Weekly Update: June 4, 2024
How Will Incarcerated Medicaid Beneficiaries Impact Correctional Operations?

COCHS WEEKLY UPDATE: June 04, 2024


Highlighted Story

Editor's Note
This week's highlighted story talks about Darrell Palmer, who while incarcerated in the Allegheny County Jail required surgery to repair a hernia but was unable to receive it. As our subscribers may know, Medicaid currently pays for inpatient care when someone who is in a jail or prison is in an inpatient facility for more than 24 hours. Darrell’s surgery would have required him to be in the hospital more than 24 hours.

The operational challenges this story describes show just how complicated health care delivery within corrections can be. The article outlines the steps that Darrell went through to be approved for surgery and the stumbling blocks that arose which prevented treatment. As the article details if there were time delays between any step, which often occur within corrections, the process would need to be repeated and surgery delayed.

In light of the 1115 waivers being submitted and approved for Medicaid coverage within corrections (Pennsylvania submitted an 1115 waiver in January), this story raises the question of what might have changed if Darrell had a Medicaid entitlement while incarcerated. As it is now, the provision of health services at the Allegheny County Jail are unregulated and the jail was able to create and enforce the barriers described in the article. Had Darrell been a Medicaid beneficiary while incarcerated, Pennsylvania’s Bill of Rights for Medicaid beneficiaries would have enabled Darrell to obtain timely surgical relief. We point this out to our subscribers to further demonstrate the operational changes that will be required once incarcerated individuals have the same rights to care that any Medicaid beneficiary has in the community.

Public Source: When someone in jail needs surgery, it’s no simple operation
Darrell Palmer was suffering from a large ventral hernia that had become unbearably painful while incarcerated. Palmer said jail medical staff had told him he had been scheduled three separate times for hernia surgery that never occurred. (The county gets a fiscal break when an incarcerated person is hospitalized for more than 24 hours. Federal law says that Medicaid can then be billed.) His medical records from the jail detail three appointments in 2021 and 2022 with two different Allegheny Health Network surgeons. After an emergency room visit in September 2023, he was not taken to the recommended Sept. 26 follow-up appointment with one of those surgeons. The following day, a physician’s assistant at the jail wrote in his progress notes that the appointment would have to be rescheduled. Per jail policy, incarcerated people are not informed of the date or time of their off-site medical appointments, for security reasons. Medical staff sometimes have to reschedule surgeries whenever somebody accidentally let [a patient] know that their surgery was the next day, in part for fear that family members or people with ill intent might come to the hospital.




Medicaid

Office of Senator Bill Cassidy: Cassidy Highlights Need to Protect Medicaid Access for Pre-Trial Detainees, Address Fentanyl Crisis
U.S. Senator Bill Cassidy, M.D. (R-LA) highlighted his Due Process Continuity of Care Act, which ensures pre-trial detainees are not kicked off Medicaid before being found guilty of a crime, today at a U.S. Senate Finance Committee Hearing on the fentanyl crisis. With Medicaid denying access to care, the responsibility for care for detainees struggling with addiction is shifted onto local jail budgets, resulting in unmet needs. Currently, pre-trial detainees comprise approximately two-thirds of people held in local jails.

George Mason University: More Medicaid Needed for Incarcerated Individuals with Substance Abuse Disorders
A new study examining how state Medicaid programs are helping people with substance use disorders (SUD) uncovered the need to expand the programmatic features to assist individuals who are transitioning in and out of the criminal justice system. Most states did not have specific Medicaid programs targeting people with SUD in the criminal justice system.

NC Health News: Local councils help people coming home from jail, prison make the transition
The McDowell County Reentry Council, a Local Reentry Council is an organized network of individuals, community organizations and agencies that work together to provide formerly incarcerated people with needed resources and services such as housing, transportation, employment, getting signed up for Medicaid, substance use treatment and more. In 19 counties across North Carolina, reentry councils are a key force supporting people and facilitating smoother experiences back in the community.




