Health clinics will launch pilot programs to help people leaving jail find primary care

People leaving jail are at much higher risk of opioid overdose and often do not have a primary care provider. Two clinics in New Mexico are creating programs to help that population find health care as they are released from jail.

The Health Resources and Services Administration, part of the U.S. Department of Health and Human Services, awarded $1 million to Presbyterian Medical Services for a program at the Santa Fe Family Health Center and $1 million to a Hidalgo Medical Services clinic in Lordsburg. Both will use the money for two-year pilot programs.

“We’re trying to bridge that gap to access to primary care that this population struggles with when they’re discharged,” said Executive Vice President of Presbyterian Medical Services Doug Smith.

Overall, HRSA awarded $52 million to 54 community health centers across the country to improve primary care access for people about to be released from prison or jail.

Few HRSA-funded health centers have been able to work with people in jails and prisons prior to release, said HRSA Administrator Carole Johnson.

As part of the White House’s Second Chance Initiative, HRSA is also updating its policy for HRSA health centers so that it’s easier to provide services to people who are incarcerated and expected to be released within 90 days. HRSA had a de facto policy that didn’t allow health centers to provide these services easily, Johnson said.

“The health centers we fund are primarily primary care focused, and mental health and substance use disorder services have not been required as funded services in health centers,” Johnson said in a statement. “So we, the Biden-Harris administration, have really made that a priority and have been working with Congress to get more money to health centers to do mental health and substance use disorder services.”

When someone leaves prison or jail, their risk of an opioid overdose is 10 times higher than the general population, and the risk of overdose is particularly high in the first two weeks after release, according to research from Oregon State University, Oregon Health and Science University and the Oregon Department of Corrections.

A primary care connection

The Santa Fe program will build connections between health care providers and people who are incarcerated to help them transition out of jail. A medical care coordinator and a case manager will work at the Santa Fe County jail as a transition team, according to Santa Fe County spokeswoman Olivia Romo.

The proposal includes a team of peer support workers — people who have previously been incarcerated and may have similar experiences to people being released from jail, according to Smith.

Within the Santa Fe County jail, mental health and substance use disorders are the most critical health care needs, according to Romo. The Santa Fe Family Health Center offers mental health and psychiatric substance use disorder services, as well as primary care and dental services, Smith said.

In the Santa Fe County jail, 68% of the population has a history of mental health disorders compared to 21% of the general population, according to a May 2024 survey conducted by the detention center. Rates of obesity, hypertension, heart conditions, asthma and a history of infectious disease are also higher among inmates than the general population.

The people incarcerated there often have significantly worse access to health care than the general population. The survey showed that only 25% of respondents had a primary care provider, compared to 71% of New Mexico’s general population. Within the past year, only 18% had a medical visit, compared to 76% of the general population.

“Nearly 75% of individuals incarcerated at the Santa Fe County Detention Center lack a primary health care provider, often relying on emergency rooms or urgent care centers for medical needs when living in the community,” Romo said. “Many of these individuals face housing insecurity, lack of transportation, and a range of social and economic barriers that hinder their ability to heal, thrive, and successfully reintegrate into society.”

The pilot program is a collaboration between Presbyterian Medical Services, the Santa Fe County Detention Center and The Life Link, a nonprofit that helps people with mental health services, substance abuse support, housing and transportation. It should begin operating early next year, Smith said.

Health care in Lordsburg

The Hidalgo Medical Center proposal also focused on case management, but is more specifically focused on the 72 hours after release when overdose risk is the highest, Johnson said. Hidalgo Medical Center will offer wraparound services with intensive support and preliminary screening.

The model will also focus on individuals’ goals, like remaining on medication and meeting requirements for parole, Johnson said.

“People reentering the community from incarceration are particularly vulnerable to poor health outcomes and mortality. We can change that if care and services are more closely connected to the reentry experience,” Johnson said .