Assessment of health care utilization, perceptions and needs for individuals released and soon-to-be released from New York State Prison: Focus Group Findings

Objective: Conduct a needs assessment of access to and utilization of health care services after release from incarceration in New York State prison facilities. Background: Approximately 26,000 men and women are released each year from the custody of the New York State Department of Correctional Services (DOCS). This population is disproportionately burdened with higher mortality rates post-release as well as communicable diseases and chronic mental and physical health conditions but often leave prison with no clear plan or support for obtaining needed health care. We investigated the barriers and facilitators to accessing health care that individuals experience after release from prison. Methods: We conducted 5 focus groups (totaling 20 males and 14 females) with people who had been recently released from a New York State prison or were currently incarcerated. The focus groups averaged 90 minutes each and a brief written, demographic survey was completed by each participant. The facilitators used a protocol of open ended questions to help investigate experiences, barriers/facilitators, patterns of utilization, etc. around accessing health care services. Results: Almost all participants experienced difficulties in accessing health care services. Individuals with chronic illnesses seemed to have the highest rates of utilization and were most likely to be overwhelmed in the process of accessing care. Individuals reported having competing needs that are sometimes prioritized before health care, including employment and housing. Participants also reported barriers obtaining insurance coverage for themselves and their family (particularly Medicaid), finding a provider, booking appointments, traveling to the provider, dealing with long wait times, meeting paperwork requirements, payment, and customer service. Discussion: Findings highlight the lack of information and assistance available in accessing health care for returning individuals. Timely access to Medicaid post-release has a profound impact on this population's ability to acquire services. Some models and supports are available through community-based organizations; however, the high demand and lack of knowledge and awareness seems to be a barrier to these services. Through facilitating Medicaid enrollment, sharing information and skills to navigate the health care system, and creating linkages to care, we can potentially improve the health of these individuals and their communities.