When such nonprofits as the Fortune Society are not available to help ex-inmates navigate the medical bureaucracy, many never manage to access the public health system--because they do not know how to fill in application forms for Medicaid, because they lack the necessary identification to apply, because they have no permanent address. And even those who do successfully complete the process generally have to wait several months before their benefits kick in. "Public assistance is expedited for HIV sufferers to get these services. For people with other serious illnesses it's very difficult," explains Deborah Santana, risk-reduction services coordinator of the Osborne Association program in the Bronx.

"Once I was released, I had absolutely no medical benefits," says 44-year-old Edmond Taylor, who served fifteen years in New York prisons for drug-sales convictions. Taylor, a tall African-American man with a cleanshaven head and a gentle, expressive, bespectacled face, suffers from acute facial psoriasis. "I was released back to New York City with very little cream and no pills left. I had no way of getting any help." When he applied for Medicaid at a center in Harlem--after standing in lines for two afternoons straight--they told him his application wouldn't even begin to be processed for forty-five days. "So," says Taylor, "I found someone who had Medicaid and I got them to go to the doctor and ask for stuff I needed. I paid them. I know it's illegal. I needed to get it because it affected me in my facial area and forehead--which made me very uncomfortable to go look for a job."

Because this stratagem was illegal, Taylor could have been sent back to prison as a parole violator. As it happens, he was lucky. Instead of winding up in prison again, Taylor was eventually hired by the Fortune Society, and his job provides him with health coverage. "The systems in place are designed to have people go back to prison," argues Santana. "Because they make it so difficult for them to access the services they need."

"We're in an Internet society," Taylor says in amazed frustration. "Information gets passed in the blink of an eye. If they can pass information to society that you're violent, a threat, why can't they pass medical information and eliminate the red tape? There shouldn't be a forty-five-day waiting period [for medical coverage] for someone coming out on parole."

Perhaps not surprisingly, in an era when investment in public services has been sacrificed to the funding of corporate tax cuts and tough-on-crime, tough-on-criminals rhetoric has replaced the language of rehabilitation, the Justice Department has been in anything but a hurry to make The Health Status of Soon-to-be-Released Inmates public. And so the report, along with the economic background papers, remains unpublished, and public health continues to bear the long-term costs of dealing with diseases suffered by, and spread by, ex-cons without adequate access to healthcare behind bars or upon release.

With the economic effects of 9/11 producing across-the-board budget contractions, access to public health facilities in cities like New York could become even more limited. Transitional spending on the healthcare of ex-inmates may well decrease, at a moment when HCV is emerging as a huge epidemic with long-term public health implications, and when several million Americans per year are being released from jail or prison. "We should be looking at what public health opportunities there are for intervention," says Jack Beck, a New York legal aid attorney. "When they're in prison, they're a captive audience. When the opportunities aren't being exploited, that's tragic."

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