Eliminating Gaps in Care and Coverage for Returning Citizens

Returning encapsulates more than just somatic movement between a state of incarceration, confinement of one’s physical being for the proposed purpose of correction, and release, the gathering of one’s tattered self to step back into the community from which one came.

The depth of care needs of returning citizens, formerly incarcerated persons, extends beyond them as individuals to people, families, and communities longing for repair and restoration. Formerly incarcerated people face multiple challenges as they return to their homes, from the need to find stable housing to the hunt for steady employment to search for health care. Pejorative providers unwilling to impartially extend care, the weight of persistent trauma, and the crippling effect of chronic disease compound the obstacles.?

On any given day in the United States, more than 2 million adults and nearly 50 000 youths are incarcerated in prisons, jails, or residential placement in juvenile facilities. Incarceration has long-term health, social, and economic consequences in the lives of adults and youths. Formerly incarcerated persons have higher rates of chronic conditions such as cancer, high blood pressure, stroke-related problems, diabetes, heart-related problems, kidney-related problems, arthritis, asthma, cervical cancer, and liver cirrhosis. They are also more likely to carry infectious diseases, including tuberculosis, hepatitis B and C, and other sexually transmitted diseases (STDs), and more than half of formerly incarcerated are drug dependent and face severe emotional distress and mental health disorders. Post-release, self-reported health status tends to worsen, and emergency room visits become commonplace care options as reconnecting with services and reestablishing themselves is exceedingly difficult.?

Ensuring that health care coverage is obtained before release and that there’s a care plan and systemic engagement ensures continuity of care for the formerly incarcerated, their home community, and the health systems in which they engage.

The median annual earnings of a formerly incarcerated person after the first year is less than?$11,000. Given that housing instability is a core social determinant, the pervasiveness of mental illness will send waves to emergency units, or worse, lend towards a violent offense, and most have a parole or probation obligation, having to gather and provide documentation for enrollment and redetermination seem to be a costly nonsensical eligibility requirement.

As it will take anyone at least a year to adjust to the sudden rush of free air, thus the recidivism rates within one year of release, keeping track of enrollment periods, required documentation, and the layers of paperwork and processes can be crushing and discouraging.?

This barrier could be lifted for the first 12-15 months following release, saving state agencies time and resources that could be reallocated to care planning and coordination.

A Medicare Special Enrollment Period for formerly incarcerated individuals (Incarceration SEP), which came into effect January 1, 2023, provides individuals leaving custody an opportunity to enroll in Medicare without late enrollment penalties. Under the Incarceration SEP, individuals leaving custody have a 12-month period to enroll or re-enroll in Medicare and can do so without being subject to a late enrollment penalty. Medicaid beneficiaries and managed care entities would benefit from the increased stability of special enrollment periods as it would allow time for member and provider care planning, coordination, and engagement.?

More thoughtful, proactive post-release planning would benefit long-term cost savings, more efficient post-release engagement, and relieve pressures on health systems and community safety.

Solutions Eliminating Gaps in Care and Coverage for Returning Citizens?

• Execute and evaluate a Medicaid Incarceration SEP 15 months of uninterrupted Medicaid coverage beginning 90 days before release.
• Re-evaluate the Medicaid Inmate Exclusion Policy, or “inmate exclusion.”
• Fund Federally Qualified Health Centers (FQHCs) with patient medical home PMPM that facilitates care coordination, coverage enrollment, and preventive primary care.?
• Launch Returning Community and Transitions of Care Plans executed 120 days before release for state and county jail inmates.

1. Integrated re-entry care plans include care management and discharge planning, clinical consultant services, peer services, medication management plan development, and unique benefits for persons under 21.
2. Patients currently evaluated and prescribed medications for moderate to severe mental health disorders enrolled in a 16-week supply of prescriptions upon release with 4-8 week clinical evaluations.?
3. Facilitate and evaluate Transitional Support Services, including rental assistance, housing, treatment, food, education, and employment support.

• State prisons and county jails must complete 120-day pre-release Medical Health Risk Assessments.?
• This data is secured and shared through a data repository accessible to FQHCs, hospitals, managed care organizations, and re-entry service providers.
• The Medical Health Risk Assessments would include reproductive health, A1C, blood pressure, cholesterol, nephrology, BMI, med review and prescription history, and disability assessments.
• Require post-release care coordination and navigation services, initiated 60 days before release and monitored and evaluated twice a year to one-year post-release.