Medicaid: The Necessary Bridge For Continuity of Care Between Community & Corrections?

Highlighted Stories

Editor's Note

This week’s highlighted stories come from St. Louis, Missouri, and Denver, Colorado. In St. Louis, an individual died at the Justice Center on Sunday, March 23, just one day after being admitted to—and discharged from—Barnes Hospital. In Denver, an article features the Sheriff and mental health professionals discussing how individuals reentering society from correctional settings are often lost to follow-up care, increasing the risk of rearrest due to unresolved mental health issues.

Both the St. Louis incident and the Denver report underscore the urgent need for stronger connections between community healthcare providers and correctional facilities. Too often, jails and prