Inmates forced into sobriety while locked up often turn back to drugs when they are released from jail or prison — a dangerous choice that raises their risk of an overdose because their tolerance level drops after time off from using.
State health officials came up with a smart solution two years ago to get these inmates into treatment and try to save their lives.
Now if they would only implement it.
Instead, the state is throwing inmates back into society with no support and missing a key opportunity to intervene at a time when those with substance abuse disorders are most at risk of an overdose.
The Maryland Department of Health in 2016 lobbied for and won federal authorization to put inmates temporarily on Medicaid when they are released. That way they had insurance coverage to head to rehab or a doctor’s office rather than back to using.
State health officials have decided instead to focus on enrolling people into permanent Medicaid, Meredith Cohn reported Monday. This sounds great in theory. Why wouldn’t permanent coverage be a better option? And ultimately that is the goal.
The caveat is that inmates have to prove they are eligible for Medicaid on the spot. Unfortunately, some inmates don’t have all the paperwork to show they pass the income thresholds and are U.S. citizens. That means no health coverage until they can.
With temporary enrollment, inmates have 60 days to get documentation and can still get services right away.
The state is missing many people by treating the temporary Medicaid option as a backup — and potentially contributing to overdoses. Advocates have noted the number of inmates enrolling in Medicaid increased only slightly, from about 150 people a month leaving jails or prisons to about 217 a month. About 1,718 people a month were released from the corrections system in fiscal 2018. Some may have already been enrolled in Medicaid before getting arrested, but corrections officials say most weren’t.
It makes no sense for the state not to implement a policy that we know they believe works since they lobbied for it. The Hogan administration said they are putting all the resources they can to fight an opioid epidemic that continues to kill people at alarming rates, including 1,848 Marylanders in the first nine months of last year. So why are they leaving this one on the table?
If the idea is to treat substance abuse as a public health problem and not a law enforcement issue, we need to be looking at ways to stop the drug pipeline in and out of prison. About two-thirds of people arrested are believed to have a drug or alcohol addiction or problem. People wind up incarcerated for small crimes; they steal to buy drugs or are arrested for possession.
Yet, too little is done inside the state’s correctional system to help people with addiction. There is a limited methadone program offered by the state, but it is only for those who were already using the treatment and is not available in most corrections facilities. There are also plans for a treatment center across from the Baltimore jail. But those who used other medications to control their addiction, like buprenorphine, cannot continue to be treated with it in prison and must either go without or in some cases switch to methadone, a risky proposition for those in recovery. We believe Maryland should follow Rhode Island’s example and make medication assisted therapy widely available in prisons.
But in the meantime, temporary Medicaid enrollment would help if the state would only use it. It could be a particularly effective option for county jails, where inmates spend only a short period of time so a connection needs to be made quickly. The state could take it a step further and also connect inmates to treatment centers when they are enrolled.
In addition to drug treatment, these inmates could also see doctors for other medical issues, as substance users also have higher rates of chronic conditions.
The state health department has said staffing is an issue, but more people will be dedicated to enrollment this year. Exactly what were they waiting for to hire more people?
Researchers in North Carolina found that heroin users were 74 times more likely to overdose within two weeks of leaving prison. If a Medicaid card could prevent even one of those deaths it would be worth it.