Jayne O'Donnell

USA TODAY

NEW ORLEANS — Here in the state that imprisons more of its citizens per capita than any other, the long-awaited July 1 launch of expanded Medicaid coverage will give those leaving prison a chance to at least continue what many describe as spotty treatment for the conditions that plagued them while behind bars.

These include Dolfinette Martin, who has been out of prison for four years with no health coverage or medications to control her bipolar disorder, and Maryam Henderson-Uloho, who spent more than 12 years in prison, and who says she and other inmates seldom sought medical treatment because prison officials would write them up for "malingering" when they did.​

Both women and other formerly incarcerated Louisiana residents describe prison and reentry as psychologically crushing for most people. Without access to health care when they leave prison, it's often only a matter of time until many prisoners return. The imminent expansion at least gives many hope they can get some help for problems that helped send them to prison in the first place.

"It’s unconscionable to just drop them off at a Greyhound bus station," says physician and Louisiana Secretary of Health Rebekah Gee. "They‘re just going to come right back."



But without Louisiana's new Democratic Gov. John Bel Edwards' decision to extend Medicaid benefits to everyone below 138% of the federal poverty limit, only the rare person leaving prison in the Deep South had health care. They had to either have a job that offered benefits they could afford or earn more than $33,000 for a family of four and be able to afford it with the subsidies available on the federal insurance exchange. Those earning less than that relied on emergency rooms, which would only stabilize them, or a network of sliding-scale clinics that have long waits and few prescription options.

Gee met with Corrections Secretary Jimmy LeBlanc about post-prison health care the day before Edwards held the first meeting of his new prison reform group on June 17. Expanding Medicaid was Edwards' first official action, but he told reporters recently that he's determined to also shed the distinction of being the incarceration capital of the industrialized world while he's in office.

President Obama made access to health care for those leaving prison a priority in April when he clarified that Medicaid coverage was available to those living in halfway houses and encouraged states to help enroll prisoners for Medicaid, if they are eligible, before they leave prison.

Most of those without Medicaid are the working poor

As welcome as Louisiana's expansion is to patients and hospitals, questions remain as to how the cash-starved state is going to pull this off. The state legislature wouldn’t approve even a dollar of funding for Medicaid enrollment, so Edwards isn’t sure how he will raise reimbursement for doctors in hopes of getting them to take new patients. And there will be no shortage of patients as even without funding, state officials managed to sign up about 225,000 people as of Friday.

Although Edwards distinguishes himself in the Deep South for expanding Medicaid, his state shares the poverty and poor-health of his neighboring states. Along with incarceration, Louisiana has the highest rate of obesity and is among the worst for every other poor-health measure in the United States.

The 2016 Global Nutrition Report, out this month, says it costs a household with just one obese person 8% more for health care a year. When families don't have money to pay for insurance or health care, it's the hospitals — and, ultimately, taxpayers — who pick up the tab.

Here, these people often wind up in the emergency room of University Medical Center, which would treat them for free and deal with the costly and "late complications of common disease (that) you just don’t see in an insured population," says Jennifer Avegno, a physician and associate program director at the LSU Health New Orleans department of emergency medicine. UMC physician and chief medical officer Peter DeBlieux describes these as blindness, dialysis, amputations and ultimately heart attacks for those who aren't getting treatment for their diabetes.

If you need a colonoscopy that isn't an emergency, you have to do without it because the hospital has so many emergency screenings to do. It will be able to hire more doctors and other staff to treat these patients when there is a funding stream, hospital officials said. DeBlieux describes the process patients without insurance have to go through to get care as the "fiery hoops of hell."

That's a fitting description of life behind bars for some. Among the health challenges:

• At the maximum security Louisiana State Penitentiary, also known as Angola, you could literally see people losing their minds in front of you, says Lawyer Winfield, Jr., who spent 30 years in prison, 20 of them at Angola. There, despite multiple trips to a particularly harsh punishment area of the prison known as Camp J, Winfield says he managed to keep his sanity. But he could always spot the telltale signs his fellow inmates were starting to crack: They'd stop grooming themselves and then, often, stop wearing shoes. Most chilling was when a guard showed him on a video camera that a childhood friend from the projects had gotten so bad he was eating his own excrement out of the toilet.

• In his new book Called to Heal the Brokenhearted, Episcopal priest Barnwell tells the story an Angola inmate who dealt drugs including heroin and cocaine while serving his life sentence and terrorized other inmates who wronged him by breaking the fingers on one or both hands and stepping on their feet hard enough to break their arches.The man later found God and began ministering other prisoners. Barnwell, whose book is about the prison ministry Kairos at Angola, is particular troubled by the treatment of inmates in Camp J, where inmates are confined to their cells for 23 hours a day and an inmate he befriended hung himself in April - the same day as another did the same.

More than a decade after release, they all come back

• Body contact of any type was banned at the Louisiana Correctional Institute in St. Gabriel, but Henderson-Uloho said some women felt so hopeless that they would knowingly have sexual relations with other women who were HIV positive. Henderson-Uloho says prison and reentry is particularly hard for women, who are seen as the glue keeping their families together. She watched how traumatized other inmates were when they learned of the imprisonment, rape and death of children, all of which she experienced personally.

New-found Medicaid coverage is certainly not a panacea for all that ails Louisiana's poor, whether or not they've ever done time. Martin, who now works as lead organizer for the non-profit Voice Of The Ex-offender (VOTE) here, describes a "deep untouchable hurt" facing women in prison. A former crack addict, she says she was self medicating to treat her depression and anxiety and stealing to fund her habit.

Health Secretary Gee says Medicaid expansion and the state's new goal of "treating mental illness and addiction rather than incarcerating" those who suffer from either combine to make it "a new day."

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