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The United States has the highest incarceration rate among developed nations. With more than half of offenders estimated to have mental illness or addiction, correctional systems are the largest de-facto mental and behavioral health service providers. Correctional facilities are often poorly equipped to serve as treatment facilities and are limited in scope of services due to budgetary restrictions. Historically, the coordination of care during release from jails and prisons is insufficient to secure efficient and uninterrupted care. With low continuity of community-based services during reentry periods, offenders are more likely to become caught in the revolving door of the criminal justice system. Specialty courts and new treatment and reentry models have emerged from evidence-based roots over the past decades, though such approaches have yet to become ubiquitous fixtures in the justice system. The cost of disease burden remains substantial, and large-scale implementation of evidence-based reentry has yet to become a staple of the justice system. In 2014, the Affordable Care Act (ACA) made affordable health care plans and Medicaid coverage available to justice-involved individuals, expanding the possibilities for transitional care. This article reviews the current state of mental and behavioral health care for offender populations, evidence-based models for improving reentry processes, the economic impact of mental and behavioral disorders in justice-involved populations, directions for the future of treatment and reentry, and the implications of the Affordable Care Act (ACA) for bringing about long-term change in the systemic approach to high-need offenders.