A healthier path out of prison leads to safer communities

People leaving our jails and prisons are handcuffed by a lack of resources and a stigma that makes it hard to find gainful employment and stable housing. There is no public policy panacea for these challenges, but Congress is now weighing a prescription for ensuring formerly incarcerated people are healthy enough to make the most of their freedom.

Upon incarceration, individuals lose federal health benefits under programs such as Medicaid. Pending bipartisan legislation known as the Medicaid Reentry Act would promote continuity of care by ensuring that those eligible for coverage can begin to receive health benefits up to 30 days prior to release.

In recent months, leaders in corrections and health policy have come together through the Council on Criminal Justice Health and Reentry Project to focus on the act, along with related state Medicaid waiver requests. The federal and state initiatives reflect research indicating that continuity of care for those reentering society, especially those with mental illness, is not just humane but also benefits public safety.

This proposal would enable otherwise eligible individuals to leave jails and prisons with coverage rather than face a paperwork tsunami upon discharge, a period that also requires them to juggle the complications of reuniting with family, finding a job, and securing housing.

Continuity of care is vital not just for management of physical health problems, but also mental illness and substance use disorder. In California alone, some 26 percent of incarcerated people are taking psychotropic drugs, which translates to about 19,000 people in the state’s county jails. Research indicates that when prescribed appropriately, such drugs reduce the risk of violence by incarcerated people reentering society. The proposal would ensure that fewer individuals would suddenly go off these drugs upon discharge. This is consistent with medical guidance recommending that those who no longer need psychotropic drugs taper off them slowly to avoid withdrawal symptoms that can include erratic behavior.

The proposal would also help address the elevated risk of fatal overdoses among those leaving incarceration. Data indicate that during the first two weeks following discharge from prison, the risk of death from overdose is 12.7 times that of the general population. While the details of state Medicaid programs vary, all of them cover treatment for substance use disorders, including counseling and some forms of medically-assisted treatment, such as naltrexone and buprenorphine.

But the benefits of the act go well beyond preventing and reversing overdoses; they would also promote public safety.

Many violent and property crimes involve individuals committing muggings, robberies, and burglaries to feed their untreated addictions. Even short of that, the pursuit of illegal drugs can bring formerly incarcerated people in contact with the very people and places that led to them being locked up — and are likely to propel them back behind bars.

The proposal is equally vital for addressing physical health conditions, many of which, if left untreated, make it harder for formerly incarcerated people to establish employment and housing stability. Even before the outsized impact of the COVID-19 pandemic on correctional facilities, incarcerated people were much more likely to suffer from physical and mental illnesses than the public. For example, 9.5 percent of incarcerated people, but just 1.7 percent of Americans, have Hepatitis C, for which there is a pharmaceutical treatment so effective that it is virtually a cure.

Many people leaving incarceration also have disabilities that are not so grave as to qualify them for Social Security disability benefits, but which may prevent them from finding work without the right treatment and support. Some 15 percent of incarcerated individuals have a disability, and among the most common are vision and ambulatory limitations that Medicaid often can help address.

To be sure, there is legitimate concern about providing federal health benefits to incarcerated people for an unlimited period while behind bars. A fifth of all state prison spending is devoted to health care for those incarcerated. One important question is whether an unlimited federal entitlement could have the unintended consequence of incentivizing more incarceration by making it substantially cheaper. By targeting the period immediately before release, the proposal aims to smooth transitions and thereby alleviate costs for hospital emergency rooms and jails, when people get sick post-release or recidivate and return to jails.

With the focus on continuity of coverage through the period just before and after release, long-term correctional health care costs would remain the responsibility of states and counties.

Underlying this legislation is a fundamental principle: When people are incarcerated, untreated illness should not be part of the sentence. When our fellow citizens reentering society are healthier, our shared prognosis is for safer and more prosperous communities.

Marc A. Levin, Esq. is Chief Policy Counsel for the Council on Criminal Justice and can be reached at mlevin@counciloncj.org and on Twitter at @marcalevin. Khalil A. Cumberbatch is Director of Strategic Partnerships at the Council and can be reached at khalil@counciloncj.org and on Twitter at @KhaCumberbatch.