People leaving Maryland prisons and state-run Baltimore jails often do so with complex medical needs, ranging from substance use disorder to hypertension and diabetes.

For more than a decade, a team of navigators at HealthCare Access Maryland have worked across the state to connect those returning citizens with health care access, usually through Medicaid coverage.

People who enter the prison system or jail for more than a year are booted from their Medicaid coverage when they are not able to re-apply, said Traci Kodeck, the CEO of HealthCare Access Maryland.

The group recently announced a five-year partnership with Centurion Health, the state’s new medical vendor for its correctional facilities, to help the company meet its requirement to enroll people with health care insurance before they are released from jail or prison.

Research shows that formerly incarcerated people who have Medicaid coverage upon their release are more likely to receive timely health and mental health care.

Kodeck said that she also believes it is instrumental in preventing people from cycling back into prison or jail.

“We believe that access to health care is critical to reduce recidivism,” Kodeck said. “And it’s a human right.”

But changes to how the federal government funds Medicaid could have an impact on the group’s work.

Republicans in Congress are moving forward with plans to cut government spending, and Medicaid — which is jointly funded by the federal and state governments — is on the chopping block.

Congress could shift some of those costs to states. One estimate puts Maryland’s potential loss at close to $1 billion per year — money that the state doesn’t have, given an already tight budget picture. What that may mean for people who use Medicaid remains to be seen.

Kodeck said the potential funding cuts have added new uncertainty into the mix. Until the state budget is finalized, she said, how that might materialize is hard to predict.

“We’re in limbo,” she said. “We’re just kind of waiting. Medicaid is a huge portion of our budget — about 90% comes from the federal government in some capacity."

The Maryland Department of Public Safety and Correctional Services said in a statement that the agency recognizes that health care “is a crucial factor in reducing recidivism and promoting public safety.”

“This initiative strengthens our commitment to preparing individuals for successful reentry by addressing health disparities and ensuring continuity of care post-release,” corrections secretary Carolyn Scruggs said.

Vincent DeMarco, president of the Maryland Health Care For All Coalition, said that people returning from prisons and jails are “especially in need of health care coverage because they’ve got so much going on.”

“They have to try and find new jobs, get back into the community,” he said. “It’s critical that people have the health care coverage Medicaid provides while they get their lives back together.”

Individuals earning up to 138% of the federal poverty level, about $20,000 per year, qualify for Medicaid coverage in Maryland, DeMarco said. He cited a late 2023 report showing that, with Medicaid expansion, Maryland’s uninsured rate dropped from 13% to 6%, and the state averted $460 million in uncompensated health care costs.

“Had that been spent by the hospitals, it would have gone into our insurance premiums, which is a hidden health care tax,” DeMarco said.