Former inmates face delay in Medi-Cal benefits after release from jail

Medi-Cal is a government program that provides healthcare coverage for low-income California residents. Today, it covers the healthcare costs of nearly one out of three people in the state. But, when people are arrested and booked into Santa Rita Jail, their Medi-Cal coverage is suspended or even terminated, as responsibility for inmates’ healthcare is transferred to the jail’s medical system.

The problem, activists and Alameda County representatives say, is that after a person is released, it can be hard to get their coverage immediately reinstated—and that can cause health problems if a person’s care is delayed.

“When you’re incarcerated, you have control over your medical conditions,” said Dr. Noha Aboelata, founder of Roots Community Health Clinic, a healthcare provider serving low-income people in Oakland. For example, she said, imagine “you have this nicely-controlled hypertension. And then you get out. You have no Medi-Cal, you have no meds, you have a stroke and you die.” 

To reinstate a person’s Medi-Cal upon release from the jail, they must connect with a social service agency to reactivate or reapply for benefits. If they are held at Santa Rita Jail for more than one year, they must reapply for the program. If they are in jail for less than one year, they can reactivate their status.

Kelly Glossop, a manager at the Youth and Family Services Bureau of the Alameda County Sherriff’s Office, which oversees the jail, said that her office helps people get Medi-Cal turned back on after leaving Santa Rita. “For some folks, it’s a quick process and for other folks, it takes months,” she said. Typically, she said, social services providers will not reinstate former inmates’ Medi-Cal until they come into a county office, meet a case worker and submit an application. Glossop is working within her office to expedite the process.

Since Roots started in 2015, its staff has sometimes had the ability to send case workers inside Santa Rita to help people sign up for Medi-Cal and other services prior to release. But today, Aboelata said, they rely on the jail’s health workers to refer people to Roots upon release. “We have varying degrees of access and ability to move around based on whatever’s going on with space and staffing, which does fluctuate quite a bit,” she said.

Kara Janssen, an attorney with the firm Rosen, Bien, Galvan & Grunfeld in San Francisco, said she became aware of people not receiving necessary medical coverage upon release in the course of her firm’s class action suit, which was filed in December, 2018, against Alameda County on behalf of all people incarcerated at Santa Rita. The suit alleges that prisoners are being denied adequate mental health treatment and that people with mental illness are unlawfully being segregated into “Administrative Segregation” units where they are isolated and receive little assistance. (So far, Janssen said, county officials have been willing to work with her firm to address issues, and are retaining a panel of experts to review conditions at the jail. Mediation is ongoing.)

For her clients, many who have been housed for months in isolation, Janssen said the expectation that upon release they will be able to navigate social service bureaucracies—potentially without transportation—in order to receive medical coverage “is an impossible ask.”

Beyond logistical difficulties, Janssen said, any lapse in psychotropic medications for people who rely on them directly contributes to recidivism. People released from jail without access to medications often commit additional crimes, Janssen said, “and they might be things that are very small, but then they get picked up again, and come back to the jail in about a week or two.”

“Failure to provide proper reentry services, particularly to the extent that disproportionately effects prisoners with disabilities, with psychiatric disabilities, one could argue is a violation of federal disability anti-discrimination law,” Janssen continued.

She believes the county should implement an automatic process through which anyone leaving Santa Rita would be able to have a seamless transition to Medi-Cal. “That has the potential to result in cost savings to taxpayers for allowing people to function outside of the jail and not paying for the cost of their incarceration. It has public safety benefits. There’s a lot of good reasons to do it,” she said.

Bob Britton, a member of Faith In Action, a nationwide community-based faith group and chairperson of its Live Free Committee, which focuses on criminal justice, is also concerned with the gap in medical coverage for some people leaving Santa Rita. “If you end up in the county jail because you’re schizophrenic and you’re acting out and you do anti-social things, then it’s very important that you get medication and healthcare when you get out of jail, or you’re going to be going back with the same kind of issues,” he said.

Last month, Britton helped circulate petitions among 11 different faith communities that call on the Alameda County Board of Supervisors to exercise its authority under a 2013 state law to ensure the timely resumption of Medi-Cal benefits to people leaving the jail.

“The system for suspension or termination of benefits is working smoothly but the lack of a system for reinstatement of benefits is leaving those otherwise eligible with no healthcare at all,” reads the petition signed by congregants of the Starr King Unitarian Universalist Church in Hayward. It concludes: “We ask that the Board of Supervisors of Alameda County, using its budgetary and oversight authority, exercise its power and compassion to ensure the timely resumption of these healthcare benefits to some of the neediest among us.”

On October 29, leaders from the faith groups delivered the petitions with over 1,000 signatures to the county supervisors. Delivering them “felt very good,” said Britton.

According to Erin Armstrong, the special projects assistant to Alameda County Supervisor Nate Miley (District 4), who represents Oakland, “is very supportive of a speedy and efficient re-enrollment process for people who are leaving Santa Rita Jail and reentering our society.” Armstrong said the supervisor recognizes that the requirement for recently released people to visit a county office to restore their benefits is not ideal. Indeed, Miley even signed the petition brought to him by the Faith in Action advocates last month.

But, Armstrong said, conversations with officials from the sheriff’s office and social service departments revealed challenges to bringing social service staff into Santa Rita to connect people with Medi-Cal. One challenge is union regulations, she said. “For example, in order to get social service staff, which is a unionized workforce, to go to the jail and do enrollment, they would require hazardous work conditions pay, which is an added cost,” Armstrong said.

And when Miley’s office examined the alternative of assigning workers in the sheriff’s office to enroll people onto Medi-Cal, she said, “then we run up against union issues as well, where social service employees have an exclusive right to offer those services.”

Armstrong said that Miley is working to organize a joint meeting of the board’s Social Service Committee, which he chairs, and the Public Protection Committee to discuss the issue of Medi-Cal reenrollment in early 2020. This is an opportunity for “us to ask staff at the county to bring us solutions that we can approve,” Armstrong said, adding that Miley’s office appreciates the attention Faith in Action has brought to the issue.

But Britton feels like county officials are moving too slowly. Citing the 2013 law empowering counties to set up systems to enroll inmates on Medi-Cal prior to release, he said, “they’ve had six years to act on it.”

If the supervisors don’t act soon, he said, “We are prepared to do a second round of petitions.”

Photo by Brian Perlman.