When Mercedes Smith (above) first came home from prison, she was able to sign up for Medicaid. Then she got a part-time job, which pushed her over Medicaid’s low-income guidelines. Unable to afford insurance even after getting a second part-time job, Mercedes has gone without health care for the past three years. When she needs urgent care, she goes to the emergency room. Otherwise, health care is a luxury she can’t afford.

Chart from the State of Women of Color in the United States report.

Mercedes is not the only person in this Catch 22 situation. According to a new report by the Center for American Progress (PDF), women of color account for more than half of uninsured women in the United States. Mercedes, who is African-American, is part of the one in four African-American women who are uninsured. One in four Asian-American women are also uninsured and more than one-in-three Latinas also lack health care coverage.

How will the Affordable Care Act (ACA) change this? The U.S. Department of Health and Human Services predicts that more than 8.5 million women of color will gain the ability to access affordable or subsidized health care through the Health Insurance Marketplace, including 4.6 million Latinas, three million African-Americans, and 970,000 Asian-Americans.

Chart from the State of Women of Color in the United States report.

The recent Center for American Progress report also discusses the disproportionate poverty and incarceration of women of color. African-American women are three times more likely to be incarcerated than white women and Latinas are 69 percent more likely. (The report does not discuss rates of incarceration for Asian-American women.) While the report examines the disproportionate lack of health care coverage among women of color as well as their disproportionate rate of incarceration, it does not address the intersection of these two problems and the implications the new healthcare law may have for those who are caught in that intersection.

The ACA does not extend to the nearly 2.4 million people behind bars, who continue to rely on already-existing (and frequently inadequate) services. However, policymakers and officials who work in prison health services are hopeful that the ACA—and Medicaid expansion—will help people leaving jail or prison overcome barriers to outside medical care.

A handful of systems have people on staff at prisons and jails to help enroll people in public healthcare programs as they get out. At a recent two-day symposium on the ACA and the legal system, Dr. Kathleen Maurer, director of health services for the Connecticut Department of Corrections, stated that eighty to ninety percent of the state’s approximately 17,000 people in jails and prisons are eligible for Medicaid. The Department has a small staff that helps people who are slated for release to enroll in Medicaid.

However, not every state prison system has Connecticut’s across-the-board practice. At the same symposium, Mercedes Smith noted that at New York’s Queensboro Correctional Facility, a men’s minimum-security prison and residential treatment facility, reentry staff assist men in filling out applications for Medicaid. In contrast, women returning home from New York State prisons have no similar support; they are left on their own to navigate applying for Medicaid or health care.

New York City’s jail system (which is under the control of the local Board of Corrections and not the state prison system) also has a staff devoted to discharge (or post-release) planning, focusing mainly on assisting people with HIV or mental illness. However, of the 600 people who are arrested and cycle through the jail each day, more than two-thirds have their charges dismissed once they see a judge. Although EMTs do a perfunctory medical intake when they first arrive, they don’t ask questions asked about insurance or provide guidance on how the person might access Medicaid or other coverage. For those released at arraignment, there is no discharge planning or support. The New York City Department of Health has been working with several partner organizations to enroll people in Medicaid when they first see the EMTs, but the discussions have been happening for two years with no plan yet in place. Meanwhile, nearly 400 people walk out of court each day with no more access to health insurance than when they were arrested 24 hours before. That’s a big missed opportunity to make access to healthcare more possible for the exact people who often lack it.

The new healthcare law could be a big help to women coming home from jail or prison— but only if they can access it. As of last Tuesday, Mercedes Smith was still unable to access the ACA website. She recalled her friend, who returned home from prison with Hepatitis C. Lacking insurance, she was unable to obtain health care and died. “My biggest fear is that, when I do get insurance, I’ll find out that I do have something and it will be too late for the doctors to do anything,” said Smith.