Zachary R. Ruppel, policy analyst at JustLeadershipUSA (JLUSA), lives in Columbus and advocates for restorative reentry practices and ending the permanent punishments of conviction.
As new Medicaid work requirements take effect, Ohio leaders face a choice that will shape whether thousands of people returning home from incarceration successfully rebuild their lives – or fall through the cracks.
For formerly incarcerated Ohioans reentering their communities, access to healthcare isn't a luxury.
It’s often the difference between recovery and relapse, stability and crisis.
I know what's possible because I've experienced it.
Before my release from prison, I took advantage of Ohio’s substance use disorder 1115 waiver and enrolled in recovery programming
that connected me to community-based services and scheduled my first treatment appointment months before reentering. That continuity gave me the foundation I needed to not just survive but thrive.
How Ohio implements these new rules by the Jan. 1, 2027, deadline will determine whether Medicaid remains a bridge to successful reentry or becomes another barrier.
What's at stake for those leaving prison
Nationwide, people leaving prison have disproportionately high rates of complex medical issues, infectious disease and chronic illnesses, including substance use and mental disorders.
The first weeks post-release are especially dangerous as people coming home from prison are 13 times more likely to die than the general population and 129 times more likely to die from overdose.
Medicaid is one of the most effective tools for preventing such tragedies. There's widespread recognition of this, evidenced by dozens of states seeking federal Medicaid Reentry 1115 waivers. With approved waivers from the Centers for Medicare & Medicaid Services, states can leverage federal Medicaid dollars for pre-release health services and transitional care for up to 90 days before release. On July 1, Ohio indicated its intent to submit one.
But the new federal work requirements threaten to undermine such progress. Data shows such rules often lead to massive coverage losses, not because people refuse to work, but because they struggle with the associated red tape.
A compounded struggle for formerly incarcerated people
Not only do they face pervasive stigma and discrimination, but their limited work histories and often unstable housing and unreliable transportation, further complicate their road to steady employment.
Nationally, unemployment among this population hovers around 27%, and those who do find work are regularly forced into temporary or inconsistent jobs, making satisfaction of the requirements difficult, to say the least.
Although federal law provides a three-month post-release exemption from the requirements, that timeline is insufficient as it takes an average of six months for formerly incarcerated people to secure work, with many taking far longer.
The result: eligible Ohioans lose coverage because the system fails to account for the challenges of reentry. And the consequences extend far beyond individuals. Taxpayers bear higher costs as emergency room visits and recidivism increase while public health and safety decrease.
How Ohio can get it right for formerly incarcerated
Fully utilizing applicable exemptions, particularly those lasting longer than the limited post-release one, improving pre- and post-release data sharing, and identifying activities beyond employment that fulfill the requirement, such as volunteering and education, will be essential.
Ohio should also strengthen its recently proposed Medicaid reentry waiver.
The current draft is an important start but falls short of serving the needs of all reentering Ohioans. Expanding its scope will better connect reentering people in all parts of the state to vital health services and reduce dangerous gaps in care.
Ohio can comply with federal law while supporting successful reentry and protecting public well-being by thoughtfully implementing the Medicaid work rules, enhancing its proposed 1115 waiver and advancing policies grounded in the realities of reentry.
When people come home connected to care and support, all Ohioans are stronger for it.
Zachary R. Ruppel, policy analyst at JustLeadershipUSA (JLUSA), lives in Columbus and advocates for restorative reentry practices and ending the permanent punishments of conviction.
This article originally appeared on The Columbus Dispatch: Healthcare is difference between recovery, relapse for ex-inmates. I know firsthand | Opinion
