Medicaid expansion may help former inmates get treatment

John Jacobs, a 27-year-old Medicaid recipient and former inmate from Putnam County, is getting help for a substance abuse problem at the Prestera Center. Under West Virginia’s recently expanded Medicaid program, state officials hope people like Jacobs will get help for their drug problems and not end up back in jail.

Now that he’s getting help for his drug addiction, John Jacobs is confident he won’t go back to prison.

The 27-year-old Putnam County resident spent a year locked up for pawning stolen electronics to support his addiction. He was released in January and has been at a long-term residential treatment facility through Prestera Center since then.

“I’m happy, I’m clean,” Jacobs said. “Any other time in the past I just got clean for other people… Now I just don’t want to get high.”

A kitchen worker at the FireSide Grille in Hurricane, Jacobs gets Medicaid, which pays for his substance abuse treatment.

“I was fortunate to get on Medicaid because I was getting [treatment] for free for three months through the [Veterans Administration] and then I got to pay for the rest of it,” Jacobs said. “I work, but I pay for child support and stuff so I don’t make enough to do that.”

Under the Affordable Care Act, Gov. Earl Ray Tomblin used federal money to expand West Virginia’s Medicaid program. As of last week, more than 120,000 West Virginians had signed up under the expanded program.

That number includes ex-inmates with drug addictions like Jacobs. State officials believe those people will get treatment for their addictions and mental health problems under expanded Medicaid — and fewer of them will commit crimes again and end up back in prison.

“One of the drivers behind a criminal history, directly or indirectly, is a substance abuse problem,” Jim Rubenstein, commissioner of the state Division of Corrections told the Gazette earlier this year. “[Medicaid coverage] could make a critical difference, by having some kind of coverage that would gain these individuals access to needed treatment or counseling. And while we know that substance abuse is a big issue, to have coverage for basic medical care could also make a difference in their lives as well.”

Of the West Virginia inmates released in 2009, 26.3 percent have committed crimes again, according to the latest data available from the DOC.

Under the health care reform law, West Virginia expanded its Medicaid program to cover those who earn up to 138 percent of the federal poverty line, or about $16,000 a year for an individual. As of May 27, 123,403 West Virginia residents had signed up for Medicaid under the expanded program.

According to estimates from the U.S. Department of Justice, about 35 percent of those newly eligible under the income guidelines will have a history of involvement in the criminal justice system.

The state Division of Corrections does not yet have estimates for how many of those will be eligible for Medicaid.

“The next phase of the ongoing effort to identify Medicaid-eligible inmates aims to help or guide such inmates toward enrolling for coverage upon parole or discharge,” spokesman Lawrence Messina told the Gazette earlier this year. “That phase remains in the works.”

As of March, there were 5,840 inmates in West Virginia Division of Corrections facilities and another 846 DOC inmates being held in regional jails, according to Messina. The DOC estimated that one in five state inmates have a diagnosed mental illness and 12 percent have substance abuse issues.

According to a report from the now-defunct West Virginia Prevention Resource Center, of the state’s inmates in 2010, 11.7 percent were in Department of Correction facilities for crimes directly involving drugs and 2 percent were in facilities for crimes directly involving alcohol. Some 16.2 percent were in prison for crimes that were indirectly related to drugs. About 22 percent were in prison for crimes indirectly related to alcohol.

Kim Miller, director of development for the Prestera Center, is confident that good treatment will keep former inmates like Jacobs and others from recommitting crimes.

“Will behavioral health services stop a person from being reincarcerated? It absolutely will,” Miller said. “We know beyond a shadow of a doubt that treatment is effective.”

She continued, “Treatment works when you get the person with the right person, the right clinician and staff with the right support around them with the right intensity in the right environment then you have the recipe for success for that person.”

Prestera treats people regardless of their ability to pay, but Miller said she thinks that if people have some form of coverage they’re more likely to seek treatment.

‘It eased all those problems’

The son of a Putnam County police officer, John Jacobs grew up in a good home and never got into trouble, he said. But after serving a year in Iraq with the Army, he came home with a traumatic brain injury and post-traumatic stress disorder. Getting high helped ease his symptoms.

