Transitions tries to connect its clients to services that can help meet those needs, under the theory that doing so will help them stay healthy, drug-free and out of trouble.
The Massachusetts Experience
Studies are underway to determine whether these efforts are paying off. But Massachusetts, which may have the most experience in trying to provide health care assistance to former inmates, offers some initial evidence.
Massachusetts adopted an ACA-type health insurance program in 2006, four years before President Barack Obama signed the national health law. The state expanded Medicaid benefits to childless adults, including former prisoners.
Starting in 2008, when the program was fully implemented, prison officials began working with inmates six months before their release to ensure they were enrolled in Medicaid once they got out.
If a prisoner did not have a primary care doctor on the outside, officials assigned one who practiced in the community where the inmate planned to live and who accepted Medicaid patients. They linked inmates to health clinics with flexible hours, since former prisoners often lead chaotic, rootless lives when they return to society.
A 2011 study of the Massachusetts program found that nearly 80 percent of former inmates were continuously enrolled in Medicaid during the first year after their release. The study also showed that in that first year of the program, a significantly higher percentage of former inmates obtained medical and behavioral health services, when compared to the rest of the adult Massachusetts Medicaid population.
"We thought they might access mental health and substance abuse treatment and didn’t think they would also access primary care, but in fact they did," said Warren Ferguson, one of the study's coauthors and a professor of family medicine and community health at the University of Massachusetts, which ran the prison health services until recently.
The study found that released inmates used emergency rooms at higher rates than the general Medicaid population. The finding made sense, Ferguson said, because inmates generally are less healthy than the general population and have higher rates of hepatitis C, heart disease, diabetes, HIV or AIDS, mental illness and addiction.
The good news, Ferguson said, is ex-prisoners tended to use the emergency room more often for real medical emergencies rather than non-urgent health problems.
Since Massachusetts implemented the program, it has added other elements to its transition program. It now makes appointments for primary care and specialist visits prior to an inmate’s release. Those with HIV or AIDS are set up with case managers on the outside who help former prisoners make their medical appointments and manage their medications.
Patients with alcohol and opiate addictions who take anti-addiction medications are connected to substance abuse treatment centers. And the state’s Department of Health also provides some case management for some ex-offenders with mental illness.
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