Opioid Epidemic

NASHP: State Opioid Settlement Spending Decisions
States are in different places in the settlement decision-making process. While NASHP is not tracking expenditures made at the county or local level, the “Announced Awards” and “Published Recommendations” maps show a snapshot of which state agencies or statewide opioid abatement funds that have publicly-available information about settlement spending. The “Spending Authority” map details which body (i.e. state, local, abatement fund, or split) receives and delegates the majority of settlement funding. For details on the definitions used to categorize each map, see the definition box below.

LAPPA: Model Pharmacist Collaboration for Medication for Opioid Use Disorder Act
The Model Pharmacist Collaboration for Medication for Opioid Use Disorder Act, drafted in collaboration with the Center for Health Law Studies at the St. Louis University School of Law, is intended to help save the lives and improve the health and quality of life of individuals who have an opioid use disorder (OUD) by expanding access to and availability of medication for OUD. The Act does so by increasing the health care workforce that provides medication for OUD by authorizing pharmacists to: (1) prescribe medications for OUD for treatment and refer patients for long-term treatment; and (2) prescribe, initiate, monitor, and adjust long-term treatment pursuant to collaborative practice agreements for collaborative drug therapy management.

WUNC: Many NC jails violate legal requirements by skipping meds for opioid use disorder
Jails have a legal responsibility to provide medications for opioid use disorder because people with opioid use disorder are protected under the Americans with Disabilities Act. Guidance from the U.S. Department of Justice issued in April 2022 states that it is a violation of the ADA if correctional facilities do not continue an individual on the medications to treat their addiction that they were receiving in the community before incarceration. Many North Carolina jails have yet to meet these legal requirements. Only about one-third of 92 jails provide medications for opioid use disorder in their facilities.




Mental Health

Academy of Correctional Health Professionals: Webinar: Common Mental Health Conditions in Correctional Settings (June 11, 2024, 1PM ET)
According to data from the Bureau of Justice Statistics, 41% of individuals incarcerated in state and federal prisons and 44% of individuals detained in jails report having been diagnosed with a mental health disorder. The term “mental health disorder” can describe a vast array of symptoms and experiences. In this workshop, we will identify the most common mental health conditions afflicting individuals who are incarcerated.

Kansas City Star: ‘We lack empathy.’ More Missourians stuck in jail waiting for mental health treatment
The number of people languishing in Missouri jails waiting for hospital beds to open up continues to rise and state lawmakers this year allocated no additional funding to alleviate the crisis. Across the state, 302 people are stuck in jails waiting to be moved to a mental health facility for treatment, according to a spokesperson for the Missouri Department of Mental Health.

New Press: We are failing both mental health patients and the public
A Southwest Florida man has been an unfortunate and frequent inmate at both the Lee and Charlotte County jails. Without proper medications, he becomes paranoid. He has threatened to kill his parents, police officers, medical staff, and the public. He has spent his entire life caught between Florida’s mental health and judicial systems. His mother has tried to advocate for her son his entire life. Her numerous calls to obtain appropriate help and care fall on deaf ears. The difference between a person with cancer and a person who has psychosis is that a person with cancer is willing to accept treatment. A person without awareness of their illness needs the system to step in and advocate for the care that they need.




BOP

Office of Senator Jon Ossof: U.S. House Passes Sens. Ossoff, Braun, & Durbin, Rep. McBath & Armstrong’s Bipartisan Bill to Overhaul Federal Prison Oversight
The bipartisan Federal Prison Oversight Act would establish new, independent oversight of the Federal Bureau of Prisons (BOP). It passed the U.S. House in an overwhelmingly bipartisan vote and now heads to the U.S. Senate. This legislation would also establish an independent Ombudsman to investigate the health, safety, welfare, and rights of incarcerated people and staff. The Ombudsman would create a secure hotline and online form for family members, friends, and representatives to submit complaints and inquiries.

