People with a history of incarceration are typically much sicker than the general population, especially returning inmates like Horn. Studies performed primarily in Ohio and Texas have found that more than 8 in 10 returning prisoners have a chronic medical condition, from addiction to asthma. Dr. Reggie Egins says a lot of it has gone untreated, for a range of reasons — because the health care system is tough to navigate, because they’re homeless and don’t have insurance, or because they don’t trust doctors.
“The first thing is that they usually have no permanent address, which means that they cannot apply for health insurance and/or there’s nowhere to receive those documents if they do,” says Egins, a family doctor who does correctional health care, splitting each week between serving patients at the D.C. jail and at Unity Health Care, a network of community health centers.
Now, being in jail is not healthy. But for a lot of people, the best health care they’ll receive is what they get behind bars. About 40 percent of inmates are newly diagnosed with a chronic medical condition while incarcerated. Outside, many only interact with doctors when they’re in the emergency room.
Dr. Emily Wang, a primary care doctor with the Yale University School of Medicine, and her colleagues are trying to make it easier for ex-inmates to manage their health care so they don’t end up in the ER. They work at the Transitions Clinic Network, which now has 14 sites across the U.S. and in Puerto Rico. They’re funded by private donations and by grants like one from the Center for Medicare & Medicaid Innovation.
Their patients qualify for Medicaid based on income, and the clinics are reimbursed by Medicaid. The difference is that they offer more services than Medicaid typically does — like helping patients find a halfway house they can afford.
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