This is the final installment in a 10-part series on how health care is funded and delivered in state-run prisons and how care continuity is facilitated upon release.
At least 95 percent of those in state prisons eventually leave; more than half a million individuals do so in a typical year. So prisons and communities are constantly reintegrating returning residents, a disproportionate share of whom have a chronic disease, including a behavioral health condition or an infectious disease. Therefore, prospects for successful re-entry are affected by the seamlessness of their health care transition.
In addition to concern for individuals’ well-being, prison health care systems and outside communities share a strong interest in facilitating coordinated care continuity at the time of release. This owes to the significant sums devoted to incarceration, the public health and safety implications of prevalent conditions, and the likelihood that poorly managed chronic diseases can result in avoidable and costly emergency room visits and hospitalizations.
Continuity of care helps ensure that the benefits of treatment and the investment of resources devoted to stabilizing individuals’ health while they are incarcerated are not squandered upon release. If treatment is not continued outside prison gates, the recidivism-reduction and public health effects of even well-designed and -executed health programs delivered in facilities can be undermined.
Pew research on care continuity services
A first-of-its-kind report in 2017 by The Pew Charitable Trusts details characteristics of care continuity services offered by departments of correction. State prison systems, sometimes in partnership with other state agencies and community stakeholders, take a variety of steps to smooth re-entry from a health care standpoint.
Most fundamentally, many try to help individuals acquire health coverage, often through enrollment in Medicaid. Additional actions include helping people maintain critical medications, connect with providers on the outside, and learn about how to safely manage their diseases. Records-sharing can also be a useful tool. Many systems reported providing most or all of these services, though some pointed to relatively few. Likewise, some provide their full suite to every returning resident, while others employ a more targeted approach, often prioritizing those with infectious diseases or behavioral health conditions.
Key facets of care continuity planning include:
- Medicaid enrollment. Health insurance is a key ingredient of access to quality care for all Americans, including individuals involved with the criminal justice system. The Affordable Care Act created an opportunity for states to link greater numbers of people leaving prison with coverage by expanding Medicaid eligibility criteria. The Department of Health and Human Services has said that Medicaid “connects individuals to the care they need once they are in the community and can help lower health care costs, hospitalizations and emergency department visits, as well as decrease mortality and recidivism for justice-involved individuals,” people under community supervision (such as parole), or incarcerated in prisons or jails. Some states that contract with Medicaid managed care organizations to deliver benefits and additional services to certain patients require the pairing of enrollment activities with prison discharge planning.
- Maintaining medications. As in the community, prescription drugs play an important role in the health care delivered in prisons. Treating prevalent conditions can necessitate use of medications, and continuation of these regimens can be critical to preventing relapse and other adverse outcomes. Therefore, states act to help ensure that there is no gap or drop-off after release. Most commonly, they provide a short supply of medication—usually 14 to 30 days’ worth—that can serve as a temporary bridge until people can see a prescribing provider in the community. To extend the duration, some also provide a renewal prescription.
- Linking to providers. Ultimately, health coverage and temporary medication supplies are of limited use if individuals do not connect with necessary providers. So states work to form such linkages in various ways, including providing referrals, scheduling appointments, and facilitating opportunities for doctors to communicate with their future patients before release.
- Records-sharing. Relaying medical histories, diagnoses, current medications, and laboratory test results can help save time and money, and prevent the delay or disruption of successful treatment plans. Some states routinely hand over records to individuals leaving prison or to their community provider. Several go further by enabling multiple agencies and providers to access at least some information, mindful of privacy and consent requirements.
- Teaching skills for self-management of health. Everyone—whether in prison or not—plays a large role in managing his or her own health. Hypertension and diabetes control require healthful eating and exercise. Diabetic patients sometimes monitor glucose levels and, if necessary, self-administer insulin. Controlling HIV requires following a precisely scheduled medication regimen. To equip individuals with skills to successfully manage their conditions, most states offer general educational opportunities before release. Fewer provide overdose prevention classes, which can be important, as reduced tolerance after periods of abstinence can lead to inadvertent overdose and death. Effective drug addiction treatment during and after incarceration can help prevent reuse altogether. Both approaches may be important tools as states work to combat the opioid crisis.
With nearly all incarcerated individuals eventually returning to society, treatment and discharge planning—especially for those with a substance use disorder, mental illness, or infectious disease—play an important role in statewide anti-recidivism and public health efforts. These realities, combined with other interests states have in maintaining high-performing prison health care systems, call for the attention of policymakers and administrators.
Matt McKillop leads The Pew Charitable Trusts’ research on state and local correctional health care.