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One Way To Help People Stay Out Of Jail? Sign Them Up For Health Insurance.

Inmate Reginald Sanders undergoes blood dialysis at the California Substance Abuse Treatment Facility in Corcoran, Calif. CREDIT: AP PHOTO/RICH PEDRONCELLI
Inmate Reginald Sanders undergoes blood dialysis at the California Substance Abuse Treatment Facility in Corcoran, Calif. CREDIT: AP PHOTO/RICH PEDRONCELLI

For the thousands of incarcerated Americans, prison may be the first place they’ve ever received comprehensive health care. But what happens after their sentence is up?

At least half of the inmates in America’s prisons and jails have some form of mental illness. Sixty-five percent have an substance abuse addiction. Behind bars, they may be able to get into rehab or start taking needed medication for the first time in their life.

But leaving prison can mean leaving behind this crucial health care coverage — something that can ultimately determine former inmates’ ability to successfully reenter the outside world.

At the end of April, the Department of Health and Human Services (HHS) tried to shine a light on this issue by releasing slightly updated Medicaid eligibility guidelines for former prisoners. In hopes of preventing dangerous gaps in medical coverage, the department urged state prisons to help inmates sign up for Medicaid prior to their release, and announced that those finishing their sentences in a halfway house are now eligible for Medicaid coverage.

It is important to understand the critical role access to health care plays in successful returns to the community.

“It is important to understand the critical role access to health care plays in successful returns to the community for so many Americans trying to change their lives,” said Richard Frank, HHS Assistant Secretary for Planning and Evaluation, in a press release paired with April’s announcement. The guidelines, he added, will help reduce the risk of former prisoner being “re-incarcerated or hurt.”

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For HHS, a quick look at the numbers shows just how many inmates leave prison unprepared. More than 600,000 people are released from jails and prison each year — but a recent study found only 112,525 inmates were signed up for health care when they left prison.

For those with untreated health issues, the cycle only continues. If they don’t have any access to treatment in the outside world, they may start self-medicating with drugs and alcohol.

“Next thing you know, they’re caught for heroin possession, or commit a crime that facilitates their addiction,” said Ben Breit, the communications director for Cook County Sheriff Department in Illinois. “And then they’re back where they started.”

The consequences could be even more serious than that. A study of Washington state inmates, for example, found that during the first two weeks following an inmate’s release, their risk of dying was 12 times higher than other state residents. The leading causes? Issues that stem from a lack of proper treatment — like drug overdoses, heart attacks, and suicide.

Thanks To Virginia Reforms, These People Are Voting For The First Time In DecadesJustice by CREDIT: Emily Atkin RICHMOND, VA – Election Day is usually not a proud day for Wilbur Scott*. In past years…thinkprogress.orgBreit works under Sheriff Tom Dart, the man who led Cook County Prison’s transformation into the nation’s largest mental health provider, where security guards are required to have a background in medicine and inmates are treated as patients before prisoners. The caliber of care easily beats what little public health options exist for low-income or homeless people living in or around Chicago. In fact, according to Breit, “tons and tons of people” in the area intentionally commit crimes to receive health care behind bars.

Leaving prison with Medicaid coverage, Breit said, throws a wrench in that cycle.

“Medicaid enrollment is such an important step in this process,” said Breit. “Getting [former inmates] well, giving them a chance to thrive outside the criminal justice system… If we can successfully do this, we’re going to save hundreds, thousands — if not millions — of dollars on the back end in taxpayer dollars. They’re the ones paying for prison health care right now. It doesn’t have to be that way.”

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Cook County Prison didn’t need HHS’ reminder to sign up prisoners for Medicaid. In fact, registering inmates for health insurance has been part of its prisoner intake process for three years. They enroll everyone in Medicaid coverage that will kick in when they get out.

It’s the high-risk period right after re-entry that makes or breaks someone.

Prison staffers have no idea how long incoming prisoners’ sentences will end up being. Some may be just staying for a night, some for five years. Either way, they’ll need health care when they leave.

“It’s not a silver bullet,” Breit said. “But the sooner we get their application in, the sooner they get their cards.”

This transition isn’t quite as smooth in other states. Illinois has an advantage because it expanded its Medicaid program under Obamacare to include those with incomes just over the poverty level. But in other states that have rejected Medicaid expansion, it’s often impossible to offer returning citizens an affordable health care plan right out of prison.

Virginia, where GOP lawmakers have so far blocked expansion from taking effect, is one of those states. There, 191,000 uninsured adults would be eligible for Medicaid if the program were expanded. And according to former inmates, prisoners aren’t aware of this coverage gap until they’re leaving prison — when it’s too late.

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“They won’t get any information about health care through the Department of Corrections,” said Richard Walker, founder of Bridging the Gap, an organization that helps restore former inmates’ civil rights. “And when they leave, most are under the impression that they aren’t eligible for anything. It takes a community group to inform them of their options.”

Walker, whose advice comes from his own experience behind bars, often visits inmates in state prisons to inform them of their rights they’ll gain after leaving. Part of that includes explaining the harsh gaps in health coverage.

Obamacare Helped The Sickest Americans Gain Insurance, Huge Study ConfirmsHealth CREDIT: Shutterstock A new report released Tuesday from the Blue Cross and Blue Shield Association underscores…thinkprogress.org“I try to provide them with as much [information] as I can,” he said. “But they have a lot of barriers to overcome. It’s a systemic problem.”

While conservative lawmakers in states opposed to Medicaid expansion typically say the program would financially drain the state, closing this gap could actually save state dollars that currently go toward covering housing and health care for people in prison. Untreated health issues, especially mental disorders, only nudge state recidivism rates higher. In a 2010 Connecticut study of prisoner recidivism rates, researchers found the rate for those with severe mental health disorders to be “significantly” higher than that of other prisoners.

The amount of research on people’s health post-prison remains slim. Marc Stern, the former assistant secretary of Washington State Department of Corrections’ health services, said the most definitive research comes from data on people who successfully finish substance abuse treatment programs they began while incarcerated.

“You cut down on costs, recidivism rates, unemployment,” Stern said. “It’s the high-risk period right after re-entry that makes or breaks someone.”

Stern said that while he was with the DOC, prisoners had opportunities to sign up for Medicaid before leaving. But he knows it differs between facilities. Cook County’s Breit agreed, saying he wasn’t even sure what the policies are within local halfway houses when it comes to continuing care. This disconnect, Breit said, may be one of the reasons HHS decided to issue April’s reminder.

The government is trying to break down those walls to hold us all accountable for continuous care.

“We’re all so siloed in our own facilities,” he said. “I think the government is trying to break down those walls to hold us all accountable for continuous care.”

Colleen Barry, a professor at the Johns Hopkins Bloomberg School of Public Health, told Kaiser Health News that she sees HHS’ announcement as a type of “encouragement and a nudge” to states to improve the computers used for enrollment. “They understand that this is a technology issue,” she said.

But Breit said communication may be the end challenge.

“A sheriff’s duty, technically speaking, is to hold an inmate as long as you’re told by law. When it’s time to go, it’s ‘See you later.’ They don’t always have time to think of what’s next, or what other prisons are doing,” he said. “It’s about taking that extra step that can keep those folks from coming back.”