Most former inmates leave California prisons with no consistent place to get medical care. Instead, they rely on a scattershot of county-funded clinics or end up at county emergency rooms. But in California, that's beginning to change.
The state negotiated with the Obama administration to gain early access to funds available under the federal health law. Starting in last month, counties began enrolling all low-income residents -- including ex-offenders -- into a version of Medi-Cal.
Ex-convict Darren Thurmond wears a prison-issued grey sweat suit, stretched tightly over his large belly and carries a crumbled brown paper bag, as he climbs out of the prison van stopping just outside the metal gates of San Quentin.
Waiting for him is Don Williams - a counselor from a local health clinic who's here to give Thurmond a ride to Oakland.
"I'm not sure how many times I can do this, man," Thurmond says to Williams.
Thurmond has been in and out of prison in the last twenty years for cocaine and methamphetamine possession. Now at age 45, all the drug use and hard living has damaged his heart.
Like many ex-convicts, he says hasn't had health insurance since he was a kid, and his heart problems were first diagnosed and brought under control in prison. But each time Thurmond gets out, he's left with a 4-week supply of medication and no insurance. Now that's changing.
With the early expansion of health coverage this summer, former inmates will be covered for preventive care, prescription drugs, specialty visits and mental health and substance abuse. One place where Thurmond will now get care is at the non-profit Healthy Oakland, his first stop after his release from prison.
This is one of the few clinics in the state that offers medical care to ex-convicts who have typically been excluded from public insurance programs like Medi-Cal.
Thurmond sits down for a full medical checkup with George Pearson, the clinic's physician assistant. They discuss his heart problems, his weight and the painful arthritis that's overtaking Thurmond's hips.
Pearson says a 45-year old ex-convict will often have the ailments of someone 10 years older. They have higher rates of almost all chronic conditions, like high blood pressure, diabetes and asthma. To be sure, these ailments stem from living a hard life, but it's also because they have common medical problems that go untreated.
"So the hypertension becomes heart failure. The diabetes becomes diabetic neuropathy, which can lead to amputation, even blindness," Pearson says.
Researchers say that when these pervasive problems are left untreated, they can lead right back to prison or jail, and that giving ex-offenders health insurance and assigning them a regular doctor brings some order to their chaotic lives.
"Their whole life is transitional. And it lacks stability. You need a facility that's going to be the home of their records, [that's] going to know them as a person," Pearson says. Having a regular health care provider can prevent ex-offenders from over utilizing the ER.
Expansion of Care in Some Counties
Some county health departments are using the new federal money to re-structure their safety nets to provide a fuller array of services. For example, Alex Briscoe of the Alameda County public health department says he's adding mental health specialists to primary care clinics.
"Historically, services for this population are fragmented and tend to be episodic. And what we're trying to do is prepare for health reform by assigning all consumers in our system, all clients in our system, to a medical home."
Those preparations are especially important as California begins to comply with a court order to reduce its state prison population. To relieve overcrowding, tens of thousands of lawbreakers are expected to be put on probation in their home towns instead of going to state facilities. That means even more ex-offenders signing up for the expanded health coverage.
However, health researchers say the new enrollees will likely only add to a maxed out Medi-Cal system. Wait times for specialists have long plagued Medi-Cal across California, largely due to the state's low reimbursement rate.
Still, providing coverage is important for public health, experts say. Emily Wang of the Yale School of Medicine says many former inmates return home with communicable diseases.
"Treating substance abuse, HIV, hepatitis C will reduce the disease rates in our communities," she says.
But Wang and others say health insurance though is no magical cure for a group of people with more pressing, every day needs.
After Darren Thurmond finished his doctor's visit at Healthy Oakland, this reporter drove him to a pharmacy to pick up his many prescriptions. By bus, this trip would've taken an hour, plus a painful walk with his arthritic hips.
Afterward, we headed to a Mexican restaurant in downtown Oakland for lunch. Thurmond says he had fantasized in prison about authentic enchiladas.
He's thankful that he now has a regular doctor, he says. But he's homeless. Living in his van, he's unsure how he'll get to his appointments to get his blood work checked or his prescriptions refilled.
"Being homeless, often I have the time to do it, but I don't have the gas to get there," Thurmond says.
For now, Thurmond is thinking pragmatically. On his first day out of San Quentin the basics are his main concerns: finding a job, getting money for food and gas, and a place to shower. "I'm pretty resourceful," he says with no hint of pity. "I know a few places where I can shower."
Alex Liu contributed to this story.