When Darryl is out of touch, Mr. Sanders goes to his door. “I don’t want to see you dead because you haven’t checked your damn blood pressure!” Mr. Sanders chides him.

The community workers serve as mentors. “You’re building that rapport with someone who has walked the same walk and been successful,” said Nicole Sullivan, the re-entry director for the North Carolina Department of Public Safety. It is spending $600,000 to expand the Transitions model, which started as a grant-funded pilot in Chapel Hill, across the state.

Prisons and jails are constitutionally mandated to provide health care, but that responsibility ends upon release. For those getting out, the first two weeks are particularly perilous. A study in Washington State published in The New England Journal of Medicine in 2007 found that former inmates are 12 times likelier to die than other state residents in the two weeks following their release, especially of lethal overdoses, a risk factor confirmed by later studies.

Access to health care can be a roll of the dice: Medical discharge plans vary from nonexistent to prisons with dedicated planners who coordinate health insurance and medical appointments before release. Most of the 32 Medicaid expansion states suspend, rather than terminate, coverage for inmates who previously had it and send them out with an insurance card when they leave. Ohio and Indiana, among others, have programs to enroll inmates in Medicaid prior to release.

Preventive care is often lacking in the disadvantaged neighborhoods that are home ground for many inmates, the vast majority of whom are black and Hispanic.

“There’s mistrust combined with a lack of knowledge about navigating the health system,” said Joseph Calderon, a Transitions worker. “In our communities, people are taught how to take care of their cars but not how to take care of their health.”