INDIANAPOLISBefore he went to prison, Ernest killed his 2-year-old daughter in the grip of a psychotic delusion. When the Indiana Department of Correction released him in 2015, he was terrified something awful might happen again.
He had to see a doctor. He had only a months worth of pills to control his delusions and mania. He was desperate for insurance coverage.
But the state failed to enroll him in Medicaid, although under the Affordable Care Act in Indiana had expanded the health insurance program, making most ex-inmates eligible. Left to navigate an unwieldy bureaucracy on his own, he came within days of running out of the pills that ground him in reality.
I have a serious mental disorder, which is what caused me to commit my crime in the first place, said Ernest, who asked reporters to use only his middle name to protect his privacy. Somebody should have been pretty concerned.
The health law was expected to connect Ernest and almost all other ex-prisoners for the first time to Medicaid coverage for the poor, cutting expensive visits to the emergency room, improving their prospects of rejoining society, and reducing the risk of spreading communicable diseases that flourish in prisons.
But Ernests experience is repeated millions of times across the country, an examination by The Marshall Project and Kaiser Health News shows.
Most of the state prison systems in the 31 states that expanded Medicaid have either not created large-scale enrollment programs or operate spotty programs that leave large numbers of exiting inmatesmany of whom are chronically illwithout insurance.
Local jails processing millions of prisoners a year, many severely mentally ill, are doing an even poorer job of getting health coverage for ex-inmates, by many accounts. Jail enrollment is especially challenging because the average stay is less than a month and prisoners are often released unexpectedly.
Ex-inmates with the worst chances of getting insurance and care are in 19 states that did not expand Medicaid. Only a small number qualify for coverage. Enrollment efforts by prisons and jails are almost nonexistent.
Nationwide, 16 state prison systems have no formal procedure to enroll prisoners in Medicaid as they reenter the community, according to a survey by The Marshall Project. Nine states have only small programs in select facilities or for limited groups of prisoners, like those with disabilities. These 25 states collectively release some 375,000 inmates each year.
Failure to link emerging inmates to health insurance is a missed opportunity to improve health and save money by cutting recidivism as well as visits to the hospital emergency room, advocates say. Studies have showed Medicaid access in Florida and Washington cut return trips to jail among the mentally ill by 16 percent.
I hate to say itits a captive audience. You have somebody there! You know theyre going to be released in a few weeks, said Monica McCurdy, who as head of a clinic for Project HOME in Philadelphia constantly sees homeless, recently released prisoners without Medicaid coverage. Why not do the handoff thats needed to prevent this person winding up in the ER? It defies common sense.
Health Risks Soar After Prison Release
Before the Affordable Care Act, state Medicaid programs covered mainly children, pregnant women, and disabled adults, which included only a small number of ex-offenders. Thats still generally the case in the 19 states that didnt expand Medicaid.
President-elect Donald Trump has vowed to repeal the health act and replace it with something else, leaving the laws Medicaid expansion and eligibility for ex-prisoners in doubt. Rep. Tom Price, Trumps pick to head the Health and Human Services Departmentwhich oversees Medicaidhas been one of Obamacares most vociferous critics in Congress.
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