Restarting your life after prison: Providing Medicaid at reentry can help
Returning home from prison is a profoundly emotional experience. It can also be a deadly one. In the period immediately following release, formerly incarcerated people are 12 times more likely to die than the general population, from causes ranging from heart disease to suicide and drug overdose.
I’ve weathered the prison-to-community transition, and I helped countless others through it while working at several reentry organizations in New York. For most people on that journey, obstacles such as homelessness, unemployment and fractured community support are exacerbated by another daunting, and sometimes lethal, challenge — an interruption in health care.
Justice-involved people have higher rates of physical and mental health problems, from hypertension to asthma, cancer, infectious diseases and substance use disorders. Once released from jail or prison, they lose medications for such conditions, and reestablishing prescriptions, supportive care and health coverage is a slow and frustrating process.
But now New York and other states are poised to ease such struggles by obtaining waivers from a longstanding federal law provision barring Medicaid from covering services in prisons and jails. A bipartisan bill in Congress would permit Medicaid coverage 30 days prior to release, but states aren’t waiting. In January, California became the first to receive a waiver allowing it to use Medicaid, the health insurance program for Americans with low incomes, to cover certain services for people near the end of their incarceration.
New York and 14 other states are seeking similar waivers, and this month the federal government issued long-awaited guidance on the process. That critical step has intensified optimism that in many parts of our country, people leaving prison will finally receive the care they need during the perilous reentry phase. I’m optimistic too, but cautiously so. States face multiple landmines as they translate policy into reality on the streets. If we don’t support the good ideas with sufficient funding, smart planning and strong execution, it could all just flatline.
In New York, the need — and challenges — are enormous. In 2019, there were 22,489 discharges from prisons and 170,683 from jails, 42,033 of those in New York City alone. Earlier data on people released from city jails show that one in four had mental health conditions, while two out of three struggled with substance use.
When I was on Rikers Island, I saw people enter its methadone detoxification units every day and receive treatment critical to recovery from opioid addiction. I saw those same people pushed out the front door with little, if any methadone supply to help them during reentry. Those with cancer, HIV/AIDS and other chronic illnesses typically have a similar experience.
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Another hurdle for those exiting the system is finding a health care provider, especially one with the training in the complex web of conditions experienced by many leaving prison or jail. Locating a clinician and scheduling appointments can be overwhelming. And then there’s this question: Do you disclose your formerly incarcerated status and risk shame or differential treatment? Many don’t, and fail to get the specialized care they need.
Overlaying such challenges is the absence of routine record-sharing between correctional facilities and organizations on the outside. In many jurisdictions, antiquated record-keeping — including paper files — is the norm, making continuity of care especially difficult. Differing data privacy rules across the health and justice systems complicate things further.
Closing these gaps won’t be easy. Once states receive a waiver, they must prioritize collaboration among the patchwork of systems and service providers involved in that precarious prison-to-community transition. That means supplementing federal Medicaid dollars and creating infrastructure for cross-system communication, a step called critical by a broad range of stakeholders convened by the Health and Reentry Project.
Another priority is hiring and training more case managers, including formerly incarcerated people, to help people on the runway from prison to the world outside. Even the best in-prison preparation means little if those released have no housing, job prospects or other support.
Creating this vital bridge to community-based services reflects research showing that continuity of care improves the odds of successful reintegration. That, in turn, benefits public safety, which helps explain law enforcement support for the reform.
Despite the challenges, I believe New York has the resources, experience and community partners to navigate this historic policy shift. If that happens, it will be transformative — saving lives while also reducing recidivism. If not, shame on us, because people who have served their time for their crimes will continue to die.
Cumberbatch is director of strategic partnerships at the Council on Criminal Justice, an invitational membership organization and nonpartisan think tank focused on the criminal justice field.