RACHEL MARTIN, HOST:
Prisons are full of people dealing with serious health problems. Mental illness, addiction and other diseases are rampant in the correction system. Inmates can get treatment while they're incarcerated, but getting out often means losing health care. Some states are trying to get released prisoners under Medicaid, but many ex-inmates are still left out. Jake Harper of Side Effects Media - Side Effects Public Media spoke with one man in Indianapolis.
JAKE HARPER, BYLINE: Ernest takes two drugs - lithium and an anti-psychotic.
ERNEST: Well, I suffer from manic depression. And I - what caused my crime was an acute severe psychotic episode.
HARPER: He's been trying to find a job. That and his crime are why he asked us to use just his middle name. In 1991, Ernest killed his 2-year-old daughter. He thought God would stop him, like in the story of Abraham. The medication he got in prison stabilized him, and he served 24 years. Before he was paroled, he tried to get his insurance set up. It didn't work.
ERNEST: You know, I don't have a job. I don't have any money. How can I buy medication?
HARPER: He got out of prison with a 30-day supply of his meds, unsure how he would get a refill. He worried about another psychotic episode, about hurting someone.
ERNEST: I made some impassioned calls to people saying, hey, I'm about to run out here, and it's very important because my whole world comes crashing down if I'm not mentally stable. You know, if I don't get this medication, then there's - there's going to be some problems because I'm - you know, I'm mentally ill. And so, for me, that was my main concern.
HARPER: Ernest should have left prison with Medicaid. Under Obamacare, 31 states have expanded Medicaid to cover most low-income adults, including ex-prisoners. The Medicaid expansion may or may not survive Republican promises to change Obamacare. But for now, if you get out of prison or jail in one of those 31 states...
DAN MISTAK: You know, it's slim chances that you wouldn't qualify for Medicaid.
HARPER: Dan Mistak says prisons and jails can sign people up for Medicaid while they're incarcerated, suspend it and then activate it once they get out. Mistak is an attorney at Community Oriented Correctional Health Services, and he says some states, like Colorado and California, are doing that.
MISTAK: But that is - that is not the practice across the country.
HARPER: In an investigation, Kaiser Health News and the Marshall Project looked at how prison systems across the U.S. are dealing with this. Beth Schwartzapfel is a reporter with the Marshall Project.
BETH SCHWARTZAPFEL: What we found is a really mixed bag.
HARPER: The Federal Bureau of Prisons in 16 states have no procedures to enroll inmates before release. And nine states only enroll certain prisoners, such as those with disabilities.
SCHWARTZAPFEL: And then the remainder of the states are making a good-faith effort. There's just so many ways that people can fall through the cracks.
HARPER: For instance, Indiana has a system to apply for Medicaid on a prisoner's behalf, but the Marshall Project found that some of those released were left out, people like Ernest. The situation is more uncertain in local jails, where rates of mental illness are even higher. The ones that do enroll people in Medicaid come up with their own process.
DEBBIE SULLIVAN: Who else needs paperwork?
HARPER: Lieutenant Debbie Sullivan asks inmates to fill out Medicaid applications at the Marion County Jail in Indianapolis. She yells through the bars to a cell block of about a dozen women.
SULLIVAN: Ladies, on that second page, it's going to ask for your first and last name and the last four of your Social Security number and your date of birth.
HARPER: Handing out applications is step one, but a lot can still go wrong. Leaving prison or jail is a chaotic time. Ex-inmates need a place to live, a job, transportation. Indiana prison data show that only about half of released inmates follow up, and even fewer go on to actually get coverage. Part of Sarah Barham's job is to help mentally ill clients sign up for Medicaid. She works as a recovery coach in Indianapolis.
SARAH BARHAM: It can very much be a nightmare.
HARPER: Even when she's there to help, it's overwhelming, especially when someone's supply of medication disappears.
BARHAM: It's like a train wreck. You're just watching it. And so they get out in the community with all the other barriers and stressors they have, and now suddenly they're pulled off their medication cold turkey and expected to just hang in there.
HARPER: Ernest did manage to hang in there, but just barely. A local clinic filled a prescription for free.
ERNEST: Just, like, at the last minute, somebody managed to get things taken care of so that I was actually, you know, supplied with medication.
HARPER: Then, finally, he got Medicaid. He says he was lucky. But given his condition, he says it wasn't something that should have been left to chance. For NPR News, I'm Jake Harper.
MARTIN: For more on this investigation, go to npr.org. This story is part of a report - reporting partnership with the Marshall Project, Kaiser Health News and Side Effects Public Media.
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