RENEE MONTAGNE, HOST:
The Affordable Care Act could be a big help to former prisoners. About 90 percent of people coming out of jail or prison qualify for health coverage in states that expanded Medicaid under
Obamacare. Local sheriffs' departments hope that might help keep ex-cons on the straight and narrow. April Dembosky from KQED in San Francisco visited the local county jail to learn why.
APRIL DEMBOSKY, BYLINE: A dozen women in bright orange uniforms sit in a circle, slouching and shifting. One of them, Sophia, is just days from release. She was caught driving a stolen car in January. It's a choice she blames on drugs and mental health problems that resurfaced when her health coverage ran out.
SOPHIA: And I didn't get it reinstated. So I didn't address any of my issues, and I guess that's why I found myself in a car (Laughing) driving around.
DEMBOSKY: San Francisco Sheriff Ross Mirkarimi has a plan that he thinks will help prevent crimes like this and prevent people like Sophia from coming back. Half the inmates in prison and jail have a mental health disorder. That's why Mirkarimi wants to enroll every inmate into health coverage under the Affordable Care Act - so they'll be insured by the time they're released.
ROSS MIRKARIMI: You have, essentially, a captive audience.
DEMBOSKY: San Francisco is one of the first cities in the country to authorize the staff at the Sheriff's department to do this. Mirkarimi says it's fast and efficient for his deputies to do the paperwork at the same time suspects get booked into custody.
MIRKARIMI: We're a 24/7 operation.
DEMBOSKY: But Mirkarimi acknowledges that just because someone walks out of jail with a newly minted Medicaid card, or Medi-Cal as it's known in California, doesn't mean they'll know how to use it.
MIRKARIMI: You're going to have to demonstrate the wherewithal and resourcefulness to use that Medi-Cal card. We and our staff help them get ready, but ultimately, it's on them.
DEMBOSKY: If this plan is really going to work, people getting out of jail are going to need help on the other side.
WANDA FAIN: And it's hard - so utterly hard.
DEMBOSKY: Wanda Fain was just released from state prison after 21 years behind bars. Everything is new to her. She says she needs a friend just to help her ride the bus.
FAIN: They tell me which bus we on. They tell me what stops to get off.
DEMBOSKY: Navigating the health care system is even more confusing. Fain has seizures, lymphoma and bipolar disorder. In prison, the guards regulated all of her care for her. If she didn't take her meds, she didn't eat.
FAIN: In order to get your meal, you got to go to the meal-line window.
DEMBOSKY: But on the outside, it's up to parolees to find the right doctor, the right pharmacy, and to figure out which buses they need to take to get there.
FAIN: It's little things like that, that people think are so easy. They are so overwhelming.
DEMBOSKY: Fain says she's lucky that she lives near a unique health clinic in San Francisco that really gets this. The Transitions Clinic is designed specifically for former prisoners and staffed by former prisoners. They help patients find a job, a place to live, food and see their doctor or psychiatrist, all in one place. Juanita Alvarado is one of the community health workers.
JUANITA ALVARADO: I was incarcerated, and I was homeless. I was alone and scared and afraid. That's what I say to them, and that usually opens a door.
DEMBOSKY: Wanda Fain says the staff are helping her get her life on track.
FAIN: They're very helpful because they've been there, done that. If I didn't have Juanita Alvarado, I don't know where I'd be. Probably on my way back.
DEMBOSKY: Most people do go back. 61 percent of people who leave a California prison return within three years. San Francisco is hoping Obamacare might be one piece of a possible solution. For NPR News, I'm April Dembosky.
MONTAGNE: And that story is part of a reporting partnership between NPR, KQED and Kaiser Health News. And you are listening to NPR News.
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