on disparities between LGBTQ+ youth and non-LGBTQ+ youth.

Department of Correction and Houses of Correction

  • Shift healthcare contracts away from the capitated payment model, which incentivizes cost-cutting over patient care.

  • Contract with non-profit healthcare providers to improve medical outcomes.

  • Establish a clearly defined community standard of care through policy and regulation that is not watered down.

MassHealth

  • Opt into CAA 2023 Section 5122 to extend Medicaid coverage to eligible incarcerated juveniles pending charge disposition.

  • Develop a continuous care model to support youth transitioning from incarceration back into the community.

  • Improve tracking and transparency around the implementation of Medicaid waiver provisions.

Academics and Policy Researchers

  • Conduct comparative research on state-level juvenile justice healthcare governance models.

  • Center the voices of justice-involved youth in research efforts.

  • Study healthcare outcomes for youth in the DYS system compared to other states to assess the effectiveness of Massachusetts' approach.