Returning prisoners face health care uncertainty
Published 12:00 am, Friday, April 21, 2017
Since 2011, Connecticut has issued more than 39,000 new Medicaid cards to prisoners returning to communities, with the goal of keeping them healthy and out of prison.
This initiative, which allows ex-offenders to see a primary care physician on a regular basis and access mental health and drug-abuse treatment programs, exists because of the Affordable Care Act, and Medicaid pays most of the costs.
Data show the initiative is working, state officials say. Yearly, the Court Support Services Division refers about 20,000 adults on probation to behavioral health programs and tracks them for 12 months. In 2016, CSSD said 23.1 percent of adults who completed their program were rearrested, a five-year low. For those who dropped out or were kicked out of the program, 41 percent re-offended within 12 months.
But the re-entry programs, which rely on reimbursements under Medicaid, are in jeopardy, as President Donald Trump and the Republican-controlled Congress continue to discuss plans to replace the ACA and trim Medicaid funding.
State officials are monitoring to see if the new administration will roll back policy changes that have made it easier to connect ex-offenders to health care and drug treatment programs.
And community-based organizations that now bill Medicaid directly for behavioral health services are also worried funds will disappear.
“Access to health care plays a critical role” in prisoner re-entry, said Jeff Grant, executive director of Bridgeport nonprofit Family ReEntry. “All of these returning citizens who return to the street without adequate wraparound services are going to return to the behavior that got them in trouble in the first place.”
Studies in other states have found that programs that link people to health care contribute to reduced recidivism. In Connecticut, Gov. Dannel P. Malloy’s administration credits access to community health services as one reason overall recidivism rates dropped slightly, from 32.9 percent in 2011 to 32.4 percent in 2014.
A year ago, community-based mental health providers took a big hit in the state budget, when the state terminated $5.4 million in service contracts.
Some providers started billing Medicaid directly for ex-offender treatment — a move they said has allowed them to continue serving at least some of their clients. It is that backup plan that is in jeopardy as Congress works to cut Medicaid.
After losing a $1 million contract, Central Naugatuck Valley Help, Inc., which operates in Torrington, Danbury and Waterbury, cut staff and employment programs, reduced the size of its space at each of its locations, and shifted behavioral health programming to Medicaid.
“We’ve been trying to hold on by billing Medicaid for the behavioral health services, and it’s challenging.” said Roberta Murtagh, executive director of Help, Inc.
Murtagh said the agency didn’t see a big change in the number of clients in Torrington and Danbury, but in Waterbury the numbers plummeted from 200 clients a year ago to about 70.
Those who get treatment say it is working. Ryan Puzinski, 29, of Torrington, said drug abuse treatment at Help, Inc.’s Watkins Center has helped him stay clean after serving 18 months for selling heroin.
Medicaid pays for Puzinski’s drug-abuse counseling sessions, as well as methadone, urine testing and LogistiCare transportation for medical appointments.
“I get a lot out of it,” he said. “It’s definitely helped me with identifying my triggers and my issues.”
Not all nonprofits had the resources to switch to Medicaid. Family ReEntry, which operates in Bridgeport, New Haven and Norwalk, lost its $1.9 million behavioral health state-funded contract. They cut their behavioral health programs but kept employment, housing and mentoring programs.
“A lot of eggs were in the Department of Correction budget basket. We didn’t want to … put all those eggs in a Medicaid basket only to find out that basket will be empty as well,” Grant said.
Community workers say taking care of general health is part of a successful re-entry.
“As a society, we tend to put health care on the back burner, but most of these guys never had a primary care physician,” said Jerry Smart, a community health worker for Transitions Clinic in New Haven. “If you get an illness that prevents you from working, how are you supposed to survive? Relapse is just around the corner.”