Promise of Health Care Reform Unrealized for Former Inmates

Photo: File/Getty Images/Tim Boyle
Photo: File/Getty Images/Tim Boyle

Health care is often one of several keys that unlock a new future for inmates recently released from jail or prison.

The Affordable Care Act held great promise for ex-cons, many of whom qualify for expanded Medi-Cal – California’s version of Medicaid – under the new rules.

“The protection and peace of mind that comes with health care coverage can be invaluable, and that security can help parolees focus on rebuilding their lives,” said Covered California spokesman James Scullary.

One year in, however, that promise remains unrealized for many ex-offenders, as officials work to implement sweeping changes, said those working within the new system. It will take time, Scullary said, before the potential becomes reality for many former inmates.

John Holman knows exactly how much health care means. After he was released from his last prison stint 10 years ago, Holman was diagnosed with Type II diabetes. A halfway house connected him with Healthy Oakland, now Healthy Communities, Inc., which offers medical-related services for parolees. Eventually they offered Holman a job with health benefits.

Health care helped him stay out of prison for good. Both the job and the benefits gave him stability. Without it, he said, “I probably would have remained in that revolving door.” About 60 percent of prisoners are sent back to prison for a new crime within three years of their release.

Holman, who is Healthy Communities’ IT manager and site manager, also serves informally as a re-entry coordinator. He’s seen too many released inmates get lost in the complicated system and fall through the gap between prison health care and their new benefits.

For someone waiting for medications to treat a mental illness, an old drug habit might seem like an attractive stopgap. “They come out with good intentions, but get discouraged when things don’t happen in a timely fashion,” he said.

Newly released prisoners are often in dire need of health care. A RAND Corporation study from 2009 found that two-thirds of parolees reported a drug abuse or dependence problem. The research nonprofit also found that half reported a mental illness.

Rates of infectious diseases including tuberculosis, hepatitis C and HIV were also exponentially greater among inmates than the general population, the study found.

Many inmates, however, have never had health insurance before, according to Holman. They don’t fully understand the plans, the process to enroll or how to use their benefits once they have them.

The county-level health insurance plan, HealthPAC, was once a safety net for low-income people, including recently released prisoners. Under the ACA’s new provisions, however, that program has been cut back as low-income people are moved to Medi-Cal. It is now only available for undocumented citizens.

Holman believes that the system would better serve released inmates if they were enrolled while they were still in jail or prison, with their coverage to take effect upon release.

RAND is in the process of a follow-up study and identifying the benefits former inmates are typically eligible for under the ACA. Their findings will help counties understand how to make the enrollment process easier, said Lois Davis, senior policy researcher at RAND and co-author of the 2009 study.

Her team estimates that two-thirds of formerly incarcerated Californians are eligible for Medi-Cal under ACA. The remainder would likely qualify for insurance through the state health exchange.

It’s unclear how many are actually enrolled, Davis said. “That’s the number one question.”

There are big hurdles for newly released inmates, she said. They are a transient population and their incomes can fluctuate, changing their eligibility for programs and assistance. Many are uneducated and lack computer literacy skills. Some go by several names.

Released inmates, Davis said, need enrollment specialists who are trained to meet their unique needs.

Enrollment isn’t a guarantee they will pursue the care they need, even though one-stop shops and non-profits are working to clear an easy path to health care. “A lot more needs to be done,” Davis said.

The system has made many changes to make coverage and treatment more comprehensive, streamlined and of higher quality, said Sharon Loveseth, quality assurance officer for Healthy Partnerships, which provides outpatient counseling for addiction and mental health and DUI programs. She’s not surprised the changes are taking time.

Not since the Reagan administration in the 1980s has this kind of overhaul to drug addiction treatment taken place, Loveseth said.

The prison and jail system are going through what is called “realignment” as part of prison reform. Non-serious felony offenders now serve their sentences at county jails instead of prisons. The law was meant to encourage access to treatment for addiction and mental health in the community, but the state’s publicly-funded treatment program has struggled with fraud and internal audits over the past two years.

Meanwhile, state, county and federal officials are working to create a “continuum of care” for drug addiction treatment, which will now cover residential treatment, detox, outpatient care, case management services, medication-assisted treatment and co-occurring disorders. Electronic record keeping is now mandated.

While much of these shifts are not necessarily components of ACA, the new law was the catalyst, Loveseth said, because the Medi-Cal expansion created a system that can support such changes.

The ultimate goal for inmates is that proper medical coverage and treatment will result in fewer people becoming repeat offenders. Despite the cumbersome transition process, Loveseth is optimistic.

“The action down at the county and provider level is just starting to kick in, and this will be the year I think where things really happen,” she said.

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