Over 10 million individuals enter the jail system in the United States each year. Statistically speaking, jail inmates are disproportionately male, people of color and poor. An article by Maura Ewing, published recently in The Nation, noted that “this population suffers from higher rates of many health problems, including chronic and infectious disease, injuries, mental illness and substance abuse. And people are often at their sickest when detained. Eighty percent of detained individuals with a chronic medical condition have not received treatment in the community prior to arrest.”
Jails can be considered an “emergency room” of sorts, in that individuals often are very sick and require immediate treatment. Once individuals becomes inmates, they may have access to health care that they would never have had before. As these individuals receive treatment and get healthy during their incarceration, many people are realizing that jails offer an opportunity to identify and treat people who might not otherwise seek or have access to healthcare.
The problem, though, is that the treatment inmates receive in jail ends once they are released. According to The Nation, “health records are hard to transfer in and out, leaving patients who have received care prior to arriving in jail with siloed histories, creating inefficient, costly and potentially inconsistent treatment.” Currently, there are very few processes in place to follow-up care once someone is released. And the brief average jail stay of approximately three months is not enough time to get the individual on the road to recovery. With 96 percent of these individuals returning to their home communities, the need for continuity of care is stark.
Ewing points out in her article that the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) provides a unique opportunity to address this problem. Before the ACA was enacted, 90 percent of those released from prison or jail each year were uninsured. Like many others, former inmates tended to use the ER. However, Ewing contends, “with the ACA’s Medicaid expansion in full swing in twenty-six states and Washington DC, 5.3 million people who are or have been incarcerated are newly eligible for Medicaid. The opportunity for continuity in treatment is palpable, and across the country, a movement is brewing among forward-looking jail administrators and healthcare providers to bridge this gap.”
It is time for the government to step up and ensure that individuals are provided care once they re-enter the community. State governments need to ensure that there is a process in place to transition people to coverage via the state Health Insurance Exchange or state Medicaid program. This will provide individuals with a healthy return to their communities and workforce.