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

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

“It makes my life so miserable,” said Boyd, 44, who has chronic obstructive pulmonary disease. He told his story to KHN via email and text message because sometimes it’s hard for him to talk without losing his breath.

Less than a month after he was released from prison, Matthew Boyd spent eight days in intensive care, the first of more than 40 hospital stays over the past two years. These days, he can barely get out of bed at his home south of Atlanta.

Dustin Chambers for KHN

While Medicaid is generally prohibited from paying for services people receive in jail or prison, the Biden administration opened the door for the federal program to cover care shortly before a person’s release to help them better manage their health during the transition. In February the administration announced that states could also use Medicaid to pay for drug addiction treatment in state prisons and jails. Efforts by Congress to restore Medicaid before the release of inmates across the country have so far failed.

And in most of the South, where many states have not expanded Medicaidre-access services that connect people like Boyd to health care resources are often minimal or non-existent.

More than 600 thousand people are released from state and federal prisons in the US every year, and most of them have health problems. Proposed court decision in 2019 that incarcerated persons have a constitutional right to adequate pre-release medical discharge planning, including the provision of medication or prescriptions. But it is far from clear whether states are obliged to do this.

In Georgia, it is planned to create correctional institutions discharge plan this includes conducting medical appointments and providing medication. Joan Heath, director of public affairs for the Georgia Department of Corrections, did not respond to questions about why official policy was not followed in Boyd’s case.

Matthew Boyd sits with his fiancee Amanda Hollowwood, who has been helping to care for him since his release from prison in December 2020.

Dustin Chambers for KHN

Despite official policies, people routinely leave jail or prison without medication, medical records, doctor’s appointments, or health insurance. About 84% of men and 92% of women incarcerated had a physical or mental illness or substance use disorder. a sample of people Interviews before and after their release from prison by the Urban Institute, a non-profit organization that researches justice issues.

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

“There is no bridge,” he said Stephanie Jones-Heath, CEO of the Diversity Health Center, a federal health center in southeast Georgia. At the time of admission to the center, patients with previous convictions are in uncontrolled health and have no medical records, she said. “We have to start over because we don’t have continuity of care,” she said.

The US has one of the the highest rate of imprisonment in the world. Conditions such as solitary confinement, limited access to medical care, severe stress and poor diet can also cause or worsen the disease.

“This is the sickest population in the country,” he said Dr. Mark Stern, a fellow at the University of Washington School of Public Health who previously worked for the state Department of Corrections. Stern co-authored one of the few studies on the subject. This 2007 study found that incarcerated people were 3.5 times more likely to die like 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 obtain a partial waiver that allows incarcerated people to receive services through Medicaid up to 90 days before release. More than a dozen other states looking for 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 preventing patients from having to visit the emergency room.

In Georgia, even basic discharge planning can be rare, said Craig Burns, a certified inmate support specialist. He was released from state prison in 2014 after serving nearly 15 years with a $20 debit card that was mistakenly not activated, he said. Burns, who suffers from bipolar and post-traumatic stress disorders, depression and anxiety, said he found his own way to a sheltered mental health facility near his home in Dalton.

Most of the people Burns works with have no idea how to access health care. They often 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 re-entering life after prison.

“It’s a vicious cycle that has no beginning,” he said. Burns regularly sends people to the emergency room so they can get medication and a referral to a free clinic.

Stephen McCarey, 40, has been unable to recover from heroin addiction since he was released from an Alabama prison in 2011.

In May 2019, he was told at an addiction treatment facility that funds were not available to pay for his care. McCarey, who also struggled with intermittent homelessness, never moved on. He overdosed, was arrested again for stealing from a pharmacy and is now serving another sentence.

“I wouldn’t have committed any of these crimes if I had a place to go,” he said in a phone call from Alabama’s Ventress Correctional Facility.

Alabama did not expand Medicaid, which could have helped McCary get help after his release. In Connecticut, the study found that when people connect to primary care after incarceration, they are less likely to be hospitalized or re-incarcerated, which can save public money.

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

Black people who are more common than the general population to be imprisoned and lack of insurance coveragesuffer disproportionately from the lack of health care services after incarceration.

One of the reasons people fall through the cracks is because no agency takes responsibility for the problem Dr. Evan AshkinProfessor of Family Medicine at the University of North Carolina-Chapel Hill and Director North Carolina Formerly Incarcerated Transition A program that helps ex-prisoners get medical care. Health care systems often don’t distinguish between the needs of people who have been incarcerated and others who don’t have insurance, he said. Justice systems don’t have the budgets or powers to care for people coming out of custody. About 90% of patients at the program’s clinics have no insurance, and North Carolina has yet to expand Medicaid, although lawmakers recently struck a deal to do so.

A key part of the new California waiver is the ability for providers to be reimbursed for coordinating care, which is especially important for people coming out of prison, Shavit said. “All of their basic needs are immediately up in the air, and often health care takes a back seat,” she said.

Medicaid expansion, along with the Medicaid Just Before Exit Program, helped people moving out of Louisiana the notoriously dismal prison health care systemsaid Dr. Anjali Niyogi, a professor at the 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 receive while incarcerated, she said.

Anthony Hingle Jr never received the results of the biopsy, which took place days before he was to be released from the Louisiana State Penitentiary in Angola in 2021 after serving 32 years.

Hingle, 52, learned he had prostate cancer after calling a New Orleans hospital on his own to request biopsy results. Although he had Medicaid insurance, he had to wait a few more months for his work insurance to kick in 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 that advocates for incarcerated and formerly incarcerated people, wonders how his life might have turned out if he had been diagnosed earlier.

Without simplicity, “children and a wife, that’s not the case,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and surveying, KHN is one of the three main operating programs in the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.


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