How Can We Support Youth Returning Home After Incarceration?

For young people returning to their communities after incarceration, reconnecting with healthcare can be a matter of urgency. Studies suggest that the rate of opioid overdose was more than twice as high during the first two weeks after prison release compared to later periods, highlighting the vulnerability of the transition back into the community. BMC pediatrician and health services researcher Alison Galbraith, MD, MPH, is studying whether a new federal Medicaid policy can help young people access healthcare, including substance use support and behavioral health services, during that critical period. This research draws on BMC’s range of expertise in this area, including pediatrics, general internal medicine, and psychiatry. 

The policy, part of the 2023 Consolidated Appropriations Act, requires state Medicaid programs to provide certain health screenings and diagnostic services to eligible justice-involved youth around the time of their release, as well as targeted case management for the 30 days before and at least 30 days after release. The goal is to help young people connect with health and relevant support services as they return to their communities. 

Galbraith and an interdisciplinary team of researchers will examine how the policy is working in Oregon using Medicaid, healthcare, incarceration, hospital, and vital records data. They hope the findings will help states and healthcare systems understand how to better connect young people coming out of incarceration with the care they need.  

In this Q&A with HealthCity, Galbraith shares what drew her to this research and how her work could inform policies that help young people avoid falling through the cracks after incarceration. 

HealthCity: What does your health policy research hope to accomplish? 

Alison Galbraith, MD, MPH: The policy we’re studying focuses on young people under 21 who are coming out of incarceration. Historically, when you were incarcerated, your Medicaid benefits were suspended, and then you had to figure out how to get back onto Medicaid when you were released, among all of the other things you were trying to figure out. 

Young people often have a lot of challenges when they return to their communities from incarceration. Many have substance use or mental health needs and need insurance to be able to access support services. The period right after incarceration is also a particularly vulnerable time for overdose, especially for people with a history of substance use. 

“Ultimately, I hope this research can help us build a system where young people aren’t falling through the cracks at a really important point in their lives.” 

Alison Galbraith, MD, MPH, boston medical center

The idea behind this policy is to make that transition smoother, and I think it’s a really promising policy. However, there are a lot of logistical challenges to actually implementing it. We want to understand how it works, where it works well, and where there are barriers. 

In our study, we’re looking at Oregon because we have access to a rich set of data. We can look at Medicaid data along with healthcare and hospital data, incarceration records, and vital records, including information about overdose deaths. We want to understand whether the policy helps people reconnect with healthcare and whether that improved access is associated with fewer substance use-related emergency department visits and hospitalizations, fewer overdose deaths, and lower rates of reincarceration. 

Ultimately, we want to provide evidence that can help both healthcare providers and policymakers figure out how to better support young people during this transition. 

HC: What inspired you to pursue research on health policy? 

AG: I’ve always liked policy. At one point I thought I should be a lawyer, but I like data and solving problems and I believe that our policies should be informed by evidence.  

Additionally, in health policy research you can potentially affect a lot of people. In the clinic, I can affect one person, and that’s very meaningful. But for me personally, there’s something really compelling about studying and impacting policies that can affect so many people’s lives. 

HC: What are the broader impacts of your health policy research on patients and families? 

AG: Ideally, someone should be able to come out of incarceration and have a way to get connected to Medicaid and to the healthcare they need. There should be people who can help connect them to services and help with case management. That’s really important because it’s hard to expect someone who’s just coming out of incarceration to navigate all of these systems on their own. Ultimately, I hope this research can help us build a system where young people aren’t falling through the cracks at a really important point in their lives. 

If we can learn how effective this policy is and understand what makes implementation successful, maybe we can think about whether similar approaches could help other populations. 

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This interview has been edited and condensed for clarity and length.