Office of Ron Wyden: Following Horrific Findings at FCI Sheridan, Oregon Lawmakers Demand Federal Bureau of Prisons Address Staffing Shortages and Other Alarming Risks
Oregon’s congressional delegation Friday demanded that Colette S. Peters, director of the Federal Bureau of Prisons, take swift action to address significant staffing shortages, inadequate medical care and other “alarming issues” that put staff and inmates at risk in the federal prison in Sheridan. They shared their concerns in a letter to Peters two days after the U.S. Department of Justice’s Inspector General Michael Horowitz released a scathing report stemming from an unannounced inspection of the prison in November and December.

KCBY: Report finds staffing shortages led to inadequate medical care at Oregon federal prison
A report from the Office of the Inspector Generalat the U.S. Department of Justice found a federal prison in Sheridan, Oregon is lacking adequate medical care and access to basic programs and recreation time as a result of severe staffing shortages. The report details an instance where an inmate reportedly faked a suicide attempt in order to get medical care for an ingrown hair that had become so severely infected he ended up hospitalized for five days because of it.

Miami Herald: Rival gangs brawl inside Miami’s federal prison, sources say. 4 treated for injuries
Miami’s federal prison devolved into chaos as two rival gangs participated in a violent, bloody brawl. According to a law enforcement source familiar with the incident, two rival gangs started a large brawl in which inmates were stabbed, stomped on and chairs were thrown. The source described the brawl as “a bloodbath.”

ProPublica: This Mississippi Hospital Transfers Some Patients to Jail to Await Mental Health Treatment
Roughly 200 people in DeSoto County were jailed annually during the civil commitment process, most without criminal charges, between 2021 and 2023. About a fifth of them were picked up at local hospitals. The overwhelming majority of those patients were at Baptist Memorial Hospital-DeSoto, the largest in this prosperous, suburban county near Memphis. The practice appears to be unusual even in Mississippi, where lawmakers recently acted to limit when people can be jailed as they go through the civil commitment process.




Cost of Corrections

Yahoo: How Much Each State Spends on Prisons
Make no mistake about it, the prison industry is just that — an industry. The criminal legal system relies on both federal and state prisons to hold incarcerated people and support public safety. Prisons and jails come with an immense financial burden, but they also can turn a profit as private prisons can almost incentivize the criminal justice system. When you look at how much the U.S. spends on the prison system it can be eye-opening. In a recent GOBankingRates study, it was discovered that the country, as a whole, spends over $86.9 million on corrections. This comes out to be about 1.93% of the total budget.

Alabama Reflector: General Fund grows, but Medicaid and Corrections consume more of it
The General Fund budget for 2025, approved by state lawmakers earlier this month, is the largest in state history. The Alabama Department of Corrections’ budget went from $197 million in that timespan to $737 million, a 274% increase. Other states have seen Corrections budgets skyrocket. The state was already behind the curve because lawmakers grew the Corrections system without making needed investments to house its incarcerated population safely and adequately.




Tasers

New York Times: ‘Did You Tase Him in the Face!?’ Inside ‘Goon Squad’ Deputies’ Group Chat
Between vacation photos and cookout invitations posted on their private text thread, a group of Mississippi sheriff’s deputies who called themselves the Goon Squad traded pictures of rotting corpses and joked about rape and shocking people with Tasers. They did it all in front of their supervisor, who often joined in the banter.

NBC: Bibb County inmate dies after being tased following medical emergency
During watch in the Law Enforcement Center of Bibb County, GA, deputies discovered an inmate behaving strangely, having a medical emergency. While being screened for medical conditions, the inmate became combative with assisting medical staff and deputies who were attempting to treat him. A taser was deployed in an attempt to control the inmate. The taser had no effect on the inmate.




