A San Francisco law now permits the sheriff's department to enroll inmates in health insurance policies under the Affordable Care Act — policies designed to cover medical care after a prisoner's release. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they leave jail will help keep them from committing another crime and coming back.
One inmate — Sophia — recently requested help signing up for a health plan. Sophia, who asked that her last name not be used, was caught driving a stolen car in January and sentenced to three months in San Francisco's county jail. She says she stopped getting treatment for her mental health problems and substance abuse after her health insurance expired.
"It stopped in December and I didn't get it reinstated," Sophia says. "So I didn't address any of my issues — and I guess that's why I found myself in a car, driving around."
Pretty soon, all the jail's inmates will be registered for insurance — whether they request it or not. Most new arrivals will be enrolled in post-jail health plans at booking.
"You have a captive audience," Mirkarimi explains. He says he wants to make sure the 30,000 prisoners who come through the jail system every year are covered on the day they're released.
The sheriff was behind the new city law that authorizes his staff to enroll inmates in health plans 24 hours a day, 7 days a week. Other counties and states are undertaking or exploring similar efforts for people exiting jail or prison.
Mirkarimi acknowledges that signing up for coverage is only a first step. Just because someone has a newly minted card for Medi-Cal (California's version of Medicaid) doesn't mean he or she will know how to use it.
"They're going to have to demonstrate the wherewithal and resourcefulness to use that Medi-Cal card," the sheriff says. "We ... help them get ready. But ultimately, it's on them."
If this plan is really going to work, people leaving jail or prison will also need help on the outside.
"And it's hard," says former inmate Wanda Fain, "so utterly hard."
Fain was recently released from state prison after 21 years. Everything is new to her. Getting on and off escalators is weird. Mobile phones are a new concept. She says she needs the help of friends just to ride the bus.
"They tell me what bus we're on," Fain says. "They tell me what stops to get off, what specific things to look for so I won't miss a stop."
Navigating the health care system has been even more confusing. Fain has multiple health problems: seizures, lymphoma, and bipolar disorder. In prison, the guards regulated all her care for her. She wasn't allowed to eat a meal until she took her meds. 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.
"It's little things like that, that people think are so easy," Fain says, shaking her head. "They are so overwhelming."
Fain says she's lucky that she lives near The Transitions Clinic in San Francisco. Designed specifically for former prisoners, and staffed by former prisoners, the one-stop shop helps patients find a job, a place to live and food — and enables them to see a doctor, social worker and psychiatrist all under one roof. Juanita Alvarado is one of the community health workers.
"I was incarcerated," Alvarado says, "and I was homeless. And I had mental health [problems]. I was alone and scared and afraid. That's what I say to them and it usually opens a door."
Wanda Fain says clinic staffers are helping her get her life on track.
"They're very helpful because they've been there, done that," she says. "If I didn't have Juanita Alvarado, I don't know where I'd be — probably on my way back."
Most people do wind up back in jail. Sixty-one percent of people who leave a California prison return within three years, statistics show. But the federal government recently gave the Transitions Clinic a $6.8 million innovation grant (created under the Affordable Care Act) to expand its concept beyond San Francisco. The team is using the money to help 11 clinics in six states and Puerto Rico hire and train former prisoners to staff similar programs. Federal health officials believe the investment will ultimately save $8 million.
The even broader hope — for Mirkarimi's plan and for the Transitions Clinic – is that health care will help keep people from returning to jail or to prison.
This story is part of a partnership between NPR, KQED, and Kaiser Health News.
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. Transcript provided by NPR, Copyright NPR.