A Just Healthcare System for Justice-Involved Youth in Massachusetts
Every young person deserves access to developmentally appropriate services that address their needs, including quality healthcare. This includes young people who find themselves incarcerated in juvenile and adult facilities. Research establishes that poor health is correlated with crime and delinquency, meaning that access to quality healthcare for young, incarcerated people is necessary for their positive development and ultimately greater public safety. In the absence of strong pro-health policies and practices, incarcerated youth can experience difficulty accessing healthcare due to coverage and continuity gaps, miscommunications between facilities, and their inability to form client-physician relationships with providers while in state custody. CfJJ’s new report, “Just Healthcare: An Overview and Analysis of Healthcare, Delivery in the Massachusetts Juvenile Justice System”, highlights healthcare policies and practices affecting incarcerated youth and emerging adults in Massachusetts, with a focus on the importance of - and need for - a community standard of care.
Healthcare for incarcerated youth in Massachusetts is relatively robust under current DYS practice. However, there are still improvements that need to be made to ensure that a community standard of care is provided for those who are involved with the justice system. Additionally, healthcare policies and practices that impact emerging adults who are incarcerated at HOCs and DOC require significant attention and transformative change.
Standard of Care
Department of Youth Services (DYS) contracts with multiple providers to deliver medical and behavioral health services. These contracts outline a strong community standard of care, the same standard expected “for the larger community”. 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. As a result, it remains vulnerable to future administrative changes that could weaken protections.
CfJJ recommends codifying the “community standard of care” language and current medical guidelines into a legislative framework. Safeguarding these standards in legislation protects against them being repealed by an administrative order or changed by a future DYS Commissioner. There is a bill currently pending before Massachusetts Legislature’s Joint Committee on Children, Families and Disabilities during the 2025-26 legislative session that would codify this standard of care.
The Gap for Emerging Adults
Healthcare practices and policies in the adult correctional system in Massachusetts differ significantly from those in DYS, creating additional barriers to care for incarcerated emerging adults. One key difference lies in each system’s use of the term “Community Standard of Care”. DOC claims that health care will be provided at the same level of “the community” but then defines the community as those in other prison systems. This weak, restrictive definition does not reflect a true ‘community standard’ of care that treats individuals in incarcerated spaces with the same level of care as their non-incarcerated peers in the communities that they are from.
Healthcare in the adult prison system is also notorious for its poor access to and quality of care. The individuals CfJJ spoke to in developing this report corroborated our findings of inadequate care delivery in the adult system, reporting long wait times for care and medical neglect. One individual stated “[at the DOC] I wasn’t receiving the resources that I need…if you don’t know what you’re entitled to, [personnel at the DOC] don’t give it to you... and when you do bring it up, they don’t provide it.”
““[at the DOC] I wasn’t receiving the resources that I need…if you don’t know what you’re entitled to, [personnel at the DOC] don’t give it to you... and when you do bring it up, they don’t provide it.””
To protect and expand access to quality healthcare for incarcerated youth, CfJJ urges the Massachusetts Legislature to support raising the age of juvenile jurisdiction to include 18- to 20-year-olds in the Juvenile Court system. Youth in DYS custody are more likely to receive comprehensive and developmentally appropriate healthcare than are adults in DOC custody. Consequently, raising the age of juvenile jurisdiction to include 18- to 20-year-olds would increase access to healthcare among young adults. There is a bill currently pending before Massachusetts Legislature’s Joint Committee on the Judiciary during the 2025-26 legislative session that would bring about this change in jurisdiction.
Access to quality healthcare for incarcerated young adults is not only a matter of justice, it is foundational to healthy development and long-term public safety. Key stakeholders, including the state legislature, have critical roles in reforming the system to align with ethical medical practices and ensuring continuity of care. CfJJ’s report, “Just Healthcare: An Overview and Analysis of Healthcare, Delivery in the Massachusetts Juvenile Justice System”, explores the impact of these critical policy decisions on health outcomes and provides targeted recommendations for improving healthcare access and quality for all incarcerated youth in the Commonwealth. Read the full report here to learn more.