How Medicaid enrollment can disrupt the cycle of incarceration

One of the first stops for people leaving prison in central Missouri is the Reentry Opportunity Center in Columbia. The center sees about 80 people a month who are in the process of putting their lives together after being incarcerated.

According to the center's program director, D'Markus Thomas-Brown, leaving prison often means starting from scratch.

"When someone comes out ... they need everything, and they need it now," Thomas-Brown said.

The center looks to link its clients to the many resources they might need, by creating what Thomas-Brown calls “warm hand offs” — personal connections to local organizations.

"We’re not just telling them, 'Hey if you go down to [the Voluntary Action Center] on Wednesdays, you can possibly get help,'" Thomas-Brown said. "We’re able to give the hand off and say, ‘Well, so-and-so is waiting for you,’ or ‘Do we need to meet you down there?’”

Thomas-Brown points to health care as one of the biggest needs for people reentering society. While they can typically access basic health services while incarcerated, that option goes away on the outside.

“If they were taking meds, whether it be for mental [health] or even stabilizing for recovery from substance use disorder, how to get those meds now on the outside is a huge obstacle,” Thomas-Brown said.

A recent Medicaid expansion offers a new option for many uninsured individuals, as it opens eligibility up for most Missourians making less than 138 percent of the federal poverty level, or $18,754 per year for an individual. That expanded group includes people leaving prison, who often go from having basic health care in prison, to not having any on the outside.

But being eligible for Medicaid isn’t the same as being enrolled in the program.

More than 71,000 Missourians have enrolled in expanded Medicaid since the state started implementing the program in the fall. That’s just over one-quarter of the estimated 275,000 Missourians newly eligible through the expansion.

The state has done little to promote the program, and that work has largely fallen to advocates and nonprofits.

St. Louis-based Concordance is one group connecting people leaving prison to Medicaid. Michelle Smith, the organization’s president, said Medicaid expansion offers an opportunity, but there are still obstacles.

For example, a Medicaid application in Missouri takes on average 99 days to process, according to a state report published in January. Federal data shows most other states process applications within a week, according to Kaiser Health News.

For people leaving incarceration, the period just after a person completes their sentence is critical, Smith said.

“If they have some type of medication when they’re released from prison, they’re only released with a 30-day supply," she said. "So oftentimes, if you can’t get Medicaid-eligible or see a health care doctor within those 30 days, your prescriptions will lapse."

Smith said Concordance starts filling out applications with its clients in the final days of their sentence in order to speed up the process, and several have successfully enrolled in the program.

Her group's overall goal is to reduce recidivism, and it’s possible this Medicaid expansion can help with that. Recent research has found states that expanded Medicaid had lower rates of recidivism than those that didn't.

Erkmen Aslim, an economics professor at Grand Valley State University in Michigan, led that study and found that mental health was a likely factor.

“We find a very sharp decline in violence and public order crimes and this supports our hypothesis that the policy is really effective in curbing recidivism, associated with crimes that are most likely committed impulsively,” Aslim said.

Aslim's research also touched on the benefits of reducing recidivism, both to individuals and society more broadly. Fewer people reoffending means fewer fiscal costs to imprison them, not to mention the direct costs to victims of crime.

But to see those benefits, the research suggests, states must actively enroll their eligible residents in Medicaid, which Missouri has struggled to do so far.

This story comes from a reporting collaboration that includes KBIA and Side Effects Public Media — a public health news initiative based at WFYI. Follow Sebastian on Twitter: @sebastiansings.

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