State Roundup

California
Corrections 1: Calif. to examine medical staffing at state prisons and hospitals
California will evaluate the outsourcing of medical and mental health care services at state prisons and hospitals with an audit request suggesting it costs the state up to three times more for contracted medical staff compared to using state employees. The California Association of Psychiatric Technicians, which represents care providers within the Department of State Hospitals, has 1,300 of its 4,300 budgeted positions vacant, a 30% vacancy rate. At some Department of Corrections and Rehabilitation facilities, the vacancy rate is as high as 45%.

San Francisco Chronicle: Chemical release at San Bruno jail sickens nearby schoolchildren
Chemicals being used in a training exercise Tuesday afternoon at the San Francisco jail in San Bruno got out of control, wafted over a hill and sickened 20 schoolchildren and one adult who were left with irritated eyes, throats and noses, officials said. The chemicals, which included tear gas and pepper spray, didn't send the Portola Elementary School victims to hospitals, but ambulance and San Bruno Fire Department responders dashed to the scene.

Georgia
Corrections 1: Ga. corrections officer charged with murder in death of inmate
A Georgia correctional officer has been charged with murder in the death of a state prison inmate, a rare charge that adds a new dimension to the ongoing crisis related to violence and corruption within the Georgia Department of Corrections. Lloyd Hopkins, a correctional officer at Augusta State Medical Prison, was charged with murder, aggravated assault and violation of oath of office in connection with the death of Roderick Hayes.

Massachusetts
Greenfield Recorder: Health care gaps create reentry hurdle for incarcerated individuals
Despite ongoing reform efforts, the Massachusetts prison health care system continues to be confronted with significant challenges, deeply affecting the well-being of incarcerated individuals and complicating their reentry into society post-release. Those challenges include systemic factors, social stigma and gaps in health care. Mary Ellen Mastrorilli, associate chair of applied social sciences at Boston University’s Metropolitan College, said mental health issues and substance use disorders are usually not addressed within the prison system, with health care service limited to emergency psychiatric care.

Ohio
Cleveland.com: Cuyahoga Sheriff estimates $40 million overruns for jail operations, medical services
The Cuyahoga County Sheriff’s Office needs nearly $27 million to provide medical services for inmates in the jail through January 2025 and is projected to need another $13 million by the end of the year to cover other operational costs. Under the county’s current contract with MetroHealth the hospital makes all decisions about the type of care inmates need and where it is received. Aisha Parnell, MetroHealth’s director of nursing for correctional medicine, listed numerous compounding factors that have increased costs , including higher salary costs for nursing, a higher daily population in the jail in need of medical attention, and increased use of costly medicines for illnesses like cancer and HIV.

Oregon
Salem Reporter: Medical visits backlogged at Oregon women’s prison as hundreds wait months for care
The medical staff at Oregon’s only women’s prison either failed to complete or significantly delayed the routine care and annual wellness exams and preventative cancer screenings, public records from an inspection of the facility’s medical services shows. The prison faces other problems that include sexual abuse and a culture of retaliation that discourages staff and women from reporting wrongdoing.

Pennsylvania
Pittsburgh Post-Gazette: Food poisoning and malnutrition can't be punishments for lawbreaking
Inmates in Pennsylvania state prisons are being served food so nutritionally deficient it should be considered its own form of punishment. Withholding adequate nutrition from prisoners already at the mercy of the correctional system — and causing health issues that can last a lifetime — is inhumane. A recent study from the Pennsylvania Prison Society, as reported by the Philadelphia Inquirer, found just how much funding has dropped: The Department of Corrections’ daily spending on food per inmate went from $11.09 in 1996 to $5.08 in 2023.

Texas
Reason: 3 People Died of Thirst in a Texas County Jail in Under 2 Years
A woman with severe mental illness died of dehydration in a Texas jail despite having ready access to water. A local TV station found that she was one of at least three people who died that way in one county within a two-year period. According to a federal lawsuit filed against the jail by her sons last year, Baldwin was clearly in the throes of a severe mental health episode. Despite a detective recognizing that Baldwin was unwell, the lawsuit claims, she was arrested for making a terroristic threat to a peace officer—a felony charge—and sent to jail in Tarrant County, Texas.




