After 18 years in prison, Las Vegas man helps cancel medical debt for formerly incarcerated

When Frank Macias left prison after nearly 18 years in the Nevada Department of Corrections, he was feeling a flood of emotions knowing he had to start from scratch.

But then he received a letter saying he still owed more than $7,000 in medical debt from a broken wrist and was told he had to pay it back in 30 days, or else it would be sent to a collection agency. He only had $25 when he was released.

“I think my anxiety kind of went through the roof because when I received that letter, it was like my heart dropped. I couldn’t imagine how that was possible,” Macias said. “After all, I gave them nearly 18 years of my life, and they still want to attack me. I felt attacked.”

Macias, now a legal assistant at the LJU Law Firm in Las Vegas, successfully pushed for legislation to ensure no one else leaves prison with medical debt that hampers their ability to successfully reintegrate into society.

With state Sen. Melanie Scheible and organizations including the Fines and Fees Justice Center and Return Strong Nevada, Macias helped pass Senate Bill 88, which cancels medical debt inmates incur while in prison when they are released. The Senate passed the bill mostly on party lines, and the Assembly passed it unanimously with three members excused. Gov. Joe Lombardo approved the bill June 10.

Before the passage of the bill, the Nevada Department of Corrections attempted to collect the debts that formerly incarcerated people have been unable to pay, wasting department resources and leaving newly released individuals strapped with high-interest debt.

Before SB88 became law, formerly incarcerated individuals owed about $13 million in outstanding medical debt, according to Nick Shepack, the Nevada state director of the Fines and Fees Justice Center. But in the past two years, the Nevada Department of Corrections managed to collect only $6,000 each year while spending about that much attempting to collect the debt. Last year, the department only made $175 in profit, he told lawmakers during a hearing.

Shepack said it is almost impossible for formerly incarcerated individuals to legally pay that debt back in the time frame that is required. When they can’t pay the debt, it goes to collections, where the individuals are charged interest and additional fees, hurting their credit, he said.

“These are individuals who are just starting to rebuild their lives, and then one of the first things they receive is a threatening letter from the place that they just left, and the debt just balloons,” Shepack said in the hearing.

Macias, 47, was still adapting to life out of prison when he received the letter a few weeks after he was released. He was figuring out how to get his license through the DMV, trying to find an apartment and restarting his credit, he said.

Macias was fortunate to have gotten a job at the law firm. He could afford to rent a two-bedroom townhome, but he was rejected because of his bad credit and his criminal record, he said. He lives with his family, who pitched in to help him when he was released, “but I know many individuals in prison that don’t have a single soul to help them,” Macias said.

Though he no longer owes the medical debt because of the legislation — it canceled existing and future debt — he isn’t sure if the Department of Corrections will notify credit bureaus. He is reaching out to them to make sure they are aware.

Reducing repeat offenses

James Dzurenda, director at Nevada Department of Corrections, told lawmakers the department’s mission is to provide tools to help offenders upon release to be successful. Medical debt hurts them and increases the risk that they will relapse into criminal behavior, he said.

“I do believe that something like this will help me to complete my mission with the agency,” Dzurenda told lawmakers during the bill’s hearing.

Since the bill’s passage, the department no longer actively pursues collecting medical debt when inmates are released, though if the former inmate is convicted of another crime and is returned to prison, that debt will be reinstated, according to Teri Vance, deputy public information officer for the Department of Corrections.

The number of offenders who incur medical debt while in prison varies. In May, 85 inmates were assigned medical debt, while 112 were assigned medical debt in July, Vance said.

Physicians will continue to be paid for their services, and the Department of Corrections will see no impact in loss of revenue. Prison Medical pays all outside medical claims that are not eligible for Nevada Medicaid, according to the Department of Corrections.

The inmate welfare fund — which collects funds from commissary purchases and percentages of funds families send to the inmates — reimburses Prison Medical monthly for offenders assigned medical debt. Those costs are then assigned to the offenders’ account, which can be deducted for medical treatments for injuries inflicted by the offender on themselves or other offenders, or injuries that occurred during voluntary recreational activities, according to state law.

Macias broke his wrist while playing football and was sent to an outside facility in Ely, he said.

A few months later, Macias learned he owed money when he went to buy something in the commissary and discovered the prison took 85 percent of his savings to pay off his debt, he said.

Canceling inmates’ medical debt upon release has been a work in progress for years, according to Jodi Hocking, founder and executive director of Return Strong, which works with those incarcerated, people formerly incarcerated and their families. Working with the Fines and Fees Justice Center, the organization identified the medical debt as an issue in 2021 and brought it up in the 2023 legislative session.

“I think if we want people to come home from prison and do well, we need to remove barriers that interfere in their ability to assimilate back into our communities,” Hocking said. “It’s not about absolving them from their responsibilities. It’s that if we’re choosing prison and we’ll choose incarceration as the way to solve social problems, then they shouldn’t be independently paying for it.”

Life in prison

In his early 20s, Macias worked as a corporate tax adviser, he said. In 2007 he faced charges related to attempted murder, firearm possession and robbery, a charge he still contests. He got involved with bad people, he said, and one day shot at one of them, not aiming to kill and thinking he missed, he said.

“It was a bad decision. I shouldn’t have shot the guy, period,” Macias said. “My anger as a young man got the best of me, but I paid the price.”

Macias spent his time in prison earning his paralegal license, working out, reading books, and educating himself on Nevada law.

Hocking met Macias four or five years ago, and he was one of the first people inside prison that her organization started working with. He helped organize drives and communicated issues and concerns happening inside prison, she said.

“He’s amazing,” Hocking said. “He’s always very respectful and positive and wants to see change.”

“I think Frank is really a shining example of people who are facing all of those barriers but who are doing everything to try to make sure that they do things right and they don’t go back,” she said.

He’s also a great example of what happens when people in prison are provided opportunities and barriers are removed, Hocking said. Macias received support through his family as well as organizations such as Return Strong and the Second Chance program, which aims to reduce recidivism and connect formerly incarcerated individuals with jobs.

More work to do

Hocking said there’s more work to do. She has received calls from families who say the Nevada Department of Corrections takes money out of their incarcerated loved ones’ accounts before they are released.

“It looks like what’s happening is they’re trying to collect as much money as possible while they’re still in prison because they won’t be able to collect it when they come out,” Hocking said. “I don’t think that was the intent of that bill.”

Macias, for instance, thought he’d be leaving with about $400 in his account that he planned to use to buy clothes, but the department took most of it to go toward his medical debt.

“There’s no reinforcing structure to help ease people back into society, to help them slowly reintegrate,” Macias said. “It’s just, ‘hey, there’s the door. This is what you owe us.”’

Through his career in law, he hopes to help people incarcerated reform and those formerly incarcerated reassimilate.

“We all make mistakes,” Macias said. “That was one of my biggest mistakes in my life,” referring to the acts that put him in prison. “But everything had to happen for a very specific reason, for a very specific purpose, because had that not happen, God knows where I would have been. I’m here now, just by God’s good grace.”

Contact Jessica Hill at jehill@reviewjournal.com. Follow @jess_hillyeah on X.