Evelyn Ruiz needed to find a place to live. Walking out of prison in 2011, she was 26 years old—a shy, softspoken young woman struggling to overcome a meth addiction. Since age 14, she had depended on Medicaid, the federal health-care program for low-income people, to treat a mental disorder—but her coverage was gone. (New Mexico, like many states, terminates an inmate's Medicaid enrollment after extended time behind bars.) Her parole restricted her to Albuquerque, far from her home in Las Cruces. She had no friends, no family, no idea how to get around. She was on her own.

Ruiz' predicament is far from unique. In 2009, the conservative Rio Grande Foundation put the number of New Mexico prisoners with substance-abuse problems at a stunning 85 percent (more recent data were not available as of press time). Many others suffer from mental disorders. When it comes time to be released, most leave without health insurance.

"They release you and expect you to figure it out," says Brea Hayes, a board member at Precious Gifts, one of two structured, transitional housing options in Albuquerque for women leaving prison with addiction. "It's like, 'Adios! You're free. We'll see you back here in a couple months.'"

Without health coverage, ex-offenders like Ruiz face serious challenges. Many of them become a statistic—one of the nearly 45 percent who reoffend, or worse, another overdose death or suicide. According to a 2007 article in the New England Journal of Medicine, during the first two weeks after release, ex-offenders are roughly 130 times more likely than the rest of the population to die from a drug overdose.
And last June, the New Mexico Corrections Department reported that, among ex-offenders who return to prison within three years, it takes an average of less than a year.

"I've seen a lot of people go back to prison because they haven't been given help," Hayes says.

But a new bill—as of press time, still awaiting Gov. Susana Martinez' signature to become law—seeks to change that.

Senate Bill 65, sponsored by state Sen. Gerald Ortiz y Pino, D-Bernalillo, would require the state's Human Services Department to assess inmates' eligibility for Medicaid and help them get coverage before they're released. It would also require HSD to suspend Medicaid coverage, rather than terminate it completely, for inmates who are expected to be incarcerated for less than a year.

Advocates for the bill, which passed the House on a bipartisan 49-14 vote, say the policy will help thin the startling number of state prisoners who overdose, commit suicide or return to prison after release—while slashing state budget costs in the process.

"We can cause a sea change in the reduction in overdosing, suicide, recidivism and the criminal rate in this state," says Harris Silver, a drug policy analyst and lobbyist for the bill.

Next year, under Obamacare, Medicaid coverage will expand to include another 200,000 or so New Mexicans. (Martinez approved the state expansion in January.) Nationwide, "nearly all inmates will qualify for Medicaid" under the expansion, according to a February 2012 report by the Coalition of Correctional Health Authorities. And as Medicaid expands, the federal government will pick up the lion's share of the cost.

Under SB65, HSD would be required to coordinate with NMCD and county jails to screen for newly eligible prisoners entering their facilities. A prisoner would either retain suspended coverage, if already enrolled, or receive assistance getting coverage before release. 

By moving former inmates out of emergency rooms—and prisons, if they reoffend—and into the Medicaid system, Silver estimates New Mexico could save $40 million in the first year alone. That may not be far off: After implementing a similar system in 2010, North Carolina saw its medical tab for prisoners plummet from $90.4 million to $48 million.

"NMCD views the idea as a way to reduce recidivism while maximizing the cost savings provided to the state through Medicaid expansion," NMCD Public Affairs Director Alex Tomlin writes in a statement emailed to SFR.

Not everyone agrees. HSD, while supporting the bill "in concept," opposes what it calls "prescriptive, inflexible legislation."

"SB65 is not needed at this time," HSD Communications Director Matt Kennicott writes in an email. "HSD has the ability to help train correctional facility staff and detention facility staff in how to help their inmates and detainees on how to apply for Medicaid."

But for state Rep. Mimi Stewart, D-Bernalillo, that's not enough. She abandoned similar legislation back in 2005, when HSD promised to enroll inmates on its own.

"I'm frustrated—that was eight years ago, and nothing has been done," she says. "This is a fairly easy thing to do, to help these folks. I don't understand. Why haven't [they] done it before?"

Tomlin writes that NMCD "is already working with" HSD to enroll eligible offenders in Medicaid before they're released, and that the screenings will continue "with, or without, legislation."

Yet Ruiz never saw the benefits of that work. "Absolutely not—no classes, no information," she says. "If there was, I would have totally taken advantage of it." Just before her release, Ruiz did find a home—but not through her caseworker or her prison counselor.

"I had to research everything on my own," she says. "It was word of mouth from other inmates that helped me find Precious Gifts."

And 18 months later, she's still waiting to get back on Medicaid. She's been living clean—a requirement at Precious Gifts—and is enrolled part-time at Central New Mexico Community College. She dedicates one full day a week to crisscrossing Albuquerque on the city bus for appointments she hopes will help her regain coverage. In the end, she knows her mental disorder is holding her back from finding a job and fully moving on.

"It's very hard," she says. "Because I know how much easier it is with Medicaid."