Frank Diamond

Managing Editor

There’s a gap in the proverbial health care safety net that’s big enough for a whale to swim through.

People who are incarcerated, on probation, or on parole — what a recent study calls the “justice-involved population” — make up 22% of the 13 million newly eligible people.

“The justice-involved population has a higher disease burden than the general population, yet as many as 90% of justice-involved people lack health insurance at the time of their release from incarceration,” says the study, published in Health Affairs. “This disparity between disease burden and access can drive up the cost of health care, result in worse outcomes, and cause patients to seek care later than appropriate and in care settings that are often isolated and lack care coordination.”

The study — “Integrating Correctional and Community Health Care for Formerly Incarcerated People Who are Eligible for Medicaid” — points out that jails, unlike prisons, house inmates for a year or less. There is constant turnover.

“Jails admitted an estimated 11.8 million people in the 12 months preceding June 30, 2011, the period for which the most recent data are available,” the study states.

Of particular concern are rates of substance abuse and HIV infection. Because this population has high rates of poverty and unemployment, it’s not easy to blend in again.

“Seeking health care after release from jail is often a low priority, although there is evidence that treating medical and behavioral health conditions improves the probability of successful reintegration into the community.”

The study cites programs that reduced recidivism while addressing health care needs. But it says that access to Medicaid alone is not enough, and that “clinically and socially effective engagement in care can be achieved through robust collaboration between criminal justice personnel and community health providers.”

Sometimes, it’s just a matter of pushing the bureaucracy.

“Many people who leave the criminal justice system — and their new, community-based health care providers — must wait for weeks, if not months, for accurate copies of their medical records.”

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Shelley Slade
Vogel, Slade & Goldstein

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