Weekly Update: October 17, 2023
Medicaid In Corrections: Information Technology Challenges

COCHS Weekly Update: October 17, 2023

Highlighted Stories

Editor's Note
This week’s Editor's Note covers an obscure technical issue that might be significant for Medicaid coverage of people within corrections. In Vermont, that state’s Medicaid system is unable to suspend a person's Medicaid eligibility to maintain enrollment because of its antiquated, legacy system.

Why is this important? Back in 2004, CMS recognized that the requirement by law to terminate a person’s Medicaid eligibility upon incarceration was having adverse effects. Upon release people who had had their eligibility terminated had to again go through the time-consuming process of determining eligibility and then being once again enrolled in Medicaid. If during this process there was a health crisis, people waiting to be re-enrolled might end up in emergency rooms as the provider of last choice. So CMS allowed for suspension of eligibility to help rectify this situation. By suspending a person’s eligibility and maintaining their enrollment, the idea was that on release the suspension status would be removed from eligibility and the formerly incarcerated person would immediately be covered by Medicaid, hopefully eliminating gaps in care. However, at that time, for many states this issue might not have seemed particularly pressing. There was perhaps not a significant number of people cycling through corrections who were enrolled in Medicaid, possibly explaining why many systems were not updated or not updated until recently.

Fast forward to now. Because the Affordable Care Act made Medicaid available to single low-income males, the people cycling through the criminal justice system might be more likely to be eligible and enrolled in Medicaid. In addition, with some states having received 1115 waivers to allow Medicaid coverage in the last 90 days of incarceration (and other states waiting to have their waivers approved), the issue of suspension gains a new importance. It is not only gaps in coverage where suspension might be useful, but it might be helpful for correctional institutions for determining eligibility and enrollment of incarcerated people. If a person’s Medicaid’s eligibility could be suspended, then removing that suspension 90 days prior to release to regain Medicaid coverage could save a lot of effort.

Returning to Vermont the necessity of updating that states Medicaid system is not something unforeseen by CMS. In April of this year, the State Medicaid Director letter, Opportunities to Test Transition-Related Strategies to Support Community Reentry and Improve Care Transitions for Individuals Who Are Incarcerated , explains that there would be enhanced administrative matching funds for, "Adding additional data fields and data matching logic for Medicaid program components such as eligibility and enrollment." These matching funds might be significant for Vermont as it is one of the 14 states currently applying for an 1115 waiver to cover re-entry services.

The suspension of eligibility is just one technical issue of many that might arise as Medicaid coverage is permitted within corrections. It should be emphasized before this push to bring Medicaid within corrections, incarcerated people's health care was not covered by insurance and as a result it is not uncommon for electronic health records (EHRs) within corrections to lack the ability to track procedures or diagnoses within a CPT and ICD format respectively. EHRs without this capability are not able to generate a super bill (or tie the super bill to the medical record or be able to reconcile an explanation of benefits). This functionality will be necessary for Medicaid to cover the cost of health care of incarcerated people. As articles appear concerning this technical issue the Editor’s Note will definitely highlight these stories…stay tuned.

Suspension of Eligibility
VT Digger: Vermont officials seek Medicaid benefits for incarcerated people, but federal approval could be a long time coming
Ashley Berliner, who leads Vermont’s Medicaid policy development within the Agency of Human Services, said the state works hard to ensure people exiting state custody have coverage, but with unpredictable release dates, and a decades-old computer system people sometimes exit incarceration without being enrolled. While states are barred, with few exceptions, from billing Medicaid for prison health care costs, they have the option of suspending, rather than terminating, a person’s Medicaid eligibility when they enter prison. Berliner called Medicaid eligibility suspension the “gold standard” but said Vermont’s Medicaid system “is just not capable of that functionality.”

Hepatitis C

Medical Express: Expert discusses prevalence of hepatitis C in US state prisons
The World Health Organization has a goal to eliminate hepatitis C as a public health threat by 2030. But the number of U.S. state prisons are failing to adequately address this curable disease, as approximately 55% of people in U.S. state prisons who had been infected are still not cured. The U.S. has the highest incarceration rates in the world and the prevalence of hepatitis C in prisons is about 10 times higher than it is in the general population.

Opioid Epidemic

Corrections 1: Medications for opioid use disorder (MOUD) programs in jails
MOUD programs have proven successful. Within correctional facilities, there is an opportunity to provide critical health care for inmates suffering from OUD, resulting in better outcomes within and outside of the jail. Evidence shows that MOUD programs in jails positively impact inmate behavior, stabilizing inmate moods and reducing levels of depression. This in turn results in increased safety and security for inmates, correctional personnel and the community as a whole.


