Many ex-convicts struggle to get health care after release

When Matthew Boyd was released from a Georgia state prison in December 2020, officials sent him home without drugs he takes to treat chronic heart and lung conditions and high blood pressure, he said.

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

“It makes my life so miserable,” says Boyd, 44, who has chronic obstructive pulmonary disease. He told his story to KHN via email and text because he sometimes struggles to get out of 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 in the past two years. Today, in his home south of Atlanta, he can barely get out of bed.

Dustin Chambers for KHN

While Medicaid is generally not allowed to pay for the services people receive in prison or jail, the Biden administration opened the door to the federal program to cover care shortly before a person is released to help them manage their health during the better manage transition. In February, the government announced that states would also be able to use Medicaid to pay for substance abuse treatment in state prisons and prisons. Attempts by Congress to reactivate Medicaid before prisoners are released across the country have so far failed.

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

Each year in the US, more than 600,000 people are released from state and federal prisons, and the majority have health problems. A 2019 court decision suggested that people incarcerated have a constitutional right to adequate medical discharge planning before release, including medications or prescriptions. But it is far from clear whether states are obliged to do so.

In Georgia, correctional facilities are supposed to create a discharge plan that includes making medical appointments and dispensing medications. Joan Heath, director of the public affairs bureau of the Georgia Department of Corrections, did not respond to questions about why official policies were not followed in Boyd’s case.

Matthew Boyd is with his fiancé, Amanda Hollowood, who has looked after him since he was released from prison in December 2020.

Dustin Chambers for KHN

Despite official policies, people regularly leave prison without medicines, medical records, an appointment with a healthcare provider or health insurance. About 84% of men and 92% of women incarcerated had a physical or mental health condition or substance use disorder, according to a sample of people interviewed before and after release from prison by the Urban Institute, a non-profit organization that researches equity issues.

Without timely care, formerly incarcerated patients are more likely to have a health crisis and turn to costly emergency care. Or they experience a mental health episode or commit crimes related to a substance use disorder, which lands them back in jail or jail.

“There’s no bridge,” says Stephanie Jones-Heath, CEO of Diversity Health Center, a federally qualified health center in southeastern Georgia. By the time formerly incarcerated patients come to the center, their health status is unchecked and they have no medical records, she said. “We have to start all over because we don’t have continuity of care,” she said.

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

“This is the sickest population in the country,” said Dr. Marc Stern, a member of the University of Washington faculty of public health who previously worked for the state’s department of corrections. Stern co-authored one of the few studies on this topic. That 2007 study found that people incarcerated were 3.5 times more likely to die than other residents of the state — many deaths occurred within the first two weeks of a person’s release.

In January, California became the first state to receive a partial waiver allowing inmates to receive services through Medicaid 90 days before release. More than a dozen other states are seeking similar waivers. They argue that more seamless care will reduce overdose deaths — the leading killer of people leaving prison — improve health outcomes and save money by keeping patients out of the emergency room.

In Georgia, even simple discharge planning can be rare, says Craig Burnes, a certified peer support specialist for inmates. In 2014, he was released from state prison after serving nearly 15 years with a $20 debit card that was mistakenly not activated, he said. Burnes, who has bipolar and post-traumatic stress disorder, depression and anxiety, said he found his own way into a mental illness treatment safety net near his home in Dalton.

Most of the people Burnes works with have no idea how to access 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 associated with reclaiming their lives after prison.

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

Stephen McCary, 40, was unable to find treatment for a heroin addiction after being released from an Alabama prison in 2011.

In May 2019, an addiction treatment facility told him that money was not immediately available to pay for his care. McCary, who also struggled with intermittent homelessness, never followed up. He overdosed, was arrested again for robbery from a pharmacy and is now serving another prison sentence.

“None of these crimes would I have committed if I had to go somewhere,” he said in a phone call from Alabama’s Ventress Correctional Facility.

Alabama has not expanded Medicaid, which could have helped McCary 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 could save the state money.

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

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

One of the reasons people fall through the cracks is that no one is taking 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 Formerly Incarcerated Transition Program, which helps former inmates get health care. Health systems often fail to distinguish between the needs of people who were incarcerated and those who had no insurance, he said. Justice systems have no budgets or a mandate to care for people once they leave custody. About 90% of patients in the program’s clinics have no insurance, and North Carolina has not yet expanded Medicaid, though lawmakers recently signed an agreement to do so.

An important part of California’s new exemption is the ability for caregivers to receive compensation to coordinate care, which is especially important for people getting out of prison, Shavit said. “All of their basic needs are in the air at once, and often health care takes a back seat,” she said.

The expansion of Medicaid along with a program to enroll patients in Medicaid just before release has helped people get out of Louisiana’s notoriously grim prison health care system, said Dr. Anjali Niyogi, a professor at Tulane University School of Medicine who founded a clinic for formerly incarcerated people. Still, insurance coverage alone isn’t enough to make up for the lack of care people get in prison, she said.

Anthony Hingle Jr. never got the results of a biopsy that took place just days before he was released from Angola’s Louisiana State Penitentiary in 2021 after 32 years of incarceration.

Hingle, 52, discovered he had prostate cancer after calling the New Orleans Hospital on his own to request the results of the biopsy. Although he had Medicaid coverage, he still had to wait several months for job insurance before he could afford treatment and surgery to remove his prostate. Hingle, who works as an office assistant at Voice of the Experienced, a nonprofit advocacy for incarcerated and formerly incarcerated people, wonders how his life might have unfolded had he been diagnosed earlier.

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

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three major operational programmes KFF (Foundation Family Kaiser). KFF is an endowed non-profit organization that provides information on health issues to the nation.

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