Traditionally, states have canceled Medicaid coverage for people who get thrown in jail. In recent years, though, more states have changed their regulations so a prisoner is temporarily suspended from medical assistance, rather than terminated.
When Tara Novelli was released from jail in Philadelphia last year, she says she left empty-handed.
In 2014, heroin, crack and a prostitution charge sent her to a county lockup. During her seven-month stint, Novelli was given medication for her depression and anxiety.
Then she got out.
“I didn’t get sent home with anything,” Novelli says.
After leaving jail, it took about two months to get enrolled in medical assistance and finally get a prescription for her medicine, the 37 year old says.
She managed just fine for a while. But a few months later, Novelli had a relapse and landed back in rehab. She doesn’t think it mattered much that she didn’t have health coverage immediately, but that’s the worry. Re-entry experts say when you are just out of jail and scrambling to make good decisions, being off your medicines lowers the chance that you’ll be successful.
Novelli is sober now, attending support groups regularly and living in the Why Not Prosper residential home for women.
Bruce Herdman, medical director for the Philadelphia Prison System, says inmates typically leave jail with five days of medicine and two prescriptions.
“Virtually no one here has insurance, it didn’t do any good because they didn’t have the money to pay for the prescriptions,” Herdman said. “Having [medical assistance] coverage allows them to go to a pharmacy and fill those scripts.”
The jail now has several pilot programs to get some inmates signed up for Medicaid before they are released. People with serious mental illness go to the Philadelphia Mayor’s Office of Reintegration Services when they get out and staffers there make a call to get their benefits activated.
“That can be done within one or two days,” Herdman said.
Kriya Patel, a college senior from Wisconsin, also has a plan to help.
Patel first visited Riverside Correctional Facility—the Philadelphia women’s jail—for a University of Pennsylvania class called Women and Incarceration. This year, she won a $100,000 prize to help female inmates enroll in Medicaid.
“You need to find housing, you need to find a job, when are you going to find the time to sit down in front of a computer or travel to an office and actually fill out paperwork?” Patel said.
Medicaid won’t pay for the health care of people who are incarcerated, so, traditionally, states have canceled the benefit when people got locked up.
But in recent years, more than a dozen states have changed their regulations so now a prisoner is temporarily suspended from medical assistance, instead of terminated.
Pennsylvania’s Secretary of the Department of Human Services, Ted Dallas, said his team is looking into that possibility, but the change would require a big programming job for the state’s massive IT system.
“So that all we have to do is a little bit of follow-up when they are getting ready to leave, so we can flip a switch and un-suspend their benefits,” Dallas said.
“Whether you are a Democrat or Republican, I think in the last five or 10 years, folks have come to grips; this is smart policy,” Dallas said.
The goal is to make a smoother transition to health care and help people avoid another trip through the system, he said.
Nationwide, about 600,000 people return from prison every year. There’s a slogan that re-entry advocates repeat often: “They are coming home.”
Ex-felons are more likely than other people in the community to use emergency rooms and more likely to have certain illnesses including hepatitis, HIV, high blood pressure and asthma, according to a 2015 Kaiser Family Foundation report.
Illinois uses a prisoner’s fingerprints to verify if that person is eligible for Medicaid.
“When you’re incarcerated, there’s no question about who you are,” said Maureen McDonnell, director for business and health care strategy development at the Illinois’ nonprofit Treatment Alternatives for Safe Communities.
Because turnover can be so quick, in Chicago, inmates are enrolled in Medicaid on the way in to jail—instead of on the way out.
“A quarter of the people who are detained leave the jail within two days, half are gone within 13 days,” said McDonnell.
“Folks who are eligible for Medicaid often don’t know they are eligible,” McDonnell said.
Signing up for Medicaid is about the only thing you can say ‘no’ to on the day you get booked, but McDonnell said she’s pleasantly surprised at how many people say ‘yes’ when they are given the opportunity.
“That’s just not the best day of anyone’s life, even if you’ve been in the jail, chances are you didn’t wake up that morning thinking you were going to be in jail later that day,” she said.
TASC is gathering data to better understand if enrollment influences incarceration or health.
Care in Camden
Medicare covered the costs when Darryl Conquest got bacterial pneumonia earlier this year and needed a chest X-ray and lots of cough medicine.
The 65 year old has been out of prison for eight months. And after 40 years inside, everything is new.
“I can’t really put my finger on one simple thing – technology, traffic, people, movement, being out after dark, seeing the stars,” he said.
He wears the prayer cap that many older Muslim men wear, and a chunky plastic watch you might see on a much younger man. Even picking out his clothes is a freedom to celebrate.
At a recent visit to his local health center, when there was a glitch with his insurance coverage, Conquest was happy to be responsible for figuring it all out.
“This is the first time I paid a copay, today,” he said.
In 1975, Conquest killed two people — a man and an eighth-grade girl. He was 25 and an addict.
“Heroin. I was a heroin user,” Conquest said. “At that time in my life I was just all over the place – committing robberies — I used to travel up and down the East Coast just robbing people, [I] used to go to Washington, New York, Philly,”
He expected to be in prison for the rest of his life, and says he thought: “That’s it. For all practical purposes my life is over.”
But last fall, Conquest was paroled to a residential and addiction treatment program in Camden, New Jersey, operated by Volunteers of America Delaware Valley.
The transition experts there say they never used to talk about health care.
“We talked about people getting jobs, and people paying fines and people participating in treatment groups, and now we are paying attention to it,” said Chief Operating Officer Pat McKernan.
She’s done social work with ex-prisoners for two decades, but says in recent years, former prisoners are older and sicker.
For example, “the severity of the diabetes is a lot more than it used to be,” McKernan said.
“If you don’t have an insulin dose that can be life threatening immediately,” said Bill Wilson, director of VOA’s addiction treatment program.
Even younger people often have pent-up health needs.
“For people coming off opiates—everything hurts. That’s when they start recognizing I have an abscessed tooth. You can’t sit in group with an abscessed tooth,” McKernan said.
The counselors have seen every manipulation, delay tactic and drug-seeking trick in the book. But McKernan says sometimes other re-entry priorities really do have to wait so an ex-felon can get healthy.
“You have to get those things taken care of,” she said.
The counselors at Volunteers of America know a local dentist who accepts Medicaid, and they send clients to a federally funded health center in the neighborhood. They also help ex-felons build a legitimate paper trail to prove they qualify for benefits.
McKernan says some ex-felons have never had a driver’s license, others used to have multiple social security cards.
“Having real identification for who I really am can be a challenge,” she said.
Darryl Conquest got his care at The Project Hope health center in Camden.
The clinic has application counselors, but, these days, when ex-prisoners show up, often, their paperwork is already in order because the New Jersey Department of Corrections tries to enroll prisoners in Medicaid before they leave incarceration.
“It’s made a huge difference,” McKernan said.
James Comstock, who works in the behavioral health department at Project Hope, says once ex-felons have coverage, his job is to walk them through the routine health care headaches that we all deal with—such as wait times, and being put on hold when you call for an appointment.
“I’m just kind of preparing them for the future,” said Comstock, who used to work inside a prison.
He tells ex-offenders: “You had frustrations there, there are frustrations here, too.”
The health center provides HIV testing. The clinicians offer anti-addiction medicine for people who are dependent on opioids. And, there are condoms available.
For some ex-felons, it’s the first time in a long time that they’ve had a sex education conversation.
At least a “professional one,” Comstock said.