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Many ex-prisoners struggle to access health care after release

When Matthew Boyd was released from a Georgia state prison in December 2020, officials sent him home without the medication he uses to manage a chronic heart and lung condition and high blood pressure, she said.

Less than a month later, he spent eight days in an intensive care unit, the first of more than 40 hospital stays. These days, he can barely get out of bed at his home south of Atlanta.

“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 she sometimes has trouble speaking without losing her breath.

Less than a month after being released from prison, Matthew Boyd spent eight days in an intensive care unit, the first of more than 40 hospital stays over the past two years. These days, he can barely get out of bed at his home south of Atlanta.

Dustin Chambers for KHN

While Medicaid is generally prohibited from paying for services people receive inside prison or jail, the Biden administration opened the door for a federal program to help a person better manage their health condition shortly before release. . In February, the administration announced that states could use Medicaid to pay for substance abuse treatment in state prisons and jails. Congressional efforts to reactivate Medicaid before the release of inmates nationwide have so far failed.

And across much of the South, where many states have not expanded Medicaid, reentry services that connect people like Boyd with health care resources are often minimal or nonexistent.

More than 600,000 people are released from state and federal prisons in the United States each year, and most have health conditions. A 2019 judicial decision suggested that incarcerated individuals have a constitutional right to an adequate medical discharge plan prior to their release, including the provision of medications or prescriptions. But it is unclear whether states are required to do so.

In Georgia, correctional facilities are supposed to develop a discharge plan that includes making medical appointments and providing medication. Joanne Heath, director of the Georgia Department of Corrections’ office of public affairs, did not respond to questions about why government policy was not followed in Boyd’s case.

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Matthew Boyd sits with his fiancee Amanda Hollwood, who has helped care for him since his release from prison in December 2020.

Dustin Chambers for KHN

Despite government policies, people routinely leave prisons or jails for lack of medication, medical records, provider appointments, or health insurance. About 84% of men and 92% of women who were incarcerated had a physical or mental health condition or substance use disorder, according to the Urban Institute, a nonprofit that researches neighborhood issues interviewed before and after release from prison. equity

Without timely care, formerly incarcerated patients are more likely to have health crises and expensive emergency room visits. Or they experience a mental health episode or commit a crime related to a substance use disorder that lands them back in jail or prison.

“There is no bridge,” said Stephanie Jones-Heath, CEO of Diversity Health Center, a federally qualified health center in southeast Georgia. Formerly incarcerated patients have uncontrolled health conditions when they arrive at the center and have no medical records, he said. “We have to start all over because we don’t have continuity of care,” she said.

The United States has the highest incarceration rate in the world. Conditions such as the use of solitary confinement, limited access to healthcare, high stress and poor quality food can also create or exacerbate illness.

“This is the sickest population in the country,” said University of Washington public health faculty member Dr. Mark Stern, who previously worked for the state Department of Corrections Stern is a co-author of several studies on this topic. That 2007 study found that those who were incarcerated were 3.5 times more likely to die than residents of other states — with many deaths occurring within the first two weeks of a person’s release.

In January, California became the first state to grant a partial waiver that allows incarcerated people to receive services through Medicaid 90 days before release. More than a dozen other states are pursuing similar waivers. They argue that more seamless care would reduce deaths from overdoses — the leading killer of people leaving prison — improve health outcomes and save money by keeping patients out of emergency rooms.

In Georgia, even basic discharge planning can be rare, said Craig Burns, a certified peer-support specialist for incarcerated individuals. He was released from state prison in 2014 after serving nearly 15 years with a $20 debit card that was accidentally not activated, he said. Barnes, who has bipolar and post-traumatic stress disorder, depression and anxiety, said she found her own way with a safety-net foundation to treat mental illness near her home in Dalton.

Most of the people Barnes works with have no idea how to care. Often, they lack family support and stable housing, struggle with mental health or substance abuse issues, and lack the skills to navigate the bureaucracy that comes with rebuilding their lives after prison.

“It’s a vicious circle that has no beginning,” he said. Barnes regularly sends people to the emergency room so they can get medication and a referral to a free clinic.

Stephen McCurry, 40, did not seek treatment for heroin addiction after his release from an Alabama prison in 2011.

In May 2019, an addiction recovery facility told him that payment for his care was not immediately available. McCurry, who also struggled with periodic homelessness, never followed through. He suffered an overdose, was rearrested for robbing a pharmacy, and is now serving another prison sentence.

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

Alabama did not expand Medicaid, which could have helped McCurry secure care after his release. In Connecticut, a study found that when people are connected to primary care after incarceration, they are less likely to be hospitalized or re-incarcerated, which can save the state money.

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

Black people, who are more likely than the general population to be incarcerated and lack insurance coverage, are disproportionately affected by the absence of post-incarceration health services.

One reason people fall through the cracks is that no organization takes responsibility for the problem, said Dr. Evan Ashkin, a professor of family medicine at the University of North Carolina-Chapel Hill and director of the North Carolina Forlory Incarcerated Transition Program, which helps former inmates access health care. The health system often doesn’t distinguish the needs of people who were incarcerated from others because of lack of insurance, he said. The justice system does not have the budget or mandate to care for people once they leave custody. About 90% of patients in the program’s clinics lack insurance, and North Carolina has yet to expand Medicaid, although lawmakers recently struck a deal to do so.

A key part of the new California waiver is the ability for providers to be reimbursed for coordination of care, which is especially important for people coming out of prison, Shabit said. “All their basic needs go up in the air at once and often health care takes a back seat,” he said.

Medicaid expansion, along with a program to enroll patients in Medicaid just before release, has helped break out of Louisiana’s notorious prison health care system, said Dr. Anjali Niyogi, a Tulane University School of Medicine professor who founded a clinic that serves formerly incarcerated people. Still, insurance coverage alone isn’t enough to compensate people for the care they lack while incarcerated, he said.

Anthony Hingle Jr. never received the results of a biopsy that occurred days before he was to be released from Louisiana State Penitentiary in Angola in 2021 after 32 years in prison.

Hingle, 52, learned he had prostate cancer after he called a New Orleans hospital to request biopsy results. Although he had Medicaid coverage, he had to wait several more months for insurance from his job before he could afford treatment and surgery to remove his prostate. Hingley, who works as an office assistant at Voices of the Expired, a nonprofit that advocates for incarcerated and formerly incarcerated people, wonders how her life might have turned out if she had been diagnosed sooner.

Without the prostate, “having children with my wife, that’s gone,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.

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