Two years ago, at age 26, Victoria DeLorenzo was released from a 14-month jail sentence in California, her fourth incarceration in eight years, all for drug offenses.
While DeLorenzo was soon back behind bars the first three times she left, this last release has been successful beyond her dreams.
DeLorenzo, now 28, said she has stayed off drugs and out of jail for the last two years as a full-time student majoring in psychology at Grossmont College in El Cajon, with plans to transfer to San Diego State.
What made the difference this fourth time? DeLorenzo credits Medicaid, called Medi-Cal in California, the federal insurance program for low-income people. California expanded Medi-Cal under the Affordable Care Act (ACA), one of 31 states to offer the insurance to more low-income people like DeLorenzo.
She also credits San Diego’s Project In-Reach, which helps adults recently released from jail use Medi-Cal to find care for their specific needs. For DeLorenzo, that meant treatment for a heroin addiction.
Before the Medi-Cal expansion, people released from jail or prison had few resources for addressing health problems, including addictions, said Mona Minton, a clinical psychologist and the General Manager of Programs, Clinics and Community Affairs at the Neighborhood House Association, the social service agency that created Project-In Reach.
Lois Davis, a senior policy researcher at the Rand Corporation who is leading an ongoing study on how to improve access to health care for the formerly incarcerated, said it is challenging to work with this population because of factors that include low literacy and unstable housing.
Something as simple as a lack of identification could be a barrier for people applying to the Medi-Cal program. Yet health care seems to provide a crucial link to a better life after incarceration.
A study published in late 2015 in the journal Health Affairs found that since 2014, more than sixty programs throughout the U.S. helped connect people in jails and prisons to health insurance that took effect on release, thanks to the Medicaid expansion and other coverage under the Affordable Care Act. Half of those programs were in California.
The Health Affairs study estimates that the programs have helped connect at least 100,000 formerly incarcerated people with coverage and care they hadn’t qualified for in the past. “Previously people who had serious health conditions ranging from schizophrenia to heart disease to diabetes, who received medication while in prison or jail, were released with as little as a week or two supply of medication and no access to a doctor,” says Colleen Barry, lead author of the study and a professor of health policy and management at the Bloomberg School of Public Health at Johns Hopkins University.
The “first days and weeks back in the community can be lethal,” Barry said. A 2007 study in the New England Journal of Medicine found that in the two weeks after release the mortality rate among former prisoners was 13 times higher than average. Drug overdose was the leading cause of death. “If they could be successfully connected with health care services and maintained on their medications,” Barry said, “research shows that they will be more likely to do well in their communities and avoid this cycle of re-arrests.”
So far, Project In-Reach has collected two years of data from about 600 clients. Four percent of clients reported a return to jail within six months in 2014 and thirteen percent reported a return in six months in 2015. Using these data as an indication of the program’s success, however, is a challenge. Differences in how recidivism is measured by the state and country make it difficult to compare the outcomes of people in the program to state and local averages.
The San Diego Sherriff’s Department does give Project In-Reach strong marks. The department has worked with Project In-Reach for the past five years, said Patricia Ceballos, the Reentry Supervisor for the San Diego Sheriff’s Department. The “unique contribution the program provides is pre and post case management services,” Ceballos said. “The support [the program] provides, contributes to the success the participants experience in the community.”
Project In-Reach counselors begin their work at several San Diego detention centers. Inmates are referred to the program two to six months before their scheduled release date to begin therapy and coordination of medical care, if needed. Once they’re released, the program helps them access services such as free transportation to doctor visits.
Being connected to mental health and medical services, Victoria DeLorenzo said, has allowed her to leave drug use behind and embark on her future. “With the therapist I was connected to by Project In-Reach, I’ve been able to talk about what triggers might lead me back to old behaviors and it helped me to see a different perspective in life that kept me from relapsing.”
“If this change is going to make a difference, it’s not enough to give people insurance,” said Sachini Bandara, a doctoral student at the Bloomberg School of Public Health and an author on the Health Affairs study. “You need to facilitate access to health care providers.”