by Eike Blohm, MD
On January 26, 2023, the federal Centers for Medicare & Medicaid Services (CMS) granted California approval of a plan to extend Medi-Cal, the state’s equivalent to Medicaid, which provides health insurance to low-income individuals. As of that date, prisoners scheduled for release will be able to access healthcare services under the program up to 90 days before they leave custody of the state Department of Corrections and Rehabilitation (CDCR).
With encouraging results from pilot programs, the state requested $561 million in federal funding, along with a waiver from CMS to allow transfer of a prisoner’s medical care to a primary care physician prior to release.
Release from prison can be a disorienting and challenging experience for returning citizens. After years behind bars and with limited resources, they must secure all their basic needs simultaneously, including food, shelter and medical care. The latter is particularly important, since the average U.S. prisoner has more mental and physical health conditions than the population not behind bars, yet often receives substandard medical care in prison.
Unsurprisingly, the death rate immediately after release is eyepopping: Nearly three times the rate for the un-incarcerated, according to the Census Bureau. [See: PLN, Oct. 2022, p.58.] About 80% of California prisoners qualify for Medi-Cal after release. But enrollment requires literacy and time to navigate an unfamiliar system. Coverage may take months to start.
With nowhere to turn for help, returning citizens often show up in emergency rooms when sick – an expensive proposition. This helps explain why they face medical bills in their first year after release that are 400% higher than the average American faces.
To combat this disparity, California recently took several promising steps. State lawmakers passed a measure that requires eligible prisoners to be enrolled in Medi-Cal prior to their release. While an improvement, it still left the returning citizen without a primary care doctor to manage chronic health conditions and refill medications. To remedy this problem, California applied for a CMS waiver to allow Medi-Cal to provide services to certain prisoners while they are still incarcerated.
Shortly before release, prisoners with substance use disorders, disabilities, chronic health needs, mental illness or pregnancy can be evaluated by a regular civilian physician and receive their prescriptions, along with medical equipment (e.g., a wheelchair) and a follow-up appointment after their release.
So far results have been promising. Data from pilot programs show a 25% drop in emergency department utilization and a 100% increase in addiction treatment. This translates into savings – not only tax dollars but also lives. An additional benefit is that Medi-Cal provides case workers for individuals with complex needs, and they can assist with housing, transportation, and accessing medical care.
Source: Cal Matters
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