New Hampshire pushes to get ex-inmates health insurance

Last modified: 1/28/2015 2:06:01 PM
Before New Hampshire expanded its Medicaid program to cover more poor adults, those leaving the state prison system were handed 14 days’ worth of medication and not much else.

“We’d get them standing up and ready to go, and then it was like having them step off a cliff,” said Helen Hanks, assistant commissioner of the Department of Corrections. “Now we have a bridge.”

The state’s previous Medicaid program only covered low-income children, parents with nondisabled children under 18, pregnant women, older residents and people with disabilities. The expansion added anyone under 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,900 for a single adult.

About 140 people a month leave the state prison system, and nearly 90 percent of them are now eligible for Medicaid, Hanks said. That’s a small fraction of the more than 30,000 who have signed up so far, but getting them enrolled could have far-reaching ramifications, according to health and corrections officials.

“What we’re hoping to see is that people don’t return – that our recidivism rate drops – and that our communities become healthier because we’re sending people out and connecting them to services,” Hanks said.

Most notably, the Affordable Care Act requires all plans offered through Medicaid and the new online marketplaces to include substance abuse and mental health benefits. Alcohol violations are a top reason why former inmates have their parole revoked, so such treatment could be key in curbing that trend, Hanks said.

Mary Ann Cooney, associate commissioner of the Department of Health and Human Services, agreed.

“They haven’t been using while they’ve been in the correctional facility, but maybe they came from an environment where they were exposed to substance use and abuse, and if that is the case, arming them with some of the medical supports and treatment supports in the community just makes sense to help them not recidivate,” she said.

The two agencies have worked together to get people signed up, and will be further collaborating to examine whether the hoped-for benefits materialize. They’ve also worked with the marketplace assisters to reach people who left the prison system before Medicaid expansion but still have some connection to the probation and parole system.

Some of those efforts grew out of an experience Cooney had at a meeting last fall with homeless shelter officials and advocates.

“I could not believe how many of them did not know how to sign people up for the New Hampshire Health Protection Program,” she said. “I thought, gosh, of all people, it should be the corrections community, the homeless support community, who have that information.”

The Medicaid program is projected to cost $340 million a year when fully implemented and would use 100 percent federal funding through 2017. Coverage will end if federal funding drops below 100 percent and ends regardless at the end of 2016 if the Legislature doesn’t reauthorize it. Though Republicans helped craft the compromise expansion plan, some want to repeal it. Hanks said she is very concerned about that possibility.

She said the state must recognize its responsibility to send former inmates back into the community in the safest manner. A healthier population is a safer population, she argues.

“This is the one guaranteed health intervention for them. They don’t have access to health care services, they’re already an at-risk population. If we take this intervention away, we’re putting them at a greater risk of recidivism,” she said. “We have our one time opportunity to tackle these issues in a consistent manner, and if we take it away, we’re back to where we started. We’re having them step off a cliff again.”




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