Medicaid expansion is a vital piece of reentry for Oklahomans leaving incarceration

Oklahoma prisons are constitutionally required to provide medical services to the more than 21,000 people in their custody. As those individuals are released back to their communities, they are at risk of losing health care coverage unless insurance is available, leaving them with potentially untreated chronic illness or mental health needs. Most people leaving incarceration have little to no income, making them eligible for Medicaid upon release. Therefore, Medicaid expansion in Oklahoma plays a key role in ensuring continuity of care leaving prison and jail, contributing to healthier communities and reduced recidivism. 

In the year since Medicaid expansion has taken effect, the Oklahoma Department of Corrections (DOC) has taken necessary steps to start the process of enrolling every eligible person at the time of release from custody. This includes educating people about the program and providing materials on how to enroll once they are out of custody. In the coming months, this process will be streamlined through a data sharing program that will ultimately make enrollment automatic for eligible Oklahomans on release. Even with these systems not yet online, Medicaid expansion has had a major impact on the lives of people leaving incarceration across the state.

Access to health care at the time of release will improve the lives of justice-involved Oklahomans

Oklahomans exiting incarceration need health care. People detained in prison and jail face disproportionately high levels of chronic illness and mental health needs. In Oklahoma, 38 percent of people who are incarcerated have a “serious mental illness,” and a large portion of people in prison have ongoing medical needs that require treatment. Those needs include high rates of asthma, hypertension, and diabetes. Further, Oklahoma prisons face high rates of hepatitis C with the number of infected people doubling since 2013

It is vital to ensure medical coverage continues during reentry, providing necessary medication and services with no break in care. One in 70 people leaving prison are hospitalized within a week of release, and 1 in 12 are hospitalized within three months — far higher rates than the general public. Medicaid expansion — that is, prompt and affordable access to needed care — may have reduced recidivism by as much as 13 percent. When formerly incarcerated individuals have stable health access upon release, and a successful transition back into their community, their health needs are more likely to be met and recidivism falls. 

Improvements in state systems will make enrollment even easier during reentry

Understanding Medicaid’s vital role in reentry and in reducing recidivism, the state Department of Corrections has begun creating a system to ensure as many eligible people are enrolled in the program as possible at the time of their release from custody. Currently, this means educating soon to be released individuals about Medicaid, their eligibility, and the importance of the program as they transition back to their communities. 

Moving forward, DOC has started the process of streamlining and linking their computer tracking programs to various state agencies, including the Oklahoma Health Care Authority, Oklahoma’s Medicaid agency. Through this system, DOC will be able to identify individuals 30 days before release, pre-enroll them with SoonerCare if eligible, and then alert the Health Care Authority to begin benefits within days of their release from state custody. In fact, the first pilot program at some DOC facilities will come online later this summer, with potential for a widespread rollout soon after. This reflects nationwide best practices and aligns with recommendations by advocates and stakeholders. These efforts will contribute to healthier communities, increase public safety, and save lives. Oklahoma leaders and lawmakers can increase investments into these systems through budget appropriations and staffing considerations.  

While health care access is a good start, we need to do more to help Oklahomans leaving incarceration  

Most incarcerated Oklahomans will return to our communities after their time in custody. Helping Oklahomans leaving prison enroll in Medicaid is a good start in setting them up to succeed, but keeping people from returning to prison and jail requires broader support systems. This includes assistance in obtaining a birth certificate and proper ID, access to housing services, and connections to employment or job training. Health care access is only one part of the incredibly complex reentry and transition process. Medicaid expansion, combined with meaningful investments by the DOC into systems that ensure enrollment, will lead to better outcomes and safer communities for everyone.


David Gateley joined Oklahoma Policy Institute in August 2021 as the Criminal Justice Policy Analyst. Raised in Oklahoma, David received his B.A. in Political Science from the University of Oklahoma. After graduation, he earned his J.D. from the University of Oklahoma College of Law, where he wrote on topics such as the abolition of cash bail and the effectiveness of restorative justice. David is a member of the Oklahoma State Bar. He is dedicated to reforming the criminal legal system away from mass incarceration. He lives in Oklahoma City.

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