“I would get a hour and a half or two hours of sleep a night just because I couldn’t sleep — [I’d have] nightmares and stuff like that,” Jacobs said. “I’d just get high.

“I honestly started doing it because it eased all those problems and it made me party harder so the only bad thing I had to repress was my war experience, going overseas and stuff. Not a terrible childhood.”

He didn’t talk to anyone about Iraq, and instead kept his feelings “bottled up.” He used drugs as an escape, he said.

Now, as the treatment continues, Jacobs said he’s starting to feel like his old self again, something that’s not been lost on his friends and family.

“That’s what they say now — ‘You’re like the old John again,’ ” he said.

A history of addiction

Jacobs’ story of growing up in a good home but developing an addiction after combat is markedly different than that of Donnie Gooding, a 32-year-old South Carolina native with a long history of drug addiction and criminal activity.

Gooding came to West Virginia in 2008 after serving prison time in his home state. After he turned 17, he spent the better part of a decade in prison for drug-related offenses.

“I’d get out for a couple months and I’d go back,” Gooding said. “And it all revolved around addiction.”

After moving to West Virginia he eventually found work in the state’s coal mines. He got clean, got married and had a child. Things began to change after a injury in the mines had him out of work, in physical therapy and collecting workers’ compensation.

One day, a friend offered him methamphetamine.

“Within three months I was divorced, we were selling the house, and my truck was in repossession,” Gooding said. “There was no way I could go back to work because I couldn’t pass the urinalysis if I did show back up.”

Because he’d been out of work for months, his employer had dropped his health benefits, but he was still getting workers’ compensation.

“Between my bills, my child support and everything else, I couldn’t afford to buy drugs,” he said. He started making and selling meth instead. “And here come the money. That was amazing...

“You’d be surprised who gets high. It’s a revolving door though. It’s an absolute deadly epidemic,” Gooding said. “You cannot stop. When I would get done cooking I couldn’t even get high, there would be so many people waiting to buy the meth that I’d be out and I’d have to do it again... It’s a never-ending process but that’s what I became addicted to. More than the drugs, I loved the life.”

When he did seek treatment for addiction, he couldn’t afford it without health insurance. He ended up getting busted for making meth. A judge suggested he take every opportunity he could to get treatment, which led him to Prestera.

Now, thanks to Medicaid, he’s part of a long-term drug treatment program.

“This is life or death to me,” he said. “If it wasn’t for Prestera I’d be in a ditch somewhere or [the penitentiary].”

Gooding, who has been clean about seven months, said he wants to get more treatment before attempting to go back to work in the mines. He wants to address his substance abuse and mental health issues before he faces the money and the stress of his former life. He knows if not, he might be tempted to use the money he earns at work to buy drugs.

“I’d like to stay at least a year because of what I’ve addressed while I was here thanks to having Medicaid,” Gooding said. “Because I’m able to actually afford to get help now.”

Gooding said in addition to substance abuse problems, he has an antisocial personality disorder and bipolar disorder.

“Methamphetamine absolutely destroyed me,” he said. “I was out there begging for help and I couldn’t get help I didn’t have the money to pay for it.”

Unrealized potential

Medicaid doesn’t pay for all services at Prestera, just what the center’s programs deem “medically necessary.”

“We don’t get paid a lot for Medicaid, the behavioral health services,” said Miller, Prestera’s director of development.

“Reimbursement rates have not gone up in probably 15 years. So in 15 years you get more out of insurance or you get more out of other funding sources.”

Prestera has 53 locations across eight counties, employees 900 staff members and serves 20,000 people a year. While the center accepts Medicaid and health insurance, it also treats people regardless of ability to pay.

The agency raises money to pay for the services that aren’t covered by health insurance or other sources of funding. Miller hopes having more people covered by Medicaid will help the agency financially.

That hasn’t happened yet, though. The agency’s been dealing with other financial problems — including the January chemical spill into the Elk River, which closed Prestera sites and sent staff members home.

“We haven’t realized what the potential for that will eventually be by enrolling more people [in the expanded Medicaid program,” Miller said, “but it’s like saving one life at a time. Every person enrolled helps pay for some of the services that they receive.”

Reach Lori Kersey


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