Many people leaving jail are now eligible for Medicaid.
Expanding the service means that low-income inhabitants of 30 states plus DC are now eligible, if they earn less than 138% of the federal poverty level or, in 2015, less than $16,000 a year for a single, childless adult or $33,000 for a family of four.
In the past, those being released from jail or prison did not qualify for Medicaid, but now they do. These are mostly men on low incomes.
However, many do not have access to programs that would help them enroll in Medicaid once they are released.
Research shows that access to health services on release leads to greater well-being and a lower risk of committing further crimes.
For former prisoners, the first days and weeks back in the community are crucial. A 2007 study published in the New England Journal of Medicine found that in the 2 weeks after release, the mortality rate among former prisoners was 13 times higher than in the general public, especially from a drug overdose.
Many of those being released have serious health conditions, mental illness or substance abuse problems, and often, when their medication runs out, they commit new crimes that put them back in jail.
Connecting with health care services could help people maintain their medications and prevent this cycle of re-arrests.
Programs get more than 112,000 people into Medicaid
Researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, led by Colleen L. Barry, PhD, investigated programs that help enroll prisoners in Medicaid upon release.
As of January 2015, there were 64 programs - half of them in California. Only 42 of these programs have kept data on the numbers enrolled, but those that have kept count had enrolled 112,000 people by January 2015, mostly men. The total number is probably far higher.
Barry explains that men with serious health conditions, from schizophrenia to heart disease, receive treatment while in prison, but leave with 1-2 weeks' supply of medication and no access to a doctor.
Now, in participating states, many newly released prisoners are qualifying for health insurance through Medicaid. A small number of innovative programs have been created to help former prisoners enroll in Medicaid and to connect them with health care services.
Under federal law, those serving time cannot receive Medicaid, so that, on being convicted, people lose their benefits but receive treatment from the corrections system. After, it can take months to re-enroll.
One strategy involves states and counties suspending rather than terminating benefits while serving time, so that Medicaid is automatically reinstated upon release.
The Cook County Jail in Chicago takes in some 300 inmates a day, and social services staff screen them for Medicaid eligibility as they enter, thus preparing them in advance for enrollment upon release. Their jail ID is acceptable as ID to enroll in Medicaid, thus removing one barrier to enrollment.
Community support still needed
The researchers emphasize that former inmates need not only Medicaid cards but also help from the community to get appointments with doctors who take their insurance.
As study coauthor Sachini Bandara says:
"If this change is going to make a difference, it's not enough to give people insurance. You need to facilitate access to health care providers. This is a population that has been largely ignored as they have fallen through the cracks in the system. These new Medicaid eligibility requirements are a huge opportunity to make a real difference in the lives of poor men."
So far, attention has been focused nationally on the issue of warehousing people with serious mental illness in jails and prisons instead of finding better ways to connect them with health care services within their communities.
If programs designed to ease the Medicaid enrollment process are expanded to more jurisdictions, many thousands more could benefit, say the authors.
Last year, Medical News Today reported that adults on low incomes in the US largely support the expansion of Medicaid.