Many ex-prisoners struggle to maintain their health after release

When Matthew Boyd was released from a Georgia state prison in December 2020, authorities sent him home without the medication he takes to treat chronic heart and lung conditions and high blood pressure, she said. – he declares.

Less than a month later, he spent eight days in the intensive care unit, the first of more than 40 hospitalizations since. These days, she can barely get out of bed in her south Atlanta home.

“It makes my life so miserable,” said Boyd, 44, who has chronic obstructive pulmonary disease. She told KHN her story via email and text because sometimes it’s hard to speak without losing her breath.

While Medicaid is generally prohibited from paying for services provided to people in jail or prison, the Biden administration has opened the door to the federal program to provide pre-release care to help them better manage their health during the transition. . . In February, the administration announced that states could use Medicaid to pay for drug treatment in state prisons and jails. Efforts by Congress to reactivate Medicaid before prisoners across the country are released have so far failed.

In much of the South, where many states have not expanded Medicaid, reintegration services that connect people like Boyd with health care resources are often few or no.

More than 600,000 people are released from state and federal prisons in the United States each year, and many of them have health problems. A 2019 court order suggested that inmates have a constitutional right to proper medical release planning, including the provision of medication or prescriptions, prior to release. But it is not clear that states are required to do so.

In Georgia, correctional facilities must create a release plan that includes scheduling medical appointments and providing medication. Joan Heath, director of community affairs for the Georgia Department of Corrections, did not respond to questions about why official policy was not followed in Boyd’s case.

Regardless of official policy, people routinely leave jail or prison without medication, medical records, an appointment with a provider, or health insurance. According to a sample of people surveyed before and after release by the nonprofit Urban Institute, 84% of incarcerated men and 92% of incarcerated women suffer from a physical or mental health problem or substance use disorder. examines equity issues.

Without timely help, formerly incarcerated patients develop health crises and end up in expensive emergency rooms. Or they experience a mental health episode or commit a crime related to their substance use disorder that lands them back in jail or prison.

“There is no bridge,” said Stephanie Jones-Heath, CEO of the Federally Licensed Health Center of Southeast Georgia. Patients who were previously incarcerated are not screened and do not have medical records before they arrive at the center, he said. “We have to start all over because we don’t have continuity of care,” he said.

The United States has one of the highest incarceration rates in the world. Conditions such as solitary confinement, limited access to medical care, high stress and poor diets can also cause or worsen the disease.

“This is the sickest population in the country,” said Dr. Mark Stern, a University of Washington public health faculty member who formerly worked at the state Department of Corrections. Stern wrote one of several studies on this topic. That 2007 study found that people in prison were 3.5 times more likely to die than the rest of the state — with most deaths occurring within the first two weeks of a person’s release.

In January, California became the first state to receive a partial waiver that allows people in prison to receive services through Medicaid up to 90 days before their release. More than a dozen other states are seeking similar waivers. They argue that uniform care will reduce overdose deaths — the number one killer of people leaving prison — improve health outcomes and save money by keeping patients out of emergency rooms.

In Georgia, even basic release planning can be rare, said Craig Burns, a certified inmate support specialist. In 2014, he was released from state prison after nearly 15 years with a $20 debit card that was mistakenly not activated, he said. Burns, who suffers from bipolar disorder and post-traumatic stress disorder, depression and anxiety, said she found her way to the foundation of a safety net for mental health treatment near her home in Dalton.

Most of the people Burns works with don’t know how to access health care. They often lack family support and stable housing, have mental health or addiction issues, and lack the skills to navigate the bureaucracy associated with rebuilding their lives after prison.

“It’s a terrible circle without a head,” he said. Burns regularly sends people to the emergency room to get medication and free referrals.

Stephen McCarey, 40, was unable to find treatment for heroin addiction after being released from an Alabama prison in 2011.

In May 2019, she was told by the rehab center that funds were not immediately available to pay for her care. McCarey, who has struggled with chronic homelessness, has never been a role model. He overdosed, was arrested again for robbing a pharmacy and is now serving time in prison again.

“I wouldn’t have committed any of these crimes if I had a place to go,” he said in a phone call from Ventress Correctional Center in Alabama.

Alabama did not expand Medicaid, which could have helped McCary with care after his release. A Connecticut study found that when people get primary care after incarceration, they are less likely to be hospitalized or re-incarcerated, saving the state money.

“We have to look at the big picture,” said Dr. Shira Shavit, a clinical professor of family and community medicine at the University of California, San Francisco and executive director of the Transitions Clinic Network, who conducted research. . “If we invest in Medicaid, we can save money in the prison system.”

People who are more likely than blacks to be incarcerated and uninsured are disproportionately affected by the lack of post-prison health services.

One of the reasons people fall through the cracks is that no agency takes responsibility for the problem, says Dr. Evan Ashkin, a professor of family medicine at the University of North Carolina-Chapel Hill. and director of the North Carolina Ex-Prison Transition Program, which helps ex-prisoners get medical care. The health care system often doesn’t distinguish between the needs of people in prison and those of others who don’t have insurance, he said. Justice systems do not have the budget or mandate to work with people after they are released from custody. About 90% of patients in the program’s clinics do not have insurance, and North Carolina has yet to expand Medicaid, although lawmakers recently reached an agreement to do so.

A key part of California’s new waiver is the ability for providers to be reimbursed for coordination care, which is critical for people leaving prison, Shavit said. “All of their basic needs are being taken care of at the same time, and health care often takes a back seat,” he said.

Medicaid expansion and the Medicaid Enrollment Before Release program have helped people coming out of Louisiana’s notorious prison health system, said faculty professor Dr. Anjali Niyogi. Tulane University School of Medicine, who founded the clinic to serve the formerly incarcerated. However, insurance alone is not enough to compensate for the lack of care people receive while incarcerated, he said.

Anthony Hingle Jr. never received the results of the biopsy, which was taken days before his release from the Louisiana State Penitentiary at Angola in 2021 after 32 years in prison.

Hingle, 52, found out he had prostate cancer after contacting a New Orleans hospital himself to request biopsy results. Although he had Medicaid coverage, he had to wait several more months for his work insurance to kick in before he could get treatment and undergo surgery to remove his prostate. Hingle, who works as an office assistant at Experienced Voice, a nonprofit that advocates for incarcerated and formerly incarcerated people, wonders what her life would have been like had she been diagnosed earlier.

Without a prostate, he says, “having children with my wife is over.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth health journalism. Along with political analysis and polling, KHN is one of three major operational programs KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the country.