Baltimore Sun

Health resources for ex-prisoners lacking

Former inmates regularly leave facilities with no meds, insurance, follow-up care

- By Renuka Rayasam

When Matthew Boyd was released from a Georgia state prison in December 2020, officials sent him home without medicines to manage 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. These days, he can barely get out of bed in his home south of Atlanta.

“It makes my life so miserable,” said Boyd, 44, who has chronic obstructiv­e pulmonary disease.

While Medicaid is generally prohibited from paying for the services people receive inside a prison or jail, the Biden administra­tion opened the door for the federal program to cover care not long before a person is released, to help them better manage their health conditions during the transition. In February, the administra­tion announced that states could also use Medicaid to pay for substance abuse treatment in state jails and prisons. Congressio­nal efforts to reactivate Medicaid before inmates’ release nationwide have so far failed.

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

More than 600,000 people are released from prisons every year in the U.S. and the majority have health conditions. A 2019 judicial decision suggested that people who are incarcerat­ed have a constituti­onal right to adequate medical discharge planning before their release, including supplies of medication or prescripti­ons. But it’s far from clear whether states are required to do so.

In Georgia, correction­al facilities are supposed to create a discharge plan that includes making medical appointmen­ts and supplying medication­s. Joan Heath, director of the public affairs office at the Georgia Department of Correction­s, didn’t respond to questions about why the official policy wasn’t followed in Boyd’s case.

Despite policies, people regularly leave prison or jail lacking medication­s, medical records, a provider appointmen­t or health insurance. About 84% of men and 92% of women who were incarcerat­ed had a physical or mental health condition or substance use disorder, according to a sample of people interviewe­d before and after their release from prison by the Urban Institute, a nonprofit that researches issues around equity.

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

“There is no bridge,” said Stephanie Jones-Heath, CEO of Diversity Health Center, a health center in southeaste­rn Georgia. By the time formerly incarcerat­ed patients come to the center, their health conditions are uncontroll­ed and they have no medical records. “We have to start all over because we have no continuity of care,” she said.

The United States has one of the highest rates of incarcerat­ion in the world.

Conditions such as the use of solitary confinemen­t, limited health care access, high stress and poor-quality food can create or exacerbate illness.

“This is the sickest population in the country,” said Dr. Marc Stern, a University of Washington public health faculty member who previously worked for the state’s Department of Correction­s. Stern coauthored one of the few studies on the topic. That 2007 study found people who were incarcerat­ed were 3.5 times as likely to die as other state residents — many deaths taking place within the first two weeks of a person’s release.

In Georgia, even basic discharge planning can be rare, said Craig Burnes, a certified peer-support specialist for incarcerat­ed people. In 2014 he was released from state prison after a nearly 15-year stay with a $20 debit card that mistakenly hadn’t been

activated, he said. Burnes, who has bipolar disorder, PTSD, depression and anxiety, said he found his own way to a safety-net foundation for mental illness treatment 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 that comes with reclaiming their life 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 medication­s and a referral to a free clinic.

Stephen McCary, 40, couldn’t find treatment for a heroin addiction after he was released from an Alabama prison in 2011.

In May 2019, an addiction recovery facility told

him that funding to pay for his care was not immediatel­y available. McCary, who also struggled with periodic homelessne­ss, never followed up. He suffered an overdose, was rearrested for a pharmacy theft, and is now serving another prison sentence.

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

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 with primary care after incarcerat­ion, they are less likely to be hospitaliz­ed or to be reincarcer­ated, which can 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 more likely than the general population to be incarcerat­ed and lack insurance coverage, are disproport­ionately affected by the absence of post-incarcerat­ion health services.

One reason people fall through the cracks is because no one agency takes responsibi­lity for the problem, said Dr.

Evan Ashkin, a professor of family medicine at the University of North Carolina at Chapel Hill and director of the North Carolina Formerly Incarcerat­ed Transition Program, which helps former inmates obtain health care. Health systems often don’t differenti­ate the needs of people who were imprisoned from others lacking insurance, Ashkin said. Justice systems don’t have budgets or a mandate to care for people once they leave custody. About 90% of patients in the program’s clinics lack insurance.

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

Hingle, 52, learned he had prostate cancer after requesting the biopsy results from the health care provider. Even though he had Medicaid coverage, he had to wait several more months for insurance from his job to kick in before he could afford treatment and surgery to remove his prostate.

Hingle wonders how his life might have unfolded if he had been diagnosed sooner. Without a prostate, “having children with my wife, that’s gone,” he said.

 ?? DUSTIN CHAMBERS/KHN ?? Matthew Boyd was released from prison in December 2020 without medicine to manage his chronic heart and lung conditions and high blood pressure.
DUSTIN CHAMBERS/KHN Matthew Boyd was released from prison in December 2020 without medicine to manage his chronic heart and lung conditions and high blood pressure.

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