‘You Spend Real Time With a Doctor’: Halfway House Resident on Medicaid Expansion

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The expansion of Medicaid to all halfway house residents has motivated former incarcerees to seek medical help for chronic behavioral health and substance abuse problems that might otherwise have led to recidivism, according to an Urban Institute study.

The study, supported by the Office of Justice Programs’ National Institute of Justice, interviewed correctional and halfway house managers as well as 58 halfway residents in Connecticut to gauge the effect of a 2016 federal government decision to allow all individuals released into halfway houses to qualify for Medicaid services.

Previously, only those inmates released to transitional facilities on parole could be covered under federal rules that banned Medicaid support for those legally defined as “inmates”—a restriction that automatically disqualified many individuals who remained under Department of Corrections (DOC) custody.

“DOC-supervised” halfway house residents could only get medical treatment from designated prisons or penal facilities, which not only created extra red tape for staff members  who had to arrange appointments but left many residents unwilling to seek treatment.

The change made a significant difference, according to the study, which conducted interviews during 2017 over a several-month period following enactment of the revised rules.

“Residents and program staff described Medicaid enrollment as a critical early step in the transition from correctional facilities to the halfway house, particularly for individuals with chronic conditions or daily medications, for whom obtaining or transferring prescriptions was essential to avoid medication lapses,” the study said.

Within two months of the policy change, the study reported, many residents who had previously been barred from seeking outside medical help, had set up appointments with community-based health providers.

The report said interviews with correction staff confirmed that the change “promoted greater self-sufficiency and accountability” as well significantly reducing the burden on medical services inside the prisons.

And it quoted several halfway house residents who described what the change meant to them.

“The two doctors that I have had dealings with since I’ve been here have been really good,” said one. “Pleasant bedside manner, medical skills…just all around good experiences.”

“You spend real time with the doctor,” said another. “In the jail, they just try to get you in and out. The doctor will try to really see what’s going on with you.”

“I have an opinion now,” added a third. “I can go to a doctor now just like anybody else that’s free, and he understands my opinion, and this is how I’m feeling, and he works with you and gives you what you need.”

Several compared it favorably to the bad or demeaning experiences they had when they were forced to go to jailhouse medics.

“I’d rather be sick in jail than go see the doctor, because it’s…the worst,” said one. “It takes about three weeks (to set up an appointment). By the time you see them, you’re probably gonna be dead.”

But the study also noted that there were still serious issues connected with the Medicaid expansion that raised questions about whether halfway house residents were able to take full advantage of the program.

One issue noted by the authors was whether allowing patients with serious mental health or substance abuse issues to determine their own care, and maintain, for example, the medications they needed, could lead to serious relapses.

And the authors argued that it was important to ensure that halfway house residents continued to get access to care for chronic issues after leaving the facilities, which normally house them for just three or four months before they are released into the community.

“This underscores the importance of teaching residents how to navigate health care services,” the report said.

The Urban Institute said further studies would be conducted to measure whether the regulatory changes had significantly affected health outcomes.

The report was written by Kamala Mallik-Kane, Ellen Paddock and Rochisha Shukla.

A complete copy is available here.

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