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Many states are eager to provide Medicaid to people about to be released from prison. • Pennsylvania Capital Star

Vaseline

A new policy that allows states to offer Medicaid health care coverage to incarcerated people at least a month before their release has sparked bipartisan interest and a slew of state applications, including one from Pennsylvania.

Federal policy has long prohibited Medicaid spending on people incarcerated in jails or prisons, except for hospitalizations. As a result, when people are released, they typically do not have health insurance and many struggle to find health care providers and receive needed treatment. In a population that disproportionately suffers from chronic conditions such as heart disease and substance abuse, this can be fatal.

Some states end residents’ Medicaid coverage while they are incarcerated, while others simply suspend it. Both approaches can cause delays in seeking health care for people recently released from prison, sometimes with disastrous consequences: A landmark 2007 study found that former prisoners in Washington state were 12 times more likely to die within two weeks of their release to die from any cause, compared to the general population. The leading causes were drug overdoses, cardiovascular disease, homicide and suicide.

Because a disproportionate number of Black, Indigenous, and Latinx people are in prison, lowering their risk of dying after release could reduce racial health disparities among the overall population.

About 448,400 people were released from prison in 2022, according to the federal Bureau of Justice Statistics.

Under federal guidelines released a year ago, states can connect prisoners with case managers 30 to 90 days before they are released to develop plans based on their health needs. The case manager can help the person make post-release appointments with primary care physicians, mental health counselors, substance use programs, and housing and food assistance.

States that want to expand Medicaid coverage to people in prison must apply for a federal waiver. At a minimum, participating states must provide case management, medication-assisted treatment for people with substance use disorders, and a month’s supply of medications upon release, although states are free to do more.

Imagine if we had three months to prepare. Having an action plan and even having appointments already scheduled for their needs – it will be game changing.

– Alfonso Apu, director of behavioral health services at Community Medical Services Inc. in California

The Health and Reentry Project, a policy analysis organization focused on health care for former prisoners, called the new policy “groundbreaking.”

“What these waivers allow states to do is build a bridge to access to health care — a bridge that starts before someone is released and continues after their release,” said Vikki Wachino, executive director of the Health and Reentry Project and former deputy director of the Centers for Medicare & Medicaid Services.

“It’s about starting the process before they leave jails and prisons so they can have stronger connections with health care providers and treatment providers after they leave jail and prison.”

Last month, federal officials had approved waiver applications from four states: California, Massachusetts, Montana and Washington. Nearly two dozen other states are awaiting approval, according to health research organization KFF.

Jack Rollins, director of federal policy at the National Association of Medicaid Directors, said states seeking to participate are targeting different incarcerated populations and medical conditions. Some would start with prisons, others with state prisons or juvenile detention centers. Some states would provide coverage to all prisoners, others only to people with substance abuse disorders.

Source: KFF analysis of Section 1115 Waivers posted on Medicaid.gov

Washington will provide coverage for people incarcerated in jails, prisons and juvenile detention centers starting three months before they are released, an estimated 4,000 people per year. It will connect them with community health workers, engage doctors and counselors for consultations, and provide laboratory services and x-rays.

Montana will limit its program to people in state prisons who have a substance abuse disorder or mental illness, and will provide services starting one month before their release. No estimate was given of how many people would receive aid annually.

Under a bill still pending for the Keystones of Health program, Pennsylvania would suspend rather than end Medicaid coverage during incarceration, help people apply for coverage before their release, and maintain coverage for at least a year retained after their release. bed sheet. It will connect them with health care providers and community services, provide medication-assisted treatment for substance abuse prior to release and provide a 30-day supply of prescriptions upon release.

California, which will cover an estimated 200,000 people annually, has also included community health workers in its plan. Dr. Shira Shavit, executive director of the Transitions Clinic Network, a California-based national network of clinics that focuses on formerly incarcerated people, said ex-prisoners are particularly well suited for that role.

Shavit said her group consults them on where to find new clinics and strategies for reaching recently released prisoners because the workers are adept at “knowing where people are when they come into the community and finding them there.”

Research shows that connecting recently released people with others who know what it’s like to be incarcerated makes it less likely they’ll end up in the emergency room.

“They know how to connect with people, and people trust them, and will follow them to come to the clinic and feel comfortable,” Shavit said.

How many prisoners return to prison? Inconsistent reporting makes it difficult to say anything about this.

Alfonso Apu, director of behavioral health services at Community Medical Centers Inc., a California network of community health centers that serves patients in San Joaquin, Solano and Yolo counties, said it’s easy to “lose” people once they’re released.

“The complexity of these patients is so intense that they require at least three, four, five hours of primary care every month,” Apu said.

“Imagine if we had three months to prepare,” he said. “Having an action plan and even having appointments already scheduled for their needs – it will be a game changer.”

Dr. Evan Ashkin is a physician who founded the Formerly Incarcerated Transition Program at the University of North Carolina, a network of community health centers that partners with local health departments, clinics and community health workers to connect formerly incarcerated people to health care. He agreed that it is essential to employ community health workers who share the experience of previous incarceration.

“I hope we can expand this workforce,” Ashkin said. “In our state, North Carolina, there are not many people focused on access to health care for people after their release.”

North Carolina is waiting to hear about the application.

Ashkin added that “racial equity issues are very important.”

“We need to keep our eyes wide open about the kind of services we provide, and that they are designed to reach the communities that are most affected,” he said.

State border is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. If you have any questions, please contact editor Scott S. Greenberger: (email protected). Follow Stateline on Facebook and Tweet.

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