Generally, mental health care, substance abuse services, and other health services reduce recidivism. For example, the recidivism rate for participants in a Pennsylvania community mental health program was reduced to only 10%; another study revealed that participation in a substance abuse aftercare program reduced re-arrest rates among released inmates by 50 percent. Access to Medicaid is important because it is the principal source of health care financing for many former prisoners.[¹]

It is common knowledge that we have endemic incarceration in the United States. What is lesser known, however, is the overrepresentation of people with mental illnesses in the U.S. prison population.  In 2014, a National Resources Council (NRC) report produced by an interdisciplinary committee of researchers showed mental illness in U.S. jails and prisons is pervasive. The report uncovered “the presence of ‘mental-health concerns’ among 64% of inmates in the nation’s jails, 54 percent of state prisoners, and among 45% of inmates at federal facilities.”[²] This is a startlingly disproportionate number of people with mental health needs in incarceration and should be factored into in providing pre-release services in the nation’s jail and prison systems.

The Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI) application process is complicated and difficult to navigate; however, reentry programs can break the cycle of recidivism by linking offenders to Medicaid and Medicare, as well as housing.[³] The U.S. Substance Abuse and Mental Health Services Administration funds the SSI/SSDI Outreach, Access and Recovery program (SOAR), a nationwide, assistance program used at only some correctional facilities to help prisoners access disability (and associated Medicaid/Medicare) benefits upon release.

With SOAR pre-release assistance, inmates are more likely to have their Social Security disability applications approved. For example, with SOAR training for corrections staff, the program at Sing Sing Correctional Facility achieved an 87% approval rate for 183 initial SSI/SSDI applications, two-thirds of which were approved before or within one month of claimants’ release.[⁴] After the Oklahoma Department of Corrections partnered with the Oklahoma Department of Mental Health and Substance Abuse Services and SOAR, approval of SSI/SSDI applications rose to about 90%, and for those approved for SSI/SSDI, returns to prison within three years were 41% lower than those in a comparison group.[⁵]

One of the critical needs for SSI/SSDI transition services is having a knowledgeable person who can provide helpful information to not only navigate the labyrinthine processes and requirements for SSI enrollment, but potentially get the prisoner services in an expedited manner. There are different situations in which SSI payments can be received more quickly. One of them is presumptive disability (PD). If a claim is made for SSI benefits with PD, there is a potential to receive “payments for up to 6 months while … waiting for the Disability Determination Services (DDS) to make a final decision.”[⁶] This decision is based on several factors (outside of the prisoner’s financial need), including ability to perform activities of daily living and/or need for caretaking, disability severity, and available evidence.[⁷] The DDS may make a PD determination taking into consideration one of the medical conditions that the SSA includes as potentially a PD, or “on the basis of another severe condition,” as long as there is a likelihood of ultimate SSI approval.[⁸]

Another method of expediting and expanding prisoner connections to SSI/SSDI is through a prerelease agreement between SSA and the correctional institution. PD is also used here. These agreements can provide application approval 120 days before the prisoner’s release date and can allow for an SSA contact person to provide certain administrative supports.[⁹]

Many states and communities that have worked to ensure prisoner access to government benefits upon release have focused almost exclusively on Medicaid. Data from a preliminary study shows that inmates enrolled in Medicaid on the day of release commit fewer repeat offenses, and the time between offenses is longer. “This research lends support to the practice of pre-release reenrollment as well, because merely having Medicaid benefits on the day of release demonstrated improved results.”[¹⁰]

People with mental illness are disproportionately represented in prison and face extraordinary barriers to successful community reentry from jails and prisons. Reducing barriers to access SSI/SSDI and Medicaid/Medicare are worth pursuing to reduce rearrests and reincarcerations. Significantly higher rates of parolees receive disability approval through corrections staff and/or community provider training to provide transition services to inmates exiting the corrections system. These reentry programs have been shown to provide impressive benefits in pilot projects in jails and prisons. This should provide an impetus for more correctional facilities to consider these approaches as part of a foundation for successful reentry transition services across the country. More states should participate with the SSA, which coordinates these services through the SSA’s regional Commissioners’ office.