Wiley: Treatment of PTSD and SUD for the incarcerated population with EMDR: A pilot study
Adverse childhood experiences have been found to be a significant predictor of criminal recidivism. In the incarcerated population, the rate of PTSD is significantly higher as compared to the general population. Eye Movement Desensitization and Reprocessing (EMDR) treatment modality desensitizes traumatic memories by targeting the brain's information system. Treatment with EMDR in a prison setting like the one employed in the current study has been observed to be successful in improving the social, affective, and health adjustment of convicts.


Route 55: Graying prisons face accelerating health care needs
Rapidly growing numbers of older inmates with diabetes, dementia and liver disease are forcing states to reevaluate early release policies and the social safety nets that might prevent incarceration. In Florida, which has the third highest percentage of elderly prisoners, the proportion who are 50 and older has steadily grown in the past four decades, going from 4.5% of the population in 1980 to 16% in 2010 to 26.2% in 2018 and almost 28% in 2022.

WFAE: Expanded prison medical release eligibility provides opportunity for more sick, aging incarcerated people to go home before they die
Language in this year’s North Carolina state budget that passed last month expands the eligibility criteria for medical release from the state's prisons, potentially providing more sick and aging incarcerated people the opportunity to go home before they die. The new law rolls back the eligibility age for “geriatric” medical release by 10 years — from 65 to 55 — and decreases the risk standard guiding all releases.


CCJ: Suicide Among Justice-Involved Veterans: Understanding Risk and Meeting Needs
Veterans have elevated rates of suicide and justice system involvement. The suicide rate for veterans is roughly 1.5 times higher than that for the general population, and approximately 31% of veterans have been arrested at some point in their lives, compared to 18% of non-veterans.

Solitary Confinement

Philly Voice: 'Torturous' solitary confinement conditions in a Pa. prison are unconstitutional, federal lawsuit claims
A Pennsylvania prison's practice of holding inmates in solitary confinement is inhumane and unconstitutional, according to a federal lawsuit filed in the U.S. District Court in Pittsburgh. In addition to punitive and compensatory damages, the lawsuit demands an end to solitary confinement for inmates with mental health conditions.

Trib Live: Those in solitary confinement unit at Fayette prison face 'cruel and unusual punishment,' lawsuit says
Five people who have spent years in solitary confinement at a Fayette County state prison are suing the Pennsylvania Department of Corrections and prison administrators, alleging that people housed there are subjected to cruel and unusual punishment. The lawsuit, which seeks class-action status, also includes claims for due process violations and discrimination. It seeks to end solitary confinement for men confined in the Security Threat Group Management Unit at the State Correctional Institution at Fayette in LaBelle.

Huffpost: Prisoners Say New Jersey’s Alternative To Solitary Confinement Is Pretty Much The Same
New Jersey Department of Corrections created Restorative Housing Units (RHUs) in response to the passage of the Isolated Confinement Restriction Act (ICRA), a law intended to reform the use of solitary confinement. At the time, ICRA was the most progressive solitary confinement reform law in the nation. RHUs are meant to be a “less restrictive” alternative to isolated confinement. But conditions in RHUS unit differed little from solitary confinement.

Sacramento Bee: Gavin Newsom rushes solitary confinement changes. They could make reforms an ‘uphill battle’
California Gov. Gavin Newsom’s administration is expediting changes to the state’s solitary confinement rules, a move advocates say is superficial and could hurt efforts to pass more ambitious legislation reforming the practice. The revisions CDCR is rushing through the system are modest in scope compared to the changes. They also lessen the chances that more sweeping legislation can be passed and signed into law by Newsom.

State Roundup

Health Imaging: Inmate, prison guard stuck to MRI machine at unregulated site
Journalists in Arizona uncovered a previously uninvestigated incident that happened at a SimonMed Imaging center in Avondale, Arizona, involving an inmate and a prison guard who both became stuck to an MRI machine. During a routine MRI scan, a SimonMed technologist made a critical error, instructing the guard not to remove the metal shackles around Windust's waist. This mistake resulted in Windust being stuck to the inside wall of the MRI machine, where she says she immediately experienced excruciating pain as the metal shackles crushed her. The prison guard attempted to intervene but ended up stuck himself when his gun came into contact with the machine.

Mercury News: ‘An unconscionable failure’: New evidence shows deputies at Santa Rita Jail ignored man’s failing health as he slowly died
The 2021 death of an East Bay man at Santa Rita Jail is being intensely scrutinized after body camera footage released this week shows deputies ignored warning signs of his ailing health and later allegedly forged records to disguise the lack of cell checks. Maurice Monk, 45, of Oakland, died face down in his single-person cell at the Dublin jail, where he’d spent three to four days without being checked on by jail staff, the body camera footage shows.

