With Medicaid expansion, a broad swathe of low-income Missourians are now eligible to receive public health insurance. That cross section includes people leaving prison, who often go from having basic health care in prison, to not having any on the outside.
One of the first stops for people leaving prison in mid-Missouri is the Reentry Opportunity Center, in Columbia. The center sees about 80 people a month, most of whom are in the process of putting their lives together after being incarcerated.
According to the center's program director, D'Markus Thomas-Brown, leaving prison often means starting from scratch. "When someone comes out ... they need everything, and they need it now," Thomas-Brown said.
The center looks to link its clients to the many resources they might need, by creating what Thomas-Brown calls “warm hand offs” — personal connections to local organizations.
"We’re not just telling them, 'hey if you go down to [the Voluntary Action Center] on Wednesdays you can possibly get help,'" Thomas-Brown explained. "We’re able to give the hand off and say well so and so is waiting for you, or do we need to meet you down there.”
Thomas-Brown points to health care as one of the biggest needs for people re-entering society. While they can typically access basic health services while incarcerated, that option goes away on the outside.
“If they were taking meds, whether it be for mental [health] or even stabilizing for recovery from substance use disorder, how to get those meds now on the outside is a huge obstacle.”
Medicaid expansion offers a new option for many, as it opens eligibility up for most Missourians making less than 17,770 dollars a year. But being eligible for Medicaid isn’t the same as being enrolled in the program.
More than 58,000 Missourians have enrolled in expanded Medicaid since the state started implementing the program in the fall. That’s just over one fifth of the estimated 275,000 Missourians newly eligible through expansion.
The state has done little to promote the program, and that work has largely fallen to advocates and non-profits.
Concordance, in St. Louis, is one group connecting people leaving prison to Medicaid. Michelle Smith, the organization’s president, said Medicaid expansion offers an opportunity, but there are still obstacles. For example, a medicaid application takes on average 30 to 45 days to be processed. That can be a critical time period for those leaving incarceration.
“If they have some type of medication, when they’re released from prison they’re only released with a 30 day supply," Smith said. "So oftentimes, if you can’t get Medicaid eligible or see a health care doctor within those 30 days, your prescriptions will lapse."
Smith said Concordance starts filling out applications with its clients in the final days of their sentence in order to speed up the process, and several have successfully enrolled in the program.
Her group's overall goal is to reduce recidivism, and research suggests Medicaid expansion can help with that.
Recent research has found states that expanded Medicaid had lower rates of recidivism than those that didn't. Erkmen Aslim, an economics professor at Grand Valley State University in Michigan, was lead author on that study, and he found mental health was a likely factor.
“We find a very sharp decline in violence and public order crimes and this supports our hypothesis that the policy is really effective in curbing recidivism, associated with crimes that are most likely committed impulsively,” Aslim said.
Aslim's research also touched on the benefits of reducing recidivism, both to individuals and society more broadly. Fewer people reoffending means fewer fiscal costs to imprison them, and also the direct costs to victims of crime.
But to see those benefits, the research suggests, states must actively enroll its eligible residents in Medicaid, and Missouri still has a long way to go in that respect.
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