Each year, more than 650,000 people are released from state and federal prisons. Nine million others churn through local jails. For many, the transition back to the outside world poses an acute risk. Studies have shown a decline in the health of the recently released, who experience significantly higher rates of death and hospitalization compared to the general populace. The first two weeks can be especially dangerous.
Among the most common killers of this population are suicide, cardiovascular disease, homicide and, topping the list, drug overdoses. A 2007 study published in The New England Journal of Medicine found that the formerly incarcerated in Washington State were around 129 times as likely to die of an overdose in the first two weeks after their release as other state residents. The opioid epidemic has hit this cohort extra hard.
Multiple factors are fueling this tragedy. The incarcerated population already suffers from disproportionately high rates of physical and behavioral health problems, from hypertension and asthma to mental illness and substance abuse disorders. While effective treatment options can be hard to come by behind bars, returning to the community can be even bumpier, resulting in dangerous disruptions in care. People suddenly find themselves without the medication they desperately need to survive, be it insulin or antipsychotic drugs. Many face barriers to care including homelessness, unemployment and a lack of social support systems. The newly released are unusually susceptible — physically and psychologically — to overdoses.
The pressures faced during this high-risk transition period do not affect the former inmates alone. Families and communities suffer. Absent stable care, the newly released are more likely to wind up in overburdened emergency rooms — or back in trouble with the law. Experts consider improving access to and coordination of care for this population as key to reducing recidivism.
The Medicaid Re-entry Act, one of the many policy proposals thrown into limbo with the collapse of the Build Back Better Act this weekend, seeks to smooth this transition. The legislation would clear the way for states to use Medicaid to provide coverage for inmates up to 30 days before the inmates’ scheduled release. Currently, a provision of the Social Security Act known as the Medicaid inmate exclusion prohibits any federal health coverage for inmates of jails, prisons and detention centers. (There is a narrow exception for those requiring an outside hospital stay of more than 24 hours.)
When someone covered by Medicaid lands behind bars, his or her benefits are automatically suspended — and in some states terminated altogether. When the person returns to the outside world, it can take time and effort for coverage to be restored. Some states make this process easier than others.
Experts say getting inmates settled into Medicaid shortly before their release could greatly aid what is often referred to as a “warm handoff” from institutional to community-based care systems.
This unglamorous policy idea has been bumping around Capitol Hill for a couple of years, championed by Representative Paul Tonko, a Democrat from New York. (Tammy Baldwin, Democrat of Wisconsin, is its Senate sponsor.) It has earned bipartisan support in both chambers, along with a broad coalition of outside backers. At the crossroads of the public health and criminal justice systems, the plan has brought together groups ranging from the National Alliance on Mental Illness to the National Sheriffs Association, lobbying for it from multiple angles.
“In the long run this will reduce recidivism and therefore ease budgetary burdens from the jail system,” Dave Mahoney, then the president of the National Sheriffs’ Association, said earlier this year. “Our taxpayers deserve that.”
Supporters of the bill have been savvy in their positioning efforts, stressing how the measure would help address the opioid crisis — a top-of-mind concern for many lawmakers. This could help increase its appeal even for members who are skittish about Big Government — for instance, Senator Joe Manchin, the conservative Democrat from West Virginia who has been the chief impediment to passing Build Back Better Act but whose home state has been ravaged by opioids.
The bill is relatively modest in its aims. Mr. Tonko has stressed that it would not expand Medicaid eligibility. Neither does it seek to abolish the inmate exclusion provision wholesale, as some groups favor. Even so, it would cost money, and talk of providing any benefits to inmates can be politically tricky. As is often the case, the provision’s best bet is to get folded into a much larger legislative package. Proponents were hoping to attach it to the Covid relief bill that passed this year, to no avail.They then folded into Build Back Better.
As the larger spending bill shatters against Mr. Manchin’s unyielding opposition, the re-entry proposal should be rescued and revived for another day. Maybe in a pared-down version of Build Back Better to be hashed out in the new year. Maybe attached to a different vehicle entirely. The plan may not be flashy, but it could make a big difference to the masses of sick and vulnerable people who emerge from America’s jails and prisons each year — and to the communities to which they return.
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