Derek Malkhassian of Albuquerque now owns a dog, a delight once rendered impossible by his severe, allergy-induced asthma. But since he enrolled in Medicaid last year, a regimen of allergy shots and surgery for a deviated septum have helped him to breathe normally, even when Willow, a Yorkie, is around.
Medicaid also covers visits to a psychiatrist, part of his conditions of release after serving a two-and-a-half-year prison sentence that ended in September. Without the coverage, he estimates he'd have paid north of $12,000 last year for all the care he's received.
Staff at the Los Lunas prison, where Malkhassian was incarcerated on a drug charge, helped him enroll in Medicaid. With an income less than 138 percent of the federal poverty limit, he qualified for the program after the Affordable Care Act expanded eligibility requirements. He wasn't insured at the time of his sentencing.
"I can't imagine being required to have that sort of treatment if they weren't willing to pay for it," he tells SFR. "Like, if I had to foot the bill, all the things I'd have to pay for as part of my conditions." Malkhassian, who now works a construction job with limited benefits, fears he'd be more likely to renege on his conditions of release and possibly end up back in prison if he had to pay for care out of pocket.
With the US Senate mulling legislation that could change federal funding for states' Medicaid programs, the future of health care for New Mexico's newly freed is less than certain. Under the proposed change, federal dollars in the form of block grants would give state governments more latitude in choosing how to spend funds, but the money would no longer be replenished by the feds on an ongoing basis. Advocates worry that a state program to help people like Malkhassian would slip down the priority list.
New Mexico legislation passed in 2015 changed the way incarcerated people retain health care before serving their sentences and after being released. The law bars people enrolled in Medicaid from being kicked off the program during their incarceration, which is what happened before. Instead, their enrollment is merely suspended if they're incarcerated longer than 30 days. Prisons then notify the state when a Medicaid-eligible person is approaching release date. That's when either enrollment or re-enrollment kicks in.
New Mexico's adult and juvenile prisons participate in the effort as well as five county jails, including those in Santa Fe and Bernalillo counties. As of last October, there were more than 4,000 inmate applications for Medicaid enrollment filed and over 3,000 requests for reinstatement of benefits post-release statewide.
Without the financial assistance, "it makes it harder to stay out of jail," state Sen. Jerry Ortiz y Pino, D-Albuquerque, who sponsored the rule change, tells SFR by phone. "People recognized that this is going to save money. … It would reduce the number of people who commit crimes again because they have mental or substance issues and didn't get treatment."
While it's too early to know whether the program has had an impact on recidivism, other analyses support Ortiz y Pino's claim. A 2004 study conducted by the Department of Justice examining recidivism among county jail populations in Florida and Illinois found that inmates with severe mental illness who had Medicaid upon release stayed out of jail longer. Several other states have implemented similar programs to New Mexico's since the passage of the Affordable Care Act.
People passing through the Santa Fe County Correctional Facility are commonly afflicted with post-traumatic stress disorder and substance abuse issues. Many also have severe mental illness, diabetes, hepatitis C and other ailments of the poor, according to Dr. Merritt Ayad, who launched and manages the re-entry program at the jail. Because people cycle through county jails at a more rapid clip than state prisons, Ayad hired a person last month to track down inmates who were released before his staff had a chance to enroll them.
"For people who were enrolled [in Medicaid], we're going to see if they went to services, and if they didn't, we'll offer to connect them to services, and we'll track whether they complete their programs," Ayad tells SFR. He says the detention center plans to create a database not only tracking which former inmates actually signed up for Medicaid but also whether they received treatment.
The Santa Fe jail's program is funded with state and federal dollars over three years, Ayad says. If it is shown to reduce recidivism, renewed funding will be more likely.
Still, a lot is dependent on what happens to health care in DC. About two-thirds of Medicaid expenditures in the state currently pay for elderly and child care. Adult primary care and, to a smaller extent, behavioral care represent smaller shares.
If Medicaid funding is changed to a block grant, says Ortiz y Pino, he fears "behavioral health would get the short end of the stick under those scenarios. … If the total amount gets a cap, and the number of elderly needs go up, and adult needs go up, then mental health cuts will maybe be 8 percent, then 6, and before you know it we'll have 2 percent for mental health."
For all the spectacle over health care in the US Congress, the stakes are clear for Malkhassian.
"I haven't researched much about Trumpcare," he says, "but I don't know what I would do without my current health care. Since I've been out I've been in the best health I've been in my life."