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An Equitable Recovery Needs Investments in Connecting People Leaving Jail or Prison to Health Care

The recovery legislation that policymakers will soon consider provides a historic opportunity to build on the Affordable Care Act and create an equitable recovery where everyone has access to quality health care, no matter their history of incarceration. Investments in broadening access to quality health care for people leaving jail and prison — in addition to funding for subsidized employment and housing vouchers — can help avoid reincarceration and promote equity.

The health needs of low-income people leaving jail and prison have long gone unmet, contributing to high death rates following reentry and compounding the harmful effects of mass incarceration and over-policing communities of color — particularly for Black and Latinx people.

People who are incarcerated have higher rates of mental illness, substance use disorders, and chronic physical health conditions, but they often go without needed health care while incarcerated and return home without adequate access to medications or care coordination. Once home, health care often falls by the wayside as people face competing demands, including securing housing, finding work, filling prescriptions, connecting with family, and fulfilling court-ordered obligations.

The lack of resources dedicated to helping people navigate these challenges came into sharp relief as COVID-19 spread through correctional facilities. During the pandemic, many people have left jail or prison without a COVID-19 test or a plan to safely quarantine even though people who are incarcerated have faced large outbreaks and higher COVID-19 infection and death rates than the general public, likely contributing to the pandemic’s disproportionate impact on Black and Latinx communities.

Many states and localities have taken important steps to enroll eligible people leaving jail or prison in Medicaid. While states should continue these steps, many people need help beyond enrollment in Medicaid to get care. One solution is “in-reach” services where case managers, clinicians, or peer support professionals visit people in jail or prison to help them prepare to return home. In-reach services enable providers to assess people’s health, establish rapport, develop an individualized care plan, and schedule future appointments. But these services are severely underfunded and underutilized. Communities need additional, reliable funding to scale them up to fully meet need.

Recovery legislation should invest in reentry services — including in-reach services — especially to better serve people with chronic conditions, substance use disorders, and serious mental illness. For example, one proposal included in the House-passed version of the American Rescue Plan Act would lift the statutory exclusion on Medicaid reimbursement for services provided to people in jail and prison to let Medicaid pay for health care services during their last 30 days of incarceration. If enacted, states could use Medicaid to cover in-reach services, empowering providers to dedicate more staff time to these services, to invest in training, and to build information technology needed for providers and correctional systems to coordinate with each other.

Expanded in-reach services could also connect people to employment, housing, and transportation resources. People leaving incarceration report that finding work and housing are among their most urgent needs, making it difficult to prioritize their health care. Stable employment and housing greatly improve people’s chances of staying out of jail and prison, but people who were formerly incarcerated experience homelessness at nearly 10 times the rate of the general public and face an unemployment rate of over 27 percent. Homelessness and unemployment are even worse for Black people returning home from jail and prison, reflecting a long history of racial discrimination and structural racism in federal, state, and local employment and housing policy.

Greater funding for reentry supports is needed to promote more equitable outcomes for people with a history of incarceration, along with investments in workforce development — including subsidized employment proposed in the Biden Administration’s American Jobs Plan — rental assistance, and other social services.