Despite ongoing reform efforts, the Massachusetts prison health care system continues to be confronted with significant challenges, deeply affecting the well-being of incarcerated individuals and complicating their reentry into society post-release.

Those challenges include systemic factors, social stigma and gaps in health care.

“Four hundred, forty-eight thousand people leave prisons annually, and millions pass through jails and juvenile justice systems in the U.S.,” said Vikki Wachino, director of the Health and Reentry Project, during a symposium on policy pathways to improve health outcomes for incarcerated individuals.

She said that the weeks immediately following release are particularly critical, with formerly incarcerated individuals facing a much higher risk of death than the general population, especially from opioid overdoses. This statistic highlights the need for systemic health care reform and robust support systems to aid those transitioning back into society.

“We’re trying to improve the care for incarcerated people when they get released to make sure they’re directly connected,” said Sen. Jamie Eldridge, D-Marlboro, emphasizing the goal to bridge the gap between prison and society by enhancing Medicaid coverage and offering other forms of reentry support.

Challenges behind bars

The health care landscape within the prison system is fraught with deficiencies.

Wachino draws attention to the complexity of the issues, noting, “People in the weeks following incarceration are 12 times more likely to die from various causes than the general population.”

Deaths from opioid overdoses exceed those of the general population by a factor of 40 to 129, according to various studies. Additionally, formerly incarcerated individuals face high rates of homelessness.

Mary Ellen Mastrorilli, associate chair of applied social sciences at Boston University’s Metropolitan College, said mental health issues and substance use disorders are usually not addressed within the prison system, with health care service limited to emergency psychiatric care.

Experts say structural racism compounds these challenges, as people of color face disproportionate hurdles in accessing jobs and housing post-release due to systemic discrimination.

Levin Schwartz, assistant superintendent at the Franklin County Sheriff’s Office, emphasized the significant disconnect between health care provided inside prisons and the care available after release.

“Bridging this gap is crucial for successful reentry,” Schwartz stressed, emphasizing the critical importance of improving the transition to community care for better health outcomes.

Wachino shared a story from her advisory committee about an individual who, upon release, was left homeless and had no one to rely on for support except other homeless individuals. Although they could offer some assistance, the lack of structured support from the health care system led to poor health outcomes and increased health care spending in inappropriate settings.

In Alabama, a diabetic inmate was denied his medication while incarcerated, resulting in a severe illness that required expensive hospital treatment upon release. Preventive measures could have avoided this costly care, Wachino said.

A similar case occurred in Middlesex County, where an inmate with a reentry plan couldn’t access community services to continue treatment after release, leading to repeat incarceration.

Wachino pointed to an analysis in South Carolina that examined two groups of 19-year-old men. One group retained Medicaid coverage, while the other lost it. The group that retained Medicaid coverage had a significantly lower rate of incarceration than those who did not. This difference was attributed almost entirely to Medicaid’s ability to provide access to mental health care.

“Medicaid coverage has a positive impact on reducing crime rates and improving health care access for at-risk populations,” she emphasized, advocating for broader access to health care coverage for incarcerated individuals.

State-level solutions and ongoing efforts

A significant step toward addressing these issues is a Medicaid waiver, which aims to bridge the gap between incarceration and reentry by providing Medicaid coverage 90 days before release.

“This initiative seeks to ensure that individuals have health care coverage upon leaving prison, allowing them to access essential medical services immediately,” Wachino stated, explaining that Medicaid has historically been prohibited from covering health care costs during incarceration, but recent policy changes aim to correct this disparity.

Mastrorilli said the strength of this waiver is that reentry efforts will happen before the incarcerated person gets out, which removes the burden of going home with a list of phone numbers to call to make those connections.

Eldridge emphasized the importance of state-level initiatives that aim to reduce barriers to reentry.

“We need to link health care incentives to positive outcomes during and after incarceration,” he said, adding that by aligning health care provider incentives with reentry goals, the aim is to improve overall care standards and ensure that formerly incarcerated individuals have a stronger chance of reintegrating into society.

Another promising solution is the development of reentry programs that support housing and job placement.

Eldridge mentioned the creation of a housing voucher for formerly incarcerated individuals, enabling them to rent an apartment post-release and avoid homelessness. Additionally, specific programs, such as coding and solar panel installation training in some prisons, equip inmates with marketable skills to improve job prospects after release.

Bristol County Sheriff Paul Heroux said it is important to have holistic reentry plans for individuals leaving jail, noting that health care, housing and employment are the key pillars.

“We try to connect inmates with health care providers and community organizations prior to release to ensure continuity of care,” he said, acknowledging that not all inmates accept the support offered, adding further complexity to reentry efforts.

Programs for change

Programs in Boston are focusing on addressing the unique health impacts of incarceration on specific groups, such as women and those who are pregnant.

Erika Hanson, clinical instructor in the Center for Health Law and Policy Innovation of Harvard Law School, highlighted that social determinants of health, such as access to food, housing and employment, drive up to 50% of health outcomes. Access to services that address these health-related social needs has the potential to reduce emergency department visits, hospital admissions and overdose rates upon reentry. Addressing people’s underlying health-related social needs enhances everyone’s ability to thrive in their communities.

Leslie Credle, CEO of Justice 4 Housing, emphasized the importance of providing proper health care to those who are incarcerated, noting that inadequate care leads to life-threatening illnesses. Mental health impacts and poor housing options exacerbate the situation.

“You cannot heal until you have a home,” Credle stated, highlighting how essential housing is to recovery.

Boston was the first housing authority to adopt more innovative policies, opening its doors to house formerly incarcerated individuals who otherwise would struggle to find accommodation.

Jiashan Zheng writes for the Athol Daily News from the Boston University Statehouse Program.