Prison to community re-entry, with the addition of health-care coverage

In this article, we share information about important work being done by the Pennsylvania Health Law Project to expand access to health care for persons in prisons and jails in Pennsylvania. The ActionAIDS Philadelphia Linkage Program actively links clients to health-care services upon release from prison, and we applaud these

efforts to expand that access to others upon release.

People re-entering the community from Pennsylvania’s prisons and jails have a great need for medical care upon release. They are disproportionately afflicted with behavioral and physical illnesses. For example, approximately 20 percent have serious mental illnesses, more than half have substance-use disorders and 18 percent have hepatitis C. While many are stabilized by prison-health services, most do not have health insurance or a good connection to care upon release. A few programs in Philadelphia — including at ActionAIDS — currently enroll their clients in Medicaid prior to release, but most people leave custody with a few days’ supply of necessary medications and no health insurance.

Health-care reform has the potential to change that reality. Reentering individuals with incomes above 100 percent of poverty ($11,490 for an individual) can currently purchase insurance through the Health Insurance Marketplace. Most of those with lower incomes will be eligible once Medicaid is expanded; under the pending Healthy PA proposal, expansion would occur in January. According to an estimate from the Department of Justice, approximately 30 percent of the newly eligible population will be made up of people leaving custody.

As a fellow at the Pennsylvania Health Law Project, I am currently assisting Pennsylvania prisons and jails in making seamless access to health-care coverage an integral part of re-entry planning. Many people in custody qualify for coverage under current Medicaid rules, such as those whose illnesses make them unable to work or who require life-sustaining medications. If institutions begin now to enroll these people in Medicaid that becomes effective when they leave custody, there will be several benefits:

• The individuals will be able to access necessary medical services without the customary wait of 30 days or more for Medical Assistance coverage, during which their health often deteriorates.

• Communities will be healthier and safer. Studies in Florida, Washington, Rhode Island and Michigan have shown a 16-17-percent reduction in re-incarceration for re-entering individuals who are covered by Medicaid at the time of release.

• Prisons and jails will be ready to implement those enrollment practices for the larger population once Medicaid is expanded.

A number of local jails are currently enlarging their mission to include filing COMPASS applications for those who qualify. In partnership with their local county-assistance offices, they are working to have Medicaid coverage turned on the day the person leaves custody. If this process is implemented across the commonwealth, and expanded to the newly eligible population at the earliest opportunity, health-care reform can make a significant, positive difference for re-entering citizens and their communities.