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Death Sentence

A bureaucratic loophole limits halfway house residents' access to health care, making it harder to survive on the outside.

Late last January, David Isberg took a urine test at a hospital to figure out what was wrong with him. The 42-year-old inmate had started peeing blood while serving a three-year sentence at Kit Carson Correctional Center in Burlington for marijuana possession. But before the results came back, Isberg was transferred to a halfway house in Denver, where he worked an outside job as an HVAC technician during the day and returned at night to log in with his case manager and sleep.

It wasn't until May that Isberg checked back with the doctors to find out about his diagnosis, and it turned out to be a critical one: bladder cancer.

Most of the 2,984 people who live in Colorado's 35 community corrections facilities, known as comcor, are making the transition out of prison and back into society. Like Isberg, they come and go during the day, typically taking the bus to work since they're not allowed to have cars. They must call in with each stop they make and return to the house at night to sleep.

This ambiguous designation — not quite free and not quite prisoners — has left the bulk of them in a dangerous medical no-man's-land. While the homeless and the very poor are eligible for public benefits like Medicaid and the Colorado Indigent Care Program, most halfway house residents aren't. The reason is that the federal government, which helps fund these programs, considers comcor clients to be "wards of the state," meaning it believes Colorado should shoulder their health-care costs. But the state Department of Corrections won't do that, saying halfway house residents should be able to access insurance through their jobs.

Prisoner advocates say the situation isn't fair because it's difficult for ex-convicts to find a job right away, let alone one with health benefits.

Isberg, for instance, didn't qualify for health care through his employer until he'd worked three months. And since he says he couldn't afford treatment, he put it off despite his declining health. When he finally got health insurance in September, the doctor he saw was appalled that he had waited so long to seek care, and scheduled a date for Isberg's surgery.

Unless the halfway house quandary is resolved, the lack of health care puts many clients at risk of ending up behind bars again, warns Charles Smith, deputy director of the Colorado Department of Human Services' behavioral-health program. "A sick person coming out of prison with no health care will find some way to take care of himself. He might steal to pay for health care, or he might use illicit drugs to address the pain."

Other states, such as New York and Rhode Island, have ways to bridge the gap, but not Colorado, adds Julie Krow, who directs a local home for struggling mothers called the Haven. While "people who transfer through comcor are more successful than those who don't," finding health care is difficult, Krow says. "It takes months to sign up for [benefits]. At your most critical period, you need supports like housing and jobs and education. The hope is that we will put in those supports immediately."

Both Smith and Krow serve on a task force created by the state legislature in 1999 to address problems with health care and the criminal justice system. The group, which includes health-care professionals and public-safety personnel, wants to deal with the halfway house problem but has faced challenges thus far in doing so.

In January, state senator Sue Windels plans to introduce a bill that would add a person from the Colorado Department of Health Care Policy and Financing to the 26-person task force. Since the department administers federal Medicaid and indigent care, it helps decide whether and how comcor clients should receive public benefits.

"Without someone at the table with clear knowledge and expertise of the ins and outs of Medicaid eligibility, it is difficult for the task force to address those issues, and it slows things down," Windels says. The change won't solve the problem, but it will jump-start conversations about who should account for halfway house residents.

Krow believes that public insurance programs — not the Department of Corrections — should pick up the slack. "People who are locked up behind prison walls don't need public benefits," she explains. "People who are living and working in your community and at your McDonald's or your Subway need the ability to access benefits."

To get comcor residents covered by Medicaid and indigent care, however, their very classification must be changed. Right now the federal government defines these people as "involuntarily" living in halfway houses. Krow says that word is too restrictive, since most halfway house clients opt to be there. "We are trying to change the language," she says.

But the state's health-care policy department maintains that it will lose federal funding if it covers halfway house inmates. In fact, two years ago, the department sent a letter to the city's primary public hospital, Denver Health, reminding it to turn away comcor clients who come seeking discounted care.

Even so, Krow says it's up to the state to classify its own inmates, and that even a small adjustment could mean coverage for people like Isberg.

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