Bureau of Prisons: Assessment of Health Care Reentry Policies and Procedures Needed

GAO-23-105610 Published: Feb 27, 2023. Publicly Released: Feb 27, 2023.
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Fast Facts

The Federal Bureau of Prisons is responsible for the custody and care of inmates in its facilities.

As inmates reenter society, some face challenges such as getting IDs or accessing health care. Federal law requires the Bureau to create procedures to help inmates apply for federal and state benefits—like Medicaid—when they are released.

But the Bureau hasn't assessed whether its health care reentry policies and procedures are effective—including the individualized assistance provided to inmates with the greatest health needs. We recommended that the Bureau address this issue.

image of hand with keys at a prison door

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What GAO Found

Federal law requires the Federal Bureau of Prisons (BOP) to establish reentry planning procedures to help inmates apply for federal and state benefits upon release, such as Medicaid. BOP policies and procedures direct its facilities to target assistance with health coverage enrollment and continuity of care to the 3 percent of inmates BOP has designated as having greater health needs. This includes assisting with Medicaid and other benefit applications and arranging follow-up care upon release. For the remaining 97 percent of inmates who are generally healthy, BOP directs its facilities and Residential Reentry Centers to provide relatively limited health care reentry assistance.

Bureau of Prisons (BOP) Health Care Reentry Assistance

Bureau of Prisons (BOP) Health Care Reentry Assistance

GAO found that BOP has not assessed the effectiveness of its health care reentry policies and procedures, including the targeting of assistance by inmate health needs and what assistance is provided. This is inconsistent with federal internal control standards, which recommend agencies periodically reassess policies and procedures for continued effectiveness. BOP collects some information that could support an assessment, such as documentation from social workers' reentry efforts, but it is not using this information and has no plans to do so. By assessing effectiveness, BOP would have a better understanding of whether or not its approach is assisting inmates during the reentry process with their health care coverage and continuity of care needs, and whether changes are needed.

Why GAO Did This Study

BOP is responsible for the custody and care of federal inmates in BOP-managed facilities, which included almost 145,000 individuals as of December 2022. Inmates releasing from BOP custody—over 35,000 in 2021—may face challenges re-entering society, including accessing health care.

The joint explanatory statement accompanying the Consolidated Appropriations Act, 2021 includes a provision for GAO to review inmate health care, including enrollment in Medicaid upon release from prison. Among other things, this report examines BOP policies and procedures to facilitate inmates' enrollment in Medicaid or other health coverage and continuity of care upon release.

GAO reviewed BOP documentation on inmate reentry assistance. GAO also interviewed BOP officials, including those from two BOP facilities selected, in part, for variation in facility type, size, and region of the country. In addition, GAO reviewed BOP's approach against federal internal control standards.

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GAO recommends that BOP assess the effectiveness of its reentry policies and procedures for facilitating inmate enrollment in health coverage and helping ensure continuity of care. BOP concurred with the recommendation.

Recommendations for Executive Action

Agency Affected Recommendation Status
Bureau of Prisons The Director of BOP should assess the effectiveness of the bureau's policies and procedures for facilitating enrollment in Medicaid or other health care coverage for inmates nearing reentry, and for helping ensure continuity of care upon release from BOP custody. (Recommendation 1)
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

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