Humane Exposures Blog

For 30,000 people released from Philadelphia

Photo by Susan Madden Lankford

jails each year with five days’ medication and no medical coverage, getting benefits restored after incarceration can take weeks or even a few months – long enough for people to relapse.

Bruce Herdman, chief of medical operations at the jails, says:

Most people are not on medications, and are destabilized when they come in. We do a pretty good job tuning them up. But up until now, it’s been so frustrating, because we help people get healthy, and we send people out and they don’t have the resources to maintain their health.

That’s about to change though. A slew of new city- and state-level initiatives will preserve Medicaid benefits for people who have them, and sign up more of those who don’t – in particular, those leaving jail with serious mental illness and chronic disease. Together, advocates say, these efforts can decrease recidivism, save taxpayers money, and maybe even save lives.

Right now, three-quarters of all men and women arriving at Philadelphia jails are on drugs. About 28 percent have hypertension, diabetes, or significant seizure disorder. About a thousand each year will be treated for HIV. Fourteen percent have serious mental illness, and 40 percent will require psychotropic medication; Herdman notes the prison system is effectively the state’s largest psychiatric hospital.

But only about 8 percent, at last count, had health insurance – all of it Medicaid. Right now, that benefit is terminated in Pennsylvania when people are imprisoned; but, starting in November, it will instead be suspended for up to two years.

That’s important because applying for new coverage upon release takes time. “Eliminating the gap, that can be 45 or even 90 days, can make the difference in stabilizing people,” state Human Services Secretary Ted Dallas said.

It’s a fix more states are making. But it required a political and culture change – and, above all, technological upgrades.

“The biggest issue is you have these very large IT systems that determine eligibility, and getting changes to them, it’s not always an easy thing,” he said.

In the interim, a series of pilot programs at the Philadelphia Department of Prisons are focused on specific, high-need groups being released from jail.

One is targeting people with serious mental illness like schizophrenia, bipolar disorder, or major depression. They’re significantly more likely to be rearrested than other inmates, and they stay in jail an average of 25 days longer, according to the department’s statistics.

Through the pilot, people with serious mental illness can get Medicaid within two days of their release. And, they’re connected with a forensic peer specialist from the city Department of Behavioral Health and Intellectual Disability Services (DBHIDS) to help with everything from reconnecting with family to securing housing and benefits.

“If you’re not able to reconnect within the first 72 hours, it becomes more difficult,” said H. Jean Wright II, of DBHIDS. “This is a way of getting to a group of people who have historically fallen through the cracks.”

So far, he said, 45 people have gone through the program, with only four rearrests. Given that 38 percent of Philadelphia jail inmates are re-incarcerated within a year, that’s a remarkable success.

At the same time, Corizon, a contractor that provides health care in the jails, is running a separate pilot to connect people with chronic physical illnesses with Medicaid.

Herdman said:

These aren’t diseases that you cure, but you would reduce the number of times people get incarcerated. Say someone has a seizure disorder, and they are medicated when released and continue their medication. They can go to work without having their illness interfere. But if they don’t fill the prescription, maybe they have a seizure, they don’t show up for work, they lose their job and then go back to street crime.

The female jail population is especially needy, Herdman notes: 25 percent have serious mental illness, and 60 percent use psychotropic medication.

For everyone else leaving the jails – and there are thousands each month, leaving at all hours of the day and night – reentry services providers are cobbling together resources as best they can.

Soon maybe they won’t have to. Thanks to Medicaid expansion in Pennsylvania in 2015, almost everyone passing through Philadelphia jails is eligible for coverage. Herdman said efforts are underway to presume eligibility for all inmates and fill out applications for them as part of the discharge process.

But coverage alone isn’t enough, said Maureen Barden, who’s been working on the issue with the Pennsylvania Health Law Project and agencies around the state. It’s just the first step:

The handoff to services in the community is a tremendously important part, which is still to be implemented in most places. Getting people the [insurance] card is not going to be enough for most people to turn the tide and have them not return to jail. Connection to care as this movement goes forward will be recognized as an increasingly important thing.