California prisoner Richard Kamka gets help applying for Medi-Cal before he is paroled. (Julie Small/KQED)
California prisoner Richard Kamka gets help applying for Medi-Cal before he is paroled. (Julie Small/KQED)

By Julie Small

Of the roughly 40,000 people California state prisons will parole this year, only a fraction can rely on income or jobs to sustain themselves. The majority will hit the streets penniless, and often in poor health. For them, immediate access to low-cost or free health care would be a big help.

So, now that federal health reforms have made most parolees eligible for Medi-Cal — California’s version of Medicaid — prisons are doubling their efforts to enroll them.

On a recent visit to the California Medical Facility in Vacaville, a pair of counselors helped dozens of inmates fill out paperwork for Medi-Cal shortly before their scheduled release.

Richard Kamka, 64, said he welcomed the help. Kamka has been locked up for nearly a decade after being convicted of making criminal threats, possessing illegal drugs and stalking. He will be paroled to Butte County this fall. Unless prison doctors remove his cataracts, Kamka said, he won’t be able to work.

“I need to have my eyes so I can at least, you know, do something,” he said.

Before the Affordable Care Act took effect, California’s Department of Corrections and Rehabilitation (CDCR) could enroll only about 15 to 20 percent of parolees in Medi-Cal. That’s because only low-income parents, pregnant mothers and disabled people used to qualify. Now anyone who earns less than $15,000 annually can sign up.

The department’s Robert Storms estimates that 90 percent of parolees will be eligible under the new criteria. Storms wants them to walk out of prison with a Medi-Cal card in hand — and a medical provider already selected.

“What this does is provides an opportunity for immediate access to care,” Storms says.

Having Medi-Cal will allow parolees to enroll in programs to treat drug and alcohol addiction — something 75 percent of them struggle with. They’ll also be able to get preventative care and treat ongoing chronic conditions and serious illness. That’s significant in California, where nearly a third of inmates have some kind of condition that requires ongoing medical care.

Storms believes having access to treatment could reduce the risk that parolees will commit new crimes.

“They’re becoming more responsible for their own health and achieving things that helps them become independent, productive and hopefully working towards a better life,” Storms says.

CDCR officials estimate that enrolling parolees in Medi-Cal will cut parole costs by millions of dollars a year. Prison officials shifted $2.4 million in projected savings from a budget for psychotropic medicines for parolees to nearly double the number of benefit counselors. But it’s taken corrections longer to hire and train them than anticipated. One reason: They lost counselors when one of the counties providing that service quit the business.

For now, California prisons can screen only 40 percent of inmates for Medi-Cal. Corrections officials are working with counties and community groups to enroll the other 60 percent after they get out of prison. But there’s consensus that waiting to do that is risky.

“If they have the ability to go straight to a medical provider like us and be seen — it would be huge,” says John Holman of Healthy Oakland. The nonprofit offers parolees low-cost medical and mental health treatment.

Holman says former prisoners who apply for Medi-Cal when they get out wait months to get coverage. In the meantime, they still need care. Most of them take multiple drugs for chronic conditions like diabetes and hypertension. Many rely on medications to treat anxiety, depression and psychosis.

“If someone has all these conditions and they see that they can’t get any help, they know they can self-medicate,” Holman says.

Or they can turn to emergency rooms and rack up large bills they can’t afford to pay. That’s how 55-year-old Leonard Johnson dealt with it.

“When they let me out of prison I didn’t have no medical for like seven months,” Johnson says.

He served 17.5 years for assault and robbery. At Pleasant Valley State Prison he caught an airborne fungal infection called Valley Fever. But when Johnson paroled to Antioch over a year ago, he lacked medication for the disease and for his diabetes. 

“I got real sick and went to the hospital,” Johnson says.

One of the biggest challenges is signing up the 27 percent of parolees diagnosed with mental disorders.

At Telecare, a national mental health service provider that treats parolees in Southern California, Senior Vice President Faith Richie says it’s hard to locate them after they get out of prison.

“They’re coming out, and essentially the minute they hit the street, they’re homeless — unless they have a family member or friend who will take them in,” Richie says. “They don’t have income. Once they’ve burned through their gate money, they’re in the wind.”

Richie says Telecare’s staff helps patients enroll in Medi-Cal and will meet them under freeway bridges to do it. But tens of thousands of inmates paroled to other parts of the state each year won’t get that kind of individual help.

At the California Medical Facility, inmate Richard Kamka says knowing that he can go to any Medi-Cal provider in his county when he gets out calms at least one of his fears about paroling.

“It’s a scary thing,” Kamka says. “I mean it’s a happy thing, but then you’re going out there, going, ‘Hey where’s my breakfast this morning?’”

CDCR’s Robert Storms says that by spring 2015, the department will be able to help all paroling inmates apply for Medi-Cal.

For now, California’s prisons are focusing their Medi-Cal enrollment efforts on inmates with mental disorders, serious or chronic diseases and disabilities.

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