Los Angeles Daily News: Newsom vetoes $1 billion fund for troubled LA County juvenile halls, camps
Gov. Gavin Newsom has vetoed a bill earmarking up to $1 billion to support infrastructure improvements at Los Angeles County’s embattled juvenile halls and camps. Newsom sent the bill, AB 695, back to the Assembly without his signature on Sunday, Oct. 8, saying he could not support it for financial reasons.

Corrections 1: Colo. DoC settles $8M civil rights lawsuit involving a prisoner’s medical care
A man who sued the Colorado Department of Corrections for inadequate medical care that led to the amputation of his left hand and portions of his other limbs will receive an $8 million settlement. The federal civil rights lawsuit filed by Christopher Tanner in 2021 alleged that he developed pneumonia while incarcerated at the Denver Reception and Diagnostic Center in March 2020 but was not transferred to a hospital until he had deteriorated to the point of near death.

Trumbull Times: CT prisons revamp policies as number of transgender, intersex inmates more than doubles
Connecticut’s Department of Correction is revamping the way the state handles incarcerated people who identify as gender non-conforming while they're in prison. The current policy directive has been in place since 2018, when there were 21 people housed in Connecticut jails who the department recognized as gender non-confirming. As of September, the number of inmates who are transgender or intersex had more than doubled since the directive was first drafted to 57.

CT Insider: CT official appeal ruling in favor of transgender inmate
Connecticut officials have decided to appeal a judge’s ruling in favor of a transgender person who alleged she did not receive the gender-affirming care to which she was entitled to while in a state prison.

WHYY: ACLU sues Delaware for ‘deliberate indifference’ to medical care in prisons
Nearly two years after filing a lawsuit accusing Delaware’s Sussex County prison of brutalizing incarcerated men, the American Civil Liberties Union now alleges in federal court that the state’s correctional system has “systemically violated their duties to ensure adequate health care” statewide. The ACLU also accuses the Department of Correction of failing to adequately oversee and monitor Centene/Centurion and VitalCore, even though state law mandates that they do just that.

KITV: Issues with Hawai'i's prison medical record system could cause a deceased inmate's lawsuit to be dropped
Richard Turbin is a lawyer who specializes in prison medical malpractice cases. For his case, he has been waiting on medical records for an inmate who died from dehydration. Since August of last year the electronic medical record (EMR) system was reported to be down for two months. About two weeks later the Department of Public Safety said it was back up and running. However in December, it was reported that the system had been up for only two weeks until it broke down again.

Minnesota Public Radio: Ignoring inmate's infection costs Scott County $12.2 million
Scott County has agreed to pay $12.2 million to a Minneapolis man who had to have both arms amputated after jail staff ignored his pleas for medical help. Attorneys for Terrance Winborn said Wednesday that the settlement is likely the largest amount ever paid in Minnesota in a “deliberate indifference” case involving a jail.

New York
WIVB: Former correctional health director accused of collecting over $1K from fraudulent timecards
A former Erie County correctional health director was arraigned Monday morning on charges that she fraudulently obtained more than $1,000 in pay by submitting falsified timecards, the Erie County District Attorney’s Office announced. Christa M. Cutrona, 46, is accused of knowingly and falsely altering her personal timecards and stealing approximately $1,300. Between December 2021 and February 2022 she served as Director of Correctional Health for the Erie County Sheriff’s Office.

Kansas City Beacon: People in Missouri prisons say food went from bad to worse when contractor took over
Missouri volunteer prison labor tends gardens that yield about 100 tons of fresh produce a year. For the most part, that food goes to local charities. The prisoners who grow it complain they get little fresh food. Instead, they get a lot of bologna. In January, Gov. Mike Parson signed the state to a five-year, $45.7 million contract with nationwide food and concessions provider Aramark. Complaints about privatized prison food services come up across the country. Michigan signed a three-year $145 million contract with Aramark meant to expire in September 2016. But that state ended the deal a year early after problems including maggots in food.

Oklahoma Watch: Inmate Deaths Raise Questions About Temperatures in Oklahoma Prisons
The 59-year-old prisoner died overnight in his sleep, according to an offender death report obtained through the Oklahoma Open Records Act. Another older prisoner in the same housing unit died two days earlier. A corrections department employee who spoke on the condition of anonymity for fear of violating the agency’s media policy said that both inmates had pre-existing health concerns. On one particularly hot day, the temperature inside cells reached as high as 97 degrees Fahrenheit.

