East Baton Rouge Parish Sheriff Sid Gautreaux recalled last week how when he asked most teenagers where they see themselves in five years, the answers usually are about pursuing dreams: excelling in college, playing third base professionally, establishing a career or something like that.

But the 17- to 25-year-olds who commit most of the murders in Baton Rouge — and are likely to be the victims of most murderers — look him straight in the eye, then say, “dead or in prison,” he said.

“They’re living in a Third World country and there’s nothing out there for them,” Gautreaux told a forum last week for religious leaders, elected officials, law enforcement, health care professionals and others who discussed the impact of mental health issues and gun violence.

The conversation about the high rate of homicides in Baton Rouge abruptly turned from crime to health care funding. “Why is the state closing down mental health facilities?” Gautreaux asked.

Dr. Janet Higgins, of New Orleans, jumped up to ask the panel to address Gov. Bobby Jindal’s refusal to accept federal dollars for expanding Medicaid coverage, which she said would help shore up mental health services.

“It is a serious matter,” said state Sen. Sharon Broome, who moderated the discussion.

Blowing the flames of crime like a blacksmith’s bellows is the lack of options available to treat people with mental illness, or even for law enforcement to handle them. Reports show that most of the young perpetrators of violent crime in Baton Rouge have a mental illness and/or substance abuse problem that has gone untreated, she said.

Adding 400,000 Louisiana residents to Medicaid rolls would help people find help rather than forcing them to juggle these issues on their own, said Broome, D-Baton Rouge.

Broome asked those attending the forum to call their legislators and the governor. She turned to look directly into the television camera recording the conference and recited the phone number to the governor’s office: (225) 342-7015.

Collis Temple, the former LSU basketball player and civic activist, then took the microphone to rally voters to get involved and elect officials who would focus dollars on health care. “We need a person who is committed to Louisiana,” Temple said.

These conversations took place on the same day that Florida Gov. Rick Scott, an ardent critic of President Barack Obama and the president’s health care plan, reversed his position and announced that his state would take the federal dollars and expand Medicaid coverage.

Scott told reporters in Tallahassee: “I cannot in good conscience deny Floridians that needed access to health care.”

Medicaid is the government insurance program that pays for medical care for, primarily, the poor, handicapped, young and elderly. The state pays a portion, while the federal government picks up most of the costs.

Working families making too much money to qualify for Medicaid, but too little to buy their own health insurance, often go without coverage. The Patient Protection and Affordable Care Act, commonly called “Obamacare,” changed Medicaid definitions to pick up those uninsured construction workers, retail clerks, restaurant workers and other low-wage employees.

Scott joined other GOP governors of Arizona, Michigan, Nevada, New Mexico and North Dakota, all of whom announced their willingness to accept the federal monies.

The New York Times reported that the governors of Louisiana and 16 other states, mostly in the Deep South, have announced they will not participate in the expansion, while 22 states have opted to do so.

Republican opponents question whether Congress will continue to pick up 90 percent of the cost or at some time in the future, shift more of the cost onto states.

Jindal counters that the state couldn’t afford expansion, anyway.

His secretary of the state Department of Health and Hospitals, Bruce Greenstein, argues that the state is trying to revamp existing programs to more efficiently treat a variety of patients, rather than wanting to spend more money on a one-size-fits-all government program.

When Jindal was asked Thursday if he would change his mind about expansion, in light of Scott’s decision, the governor laughed and said, “No.”

Mark Ballard is editor of The Advocate Capitol news bureau. His email address is mballard@theadvocate.com.