The voices of Urban Institute's researchers and staff
December 14, 2018

Nine ways to improve postincarceration health care access

Health and reentry are closely related, and chronic medical, mental health, and substance use problems make it harder for newly released people to seek employment, obtain housing, and avoid reincarceration. Compared with the general population, justice-involved people tend to be in poorer health and need access to physical and behavioral health services, as well as the know-how and motivation to get care.

We recently talked to people released to halfway houses in Connecticut, and the staff that support them, about their experiences accessing health care.

Before a Medicaid policy change in 2016 (PDF), many halfway-house residents had to return to prison or jail clinics for health care and subsequently avoided seeking care until their problems became critical. They were afraid to return to correctional facilities because the experience felt traumatizing, they worried about the quality of care, and appointments conflicted with new jobs in the community. On top of that, the logistics of getting there were complicated and time consuming for residents, halfway-house staff, and the correctional facilities.

Once residents became eligible for Medicaid, they were more willing to seek care. Community-based care quality and access were perceived to be superior, and residents could choose their own providers and felt doctors listened to their concerns. Both residents and halfway house staff agreed that seeking care under Medicaid was logistically less challenging with no additional security risk.

Despite progress, obstacles remain around issues related to psychiatric and mental health coverage, getting to and from appointments, continuity of care, and staff assistance. Here’s how corrections personnel, halfway-house staff, and community health providers can better link people with needed community-based services.

1. Expand Department of Corrections (DOC) discharge planning services.

DOC targets discharge planning services and care coordination (e.g., setting up appointments before release) to people with severe health problems. Limited provider availability in the community can be an obstacle for people who are not severely ill but need a doctor’s appointment soon after release, especially to prevent lapses in medications. Increasing DOC’s discharge planning services to include people with less acute needs could help.

2. Help residents with Affordable Care Act (ACA) Marketplace enrollment.

Some residents become uninsured after finding employment because their income exceeds the Medicaid threshold. Most are eligible for low-cost insurance under the ACA but don’t know how to enroll. DOC, with its existing partnership with the Department of Social Services, may be able to assist.

3. Provide health education, coaching, and primary care.

Recent research found that Connecticut parolees were motivated to get preemployment physicals or to proactively have their health checked after being incarcerated. Halfway-house staff should educate and encourage residents to seek such check-ups as part of their overall work-release mission.

4. Work with community providers to enhance continuity of care.

Community-based providers may need help providing effective, culturally competent care for formerly incarcerated people. The Transitions Clinic Network has developed several strategies for engaging and retaining previously incarcerated people in care.

5. Help staff and residents with medication management.

Halfway houses store residents’ medications for safekeeping and dispense them at certain times during the day. They could foster residents’ autonomy by allowing them to manage their medication (e.g., having them fill their own medicine trays under supervision). Similarly, DOC could modify policies to let residents keep nonaddictive and over-the-counter medicines on hand to reduce their reliance on staff.

6. Emphasize to residents that they won’t go back to prison or jail for a medical condition.

Previously, correctional clinics could hold people overnight if they were too ill to safely live in a halfway house. These so-called medical remands for residents are nonexistent under the new health care plan, but many still fear reincarceration for severe medical conditions. A few residents refused to access any care in the community until they left the halfway house, which suggests DOC may need to clarify this policy to residents and staff to eliminate this deterrent.

7. Revisit community pass policies and monitoring.

Residents must request community passes to make medical visits and request extensions if visits last longer than the maximum allowed time (e.g., because of waiting or transportation time). Residents reported that, although passes were issued without hassle, getting extensions sometimes required embarrassing checks with the community provider to ensure residents’ whereabouts. Monitoring practices varied across halfway houses, so it may be beneficial for programs to share best practices and identify ways to make pass monitoring more respectful.

8. Make services consistent across halfway houses through staff training.

Staff in most halfway houses helped residents find local providers and transportation options, but assistance was inconsistent. Staff trainings should emphasize the importance of helping residents with these services

9. Plan for the next transition.

Once people complete their time in the halfway house, they may move to another town and lose newly established health care connections. Halfway houses should help residents with the transition and inform them of the next steps associated with Medicaid. Because all halfway houses are DOC contracted, DOC could maintain a central clearinghouse of local health care information using existing resources developed by halfway-house staff, parole officers, and correctional discharge planners.

Photo by Caravan Images/Getty Images.

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