KENS5: Bexar County sheriff addresses inmate deaths, new initiatives to save lives
The Bexar County Sheriff, Javier Salazar, is addressing inmates dying in his jail. In response to these recent deaths at the jail, Sheriff Salazar is launching a new initiative called Operation Lifeguard. He said right now, he has a group of deputies and jailers training to become licensed EMTs.

Rikers Island

Gothamist: Another Rikers detainee dies, marking 9th death in NYC correction custody this year
A Rikers Island detainee died marking the ninth death in New York City Department of Correction custody this year. The city's medical examiner will determine the cause of death.

Gothamist: Rikers correction officer accused of stealing overtime pay, charged with fraud
A Rikers Island correction officer was accused of stealing more than $170,000 in salary and overtime pay for hours he actually spent hanging out at home or on vacation, according to federal prosecutors. The officer was arrested and charged with federal program fraud. Internicola’s falsified timesheets included 2,250 hours that he spent at home on Staten Island and vacationing in Aruba or the Jersey Shore.

Gothamist: Judge: NYC jail officials have a week to make harm reduction plan at Rikers
A federal judge has issued an urgent order for city officials and a federal monitor to make a new plan for improvements at city jails — days after the monitor issued a damning report on violence at the facilities. In a court order filed this week, Judge Laura Taylor Swain demanded the NYC Department of Correction’s leaders meet with federal monitor Steve J. Martin no later than Oct. 18 to devise a plan that can be implemented immediately “to ameliorate the unacceptable levels of harm in the New York City jails.”

Los Angeles County

Vera: 35 People Have Died in LA County Jails This Year
17 people have died in Los Angeles County jails since June 1. Their deaths bring the total number of people who have died while in the custody of the nation’s largest jail system this year to 35—averaging just shy of one death every week. That staggering number far exceeds that of New York City Department of Correction (NYC DOC) facilities, where the rising number of deaths at the Rikers Island jail complex has led to a mounting crisis that has received nationwide attention.

San Diego County

Voices of San Diego: AG Says Sheriff Must Find Solution to Jail Deaths – Or Face Consequences
Fix the problem or face the consequences. That was Attorney General Rob Bonta’s message for the San Diego County Sheriff’s Department on Saturday regarding the unusually high number of jail deaths locally. Bonta said he wanted to give San Diego’s newly-elected Sheriff Kelly Martinez time to fix the problem. But if death rates in San Diego jails don’t come down, Bonta said he could pursue multiple legal remedies. San Diego County has had the highest rate of jail deaths among large California counties for the last 10 years.

San Diego Union Tribune: Sickness, racism and overflowing jail toilets: Complaint lodged against San Diego sheriff over jail health, safety
Numerous men locked inside the George Bailey Detention Facility have become sickened after being forced to clean up human waste that regularly overflows from the jail’s aging plumbing, a new complaint to the civilian oversight board alleges. At least two people have contracted staph infections, the complaint adds. The complaint also says that last week, on the kitchen’s chicken-and-waffles day, incarcerated people were served darkened waffles stamped with faces with exaggerated features that many found racist.

Criminal Justice's Detrimental Impact On Mental Health

ABC: 'This is the reason you’re seeing so many deaths' | Former inmate at 201 Poplar describes living conditions
Perez Estrada's death marks the 45th death in the Shelby County Jail (TN) since 2019. One former inmate, Samuel Hogan, is speaking out on his experience at the jail. “The cells are usually covered in human feces and blood,” Hogan said. “There are bugs everywhere. You have no mats. You’re sleeping on a concrete pad. I don’t see how any of that helps people who are suicidal.”

KCUR: 260 Missourians are waiting in jails for mental health services
There are currently 260 people in Missouri jails waiting to be transferred to a hospital for mental health treatment — a slight uptick from last month, as state officials work to develop plans for the “jail-based competency restoration” program approved by the legislature this year. Last month, there were 253 awaiting treatment and the wait time was eight months.

Public Defenders

New Yorker: How a New Approach to Public Defense Is Overcoming Mass Incarceration
Five years ago, partners for Justice (P.F.J.), a scrappy nonprofit began with an improbable mission: to transform the public criminal-defense system. Then as now, public defenders represent eighty per cent of all people charged with a crime, and they typically work in offices that are underfunded and understaffed. Around ninety-seven per cent of federal cases and ninety-four per cent of state cases dispatched by plea bargains—many of them coerced when a prosecutor tacks on additional charges that threaten long jail sentences if the plea is not taken—it is no wonder that nearly two million people are incarcerated in the United States.


