By Andrea D. Jones, MD
Since 1989, there have been 1,569 exonerations as documented by the University of Michigan Law School’s National Registry of Exonerations. Ex-inmates have been shown to have a higher rate of certain diseases upon release including asthma, hypertension, tuberculosis, diabetes, hepatitis and HIV/AIDS. Addiction and mental illness is also higher in ex-inmates compared to the general population. A 2007 study of Washington State ex-inmates, published in the New England Journal of Medicine, revealed that the higher incidence of the illnesses listed above and the lack of treatment after release contribute to the high mortality rate among former prisoners. The study found that in the first two weeks after release, the rate of death among former inmates was more than 12 times greater than the rate for the general public. Drug overdose and heart disease were the leading causes of death for ex-inmates. Unfortunately both the innocent and guilty share similar experiences in the prison system. One can intuitively argue that exonerees suffer the same fate as their ex-inmate counterparts.
Current Status of Health Care for Exonerees
It was widely believed that the Patient Protection and Affordable Care Act (ACA) would be the answer to the immediate health care needs of exonerees in all 50 states. No longer would Medicaid only be available to pregnant women, children and the poor with disabilities. National Medicaid expansion would be available for all poor citizens in the United States. The 2012 United States Supreme Court ruling in National Federation of Independent Business v. Sebelius allowed states to opt-out of the ACA’s Medicaid expansion requirement, therefore ending hopes that all U.S. citizens would have access to health care coverage. As a result, the hope that all exonerees would have access to health care immediately after release was also lost. Thus far, approximately twenty-two states still have not expanded Medicaid for their poor populations. The exonerees in these states, if they do not qualify for insurance in the marketplace, have to seek alternative sources for their health care needs. These sources include emergency rooms and community health clinics. The ACA does include a provision that expanded funds for community health centers. Unfortunately, the majority of community health clinics provide general primary care services only. The goal is that community health clinics will also provide referral services for additional specialty care, if needed. The reality is that it is difficult enough to get specialists to treat patients with Medicaid, let alone patients without Medicaid. Certain medical screenings, including cancer screenings, are recommended for certain age groups by several medical associations. It is essential that exonerees have access to medical care given their increased risk of certain diseases due to incarceration. Exonerees should also have access to routine health and cancer screenings as deemed necessary.
It is imperative that aftercare groups and members of the innocence network, as a whole, establish partnerships with university medical centers affiliated with innocence projects across the country in an effort to establish immediate medical and mental health services for recently released exonerees. These services are especially necessary in states that have not yet expanded Medicaid. Given the small numbers of exonerees, this initial care should not be a burden to a state’s local medical community. Doing so would help ensure the safety of the exoneree, their families and the community as a whole, until more permanent health care services can be established.
Since exonerees do not receive traditional parole services similar to their ex-inmate counterparts, it is the responsibility of aftercare groups to provide newly released exonerees with information regarding health care services and recommended health guidelines. This assistance should also include establishing partnerships with medical centers to provide immediate post-release medical and mental health care. Our goal at Life After Innocence is to assist aftercare providers across the country with the information necessary to provide their clients with information regarding the health risks of being incarcerated, the reality of the current health care market and making informed health care decisions.
 University of Michigan Law School National Registry of Exonerations, https://www.law.umich.edu/special/exoneration/Pages/about.aspx
 Ollove M. Ex-Felons Are About to Get Health Coverage, The PEW Charitable Trusts, April 2013; http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2013/04/05/exfelons-are-about-to-get-health-coverage
 Binswanger, et al. Release from Prison – A High Risk of Death for Former Inmates. NEJM 2007;356:157-65
 NFIB v. Sebelius, 132 S.Ct. 2566 (2012)