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The health care law that President Obama signed last year requires states to expand their Medicaid programs by the year 2014. California is already getting started. At least half a million people are expected to gain coverage as a result - mostly poor adults who never qualified under the old rules because they did not have kids at home. And among those who stand to benefit the most right now are ex-offenders. Inmates often leave California prisons with no consistent place to get medical care. Sarah Varney from member station KQED and our partner Kaiser Health News has more.

SARAH VARNEY: A prison van stops just outside the metal gates of San Quentin, just north of San Francisco, and Darren Thurmond lumbers out. He wears a prison-issued gray sweat suit, stretched tightly over his large belly, and carries his possessions in a crumbled brown paper bag. A counselor from a local health clinic is here to give him a ride to Oakland.

DARREN THURMOND: I don't know how many more times I can do this, man. Yeah.

UNIDENTIFIED MAN: How much parole you got left?

VARNEY: Thurmond has been in and out of prison over the last 20 years for cocaine and methamphetamine possession. Now, at age 45, all the drug use and hard living has damaged his heart. He hasn't had health insurance since he was a kid, and his heart problems were first diagnosed and brought under control in prison. But each time Thurmond gets out, he's left with a four-week supply of medication and no insurance.

DAN THURMOND: I can't afford any health care right now. Hell, I'm on parole. I'm in and out of the system. You know?

(SOUNDBITE OF DOOR OPENING)

THURMOND: Hey, John.

MAN: They can help you.

THURMOND: Thank you. Oh, I need to sign in, don't I?

MAN: Yes, sir.

MAN: How's your day going, man?

THURMOND: All right. It's going good. I'm free, you know.

MAN: That's good.

VARNEY: Thurmond's first stop after his release is here at a non-profit called Healthy Oakland. It's one of the few clinics in California that offers medical care to ex-convicts who have typically been excluded from public insurance programs.

GEORGE PEARSON: ..TEXT: What can we do? You need your refills for your Coumadin? How have you been otherwise? There's no other sickness? Look at your labs here.

VARNEY: Thurmond sits down for a full medical check-up with George Pearson, the clinic's physician assistant. They go over his heart problems, his weight and the painful arthritis that's overtaking Thurmond's hips.

Pearson says a 45-year-old ex-convict will often have the ailments of someone 10 years older. They have higher rates of almost all chronic conditions, like high blood pressure, diabetes and asthma. It's from living a hard life, to be sure, he says, but it's also because they have common medical problems that go untreated.

PEARSON: So the hypertension becomes heart failure. The diabetes becomes diabetic neuropathy, amputation, blindness.

VARNEY: But now, many of those getting out of prison and other poor adults in California are being enrolled in a Medicaid-like program. They'll be covered for preventive care, prescription drugs, specialty visits and mental health and substance abuse - pervasive problems that when left untreated, researchers say, can lead offenders right back to prison or jail.

George Pearson at Healthy Oakland says giving ex-offenders health insurance and assigning them a regular doctor brings some order to their chaotic lives.

PEARSON: Their whole life is transitional and it lacks stability. You need a facility that's going to be the home of their records, going to know them as a person. That in itself prevents overutilization of the ER and that kind of thing, 'cause if he talks to me first he may not need to go to the ER. Or if he goes there he goes intelligently.

VARNEY: Some county health departments in California are using the new federal money to restructure their safety nets, to look more like a robust health care system. Alex Briscoe runs the public health department in Alameda County, a county of 1.5 million people with an enormous ex-offender population, mostly in Oakland.

ALEX BRISCOE: Historically, services for this population are fragmented and tend to be episodic. And what we're trying to do is prepare for health reform by assigning all consumers in our system, all clients in our system, to a medical home.

VARNEY: That means asking ex-offenders to pick one place to get their basic medical care. And Briscoe says, he's adding mental health therapists to county primary care clinics.

Those preparations are especially important as California begins to comply with a court order to reduce its state prison population. To relieve overcrowding, thousands of lawbreakers are expected to be put on probation in their hometowns, instead of going to state facilities. That means even more ex-offenders signing up for coverage, adding an additional burden, many say, to an already maxed out Medicaid system.

Still, providing coverage, experts say, is important for public health. Emily Wang of the Yale School of Medicine says many former inmates return home with serious mental health problems and communicable diseases.

EMILY WANG: Treating substance abuse, HIV disease, hepatitis C will reduce the disease rates in our communities.

VARNEY: Wang and others say health insurance though is not a magical cure for a group of people with more pressing, every day needs.

THURMOND: We're going straight ahead. See that medical building on the left with the yellow poles around it?

VARNEY: After Darren Thurmond finished his doctor's visit at Healthy Oakland, I drove him to a pharmacy to pick up his many prescriptions - a trip that would have taken an hour by bus and a painful walk with his arthritic hips.

(SOUNDBITE OF CROWD)

VARNEY: After, we headed to a Mexican restaurant in downtown Oakland for lunch. Thurmond had fantasized in prison about authentic enchiladas.

THURMOND: There we go.

VARNEY: That is the largest plate of food I've ever seen.

(SOUNDBITE OF LAUGHTER)

VARNEY: He's thankful, he says, that he now has a regular doctor. But he's homeless, living in his van and can't quite figure out how he'll get to his appointments to get his blood work checked or his prescriptions refilled.

THURMOND: Being homeless, oftentimes, I have the time to do it, but I don't have the gas to get there.

VARNEY: For now, Thurmond is thinking pragmatically. It's his first day out of San Quentin and top on his mind is finding a job, getting money for food, necessities, gas and a place to shower. With no hint of pity, he says, I'm pretty resourceful.

For NPR News, I'm Sarah Varney.

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