US Department of Labor: Departments of Labor, Justice award more than $63M in grants to provide workforce training, support for people returning from jail, prison
The U.S. Department of Labor, in partnership with the Department of Justice, today announced the award of more than $63 million in funding to enhance the Bureau of Prisons’ existing rehabilitation and reentry efforts by partnering with workforce agencies in 11 additional states. The Partners for Reentry Opportunities in Workforce Development grants will provide support for people in federal custody to prepare them to succeed once they return to their communities and rejoin the workforce.

Risk Assessment

Inquest: Our Evidence-Based Obsession
While Evidence-Based Paradigm (EPB) proponents can claim partial credit for prison population declines in the early 2010s. To date, EBP has produced reforms designed to meet the needs of punishment bureaucrats. For example, actuarial risk assessment tools rationalize pretrial release decisions by removing human intuition from the equation (which alleviates political pressure on judges). As prison population declined in the early 2010s, it seems fair to say that the movement’s primary interest has been the cost effectiveness of criminalization.


Correctional News: Sensor Technology Provides Autonomous Health Monitoring Solution
Xandar Kardian’s UWB radar technology reacts to the micro-vibrations of the human body, such as a heart beating or lung pumping, for highly accurate vital sign measurements. Importantly, the Xandar Kardian sensors require no wearables on the inmate, no video or audio recordings, no software to operate, and no battery to change – providing a completely autonomous, continuous, and privacy-secure health-monitoring solution.

Correctional Health Care Vendors

Business Insider: Lawsuit alleges undisclosed relationship involving federal judge that could cloud Corizon bankruptcy deal
A complaint filed this week in federal court casts doubt over the neutrality of the judge who oversaw bankruptcy settlement talks involving Corizon, once the nation's largest prison health care provider. David Jones, the chief bankruptcy judge for the Southern District of Texas, and Elizabeth Freeman, his former law clerk and a successful bankruptcy attorney, have secretly been in a romantic relationship. Freeman represented YesCare Corp. in the settlement talks. And the talks were overseen by Jones.

St Louis Post-Dispatch: Rep. Cori Bush says St. Louis jail’s medical provider has never been effective or responsible
U.S. Rep Cori Bush, D-St. Louis, demanded the jail’s commissioner answer questions about the facility’s policies, procedures, conditions and treatment in the wake of three men dying at the City Justice Center within the past six weeks. St. Louis Mayor Tishaura O. Jones released a statement announcing she was creating a new position to oversee medical operations at the jail. Jones’ statement also confirmed that the city would not renew a contract with the jail’s medical provider, Corizon. Bush’s progressive Democratic partner in the U.S. Senate, Elizabeth Warren (D-Mass) has raised concerns about Corizon’s liability following its recent bankruptcy filing.

St Louis Post-Dispatch: St. Louis board OKs adding 11 city health employees to oversee medical care at jail
A city board a new request by Mayor Tishaura O. Jones to add 11 health department employees to strengthen medical care at the city jail downtown. The action by the Board of Estimate and Apportionment, the city’s top fiscal body, follows several deaths of inmates in recent years. The new employees, he said, would work with a yet-to-be-selected private medical care company at the jail, which is called the Justice Center. They will work with the firm to audit and provide oversight, he said.

Correctional Health Partners
Colorado Politics: Federal judge orders prison contractor to get medical care for suicidal detainee
A federal judge last week ordered a contractor for the Colorado Department of Corrections to obtain medical care for a detainee's diseased colon, after it spent months allegedly doing nothing in the face of the man's extreme pain and suicide attempt. Arthur Burnham, who is incarcerated at Centennial Correctional Facility filed a temporary restraining order in August seeking to force Correctional Health Partners to immediately arrange for treatment of his failing colon. Although U.S. District Court Judge Charlotte N. Sweeney did not take action on Burnham's request for two months.

Robert Karas
Washington Post: Inmates given ivermectin in jail will each get $2,000 after settlement
When five detainees at the Washington County Detention Center in Fayetteville, Ark., got sick with covid-19 in August 2021, they were given a “cocktail” of drugs to treat the virus, a lawsuit alleged. They later discovered that Robert Karas, the doctor who provided the detention center’s health care, had treated them with ivermectin — the deworming drug pushed by some conservatives as a cure for covid, despite warnings from the Food and Drug Administration

The Provincetown Independent: County Jail Ends Contract With Medical Provider Wellpath
Sheriff Donna Buckley ended the Barnstable County Correctional Facility’s contract with private medical care provider Wellpath two months before the contract was set to expire at the end of this month. Buckley said this week that the county jail moved to in-house medical care. The for-profit vendor, owned by a private equity firm and operating in prisons across the country, had proved unable to meet its staffing obligations since 2020, Buckley said.