Danay Burke, 43, was released from prison on Nov. 1. Among the many tasks on her to-do list for reestablishing her life was to figure out how to manage her health care needs. But she left prison without health insurance, making that a difficult and costly prospect.
“It’s slowing down the process of me helping myself,” Burke said.
She said she needs a drug assessment, medications for her anxiety and depression, birth control, a mammogram and a sleep study. However, Burke said she’s delayed all this care because she lacked medical coverage.
Burke, like many others released from incarceration, fell into a health insurance coverage gap. Historically, most people reentering society after incarceration were either uninsured or uninsurable.
But that’s poised to change in North Carolina with Medicaid expansion that took effect on Dec. 1.
The expanded eligibility rules allow people ages 19 to 64 whose incomes are up to 138 percent of the federal poverty level for their household size to gain coverage, allowing about 600,000 more low-income residents to join the state’s Medicaid rolls. Now, a single adult living in a one-person household is eligible if their annual income is $20,120 or less before taxes.
This criteria allows substantially more justice-involved individuals — people who often work in low-paying jobs or struggle to find work because of their criminal history — to enroll in Medicaid. The program can cover a variety of services, including doctor visits, behavioral health treatments and prescription drugs.
It’s a welcome change for Burke and others, who now have a path to getting health insurance that can pay for needed medical care — particularly as they shift out of a prison that was mandated to provide health care, to finding care in the community on their own.
Burke heard she newly qualified for Medicaid coverage from a staff member at Benevolence Farm — a reentry program in Alamance County offering housing and employment to women recently released from North Carolina prisons where she is staying — who helped her apply in December. Burke said she was approved for coverage, and she is eager to take advantage of the benefits to start taking care of her backlog of medical needs when she receives her Medicaid card in the mail.
However, Burke can’t help but think how much easier the path could have been without that disruption in care.
“A lot of people don’t have access,” Burke said. “They aren’t able to take care of themselves properly. Your mental health is a big thing because if you can’t take care of your mental health, a lot of people end up turning back to drugs and back to prison because we’re not able to take care of ourselves mentally and emotionally.
“It’s a big, big issue.”
The state prison system releases more than 15,000 people into the community each year, and prison officials estimate that 80 percent of them are now eligible for Medicaid.
They also recognize that inadequate access to health care can create a barrier to successful reentry into society. That’s why the N.C. Department of Adult Correction is working to ensure that fewer people are released into health care coverage gaps by helping people apply for Medicaid before they’re scheduled to leave prison.
“One of the key things with reentry is that break in service can really be detrimental,” said George Pettigrew, deputy secretary for rehabilitation and reentry at the N.C. Department of Adult Correction. “Somebody can decompensate real quick with mental health issues, substance use issues. If they don’t have that insurance ready to go where they can go and have these [health] services, that can be a problem.”
Gaining coverage
Mary Grillo, interim social work director and Medicaid expansion coordinator at the Department of Adult Correction, said the prison system has launched a department-wide effort to help people ages 19 to 64 who are within 90 days of their release date to apply for Medicaid coverage.
That effort is in line with one of the goals outlined in the state’s participation in Reentry2030, a national initiative that aims to dramatically improve reentry success. North Carolina joined the initiative through Gov. Roy Cooper’s January executive order seeking to boost reentry support.
Reaching people about 90 days ahead of time is important, Grillo said, because it can take up to 45 days for a Medicaid application to be processed and eligibility determined. The goal is to have as many people as possible covered before their release, she said.
“It’s one less thing that the individual has to do when they get out of prison,” Grillo said. “It’s one less thing to worry about.”
Grillo said prison staff, including three temporary workers hired in January to assist with the application process, are submitting about 100 Medicaid applications per week.
“The biggest challenge is getting the information out there and getting the education out there and letting people know that this is available,” Grillo said.
To spread the word about the new opportunity for Medicaid coverage upon release, the prison system has distributed a flyer through electronic tablets that are available to all incarcerated people and hung paper flyers on bulletin boards across prisons.