Correctional Officers

TribLive: Improving mental health services for correctional officers
The National Institute of Justice has found the very debilitating effects of working as a correctional officer “stem from two primary sources: the demands of responding to critical incidents within the correctional facility (and) organizational stressors ranging from understaffing shifts to toxic environments.” The study found the suicide rate of correctional officers is seven times the national average. An Allegheny County Jail study found the life expectancy of officers is 61, 16 years below the national average.




Bail

Brennan Center For Justice: How Profit Shapes the Bail Bond System
Every day in courtrooms around the country, judges decide whether to release, detain, or set bail for people charged with crimes. For many, those conditions include an amount of money that is often beyond their ability to pay. Evidence shows that this unfair system is ineffective at advancing public safety. But efforts at reform often run into challenges. One reason is lobbying by a for-profit industry, whose revenue of about $2 billion a year depends on people being unable to afford to pay bail upfront. The United States is only one of two countries (the other is the Philippines) where the profit motive dominates the legal system in this way.




Correctional Health Care Providers

Wellpath
WNEP: In prison death lawsuit, federal judge lets claims against Luzerne County and medical provider survive
A federal judge this week allowed a lawsuit to move forward on claims alleging that Luzerne County and its jail's medical provider, Wellpath, are liable for an inmate's death more than three years ago. The lawsuit stems from the death of Mary Ellen Balliet, 30, in August 2020. Pittston police arrested her on bench warrants and brought her to the Luzerne County Correctional Facility. She was dead in a cell by the next day. Her father brought a lawsuit two years later that alleged jail and Wellpath staff stood by while she was "physically deteriorating and dying right before their eyes."

Colorado Politics: Federal judge refuses to dismiss lawsuit against Jeffco jail contractor for detainee's death
A federal judge earlier this month refused to dismiss a constitutional rights lawsuit filed against the Jefferson County jail's medical contractor, Wellpath, involving multiple personnel who allegedly failed to provide adequate care to a detainee before she died of an infection. In a May 20 order, U.S. District Court Judge Charlotte N. Sweeney denied Wellpath's motion to dismiss.

Centurion
Corrections 1: Lawsuit accuses Ga. prison system of violating state law to replace healthcare provider
The Georgia Department of Corrections has awarded a $2.4 billion contract for healthcare in the prison system to a new company without the competitive process required under state law, the present contractor alleges in a lawsuit. Wellpath, the Nashville-based company that has provided healthcare for the department, also asserts that it was blind-sided by the out-of-control violence in Georgia prisons. The lawsuit adds another wrinkle to the numerous issues confronting the GDC, contending that the agency engaged in conduct that was “truly unprecedented” when it decided in April to award its healthcare contract to Virginia-based Centurion Health.

Wexford
Miami Herald: Inmate needed an amputation after medical needs ignored, suit says. Doctor owes $400K
An Alabama inmate’s toes needed to be amputated after a blister on his foot turned into a wound that wasn’t properly treated, according to a federal lawsuit against his prison doctor. The jury found that Dr. Manuel Pouparina, the prison’s medical director, “was deliberately indifferent to the necessary medical needs of Canyon Moye,” according to a verdict form signed May 20. Pouparina and the prison’s medical staff were employed by Wexford Health Sources Inc., a correctional healthcare provider.

Naphcare
Wyoming Public Radio: Wyoming Department of Corrections severs ties with embattled prison medical company
After working with the same prison medical company for 18 years, the Wyoming Department of Corrections is on the cusp of entering into a new partnership designed to serve the needs of inmates across the Cowboy State. NaphCare is a correctional healthcare management company that is currently partnered with 170 facilities across 34 states. They will replace YesCare, Wyoming’s outgoing contractor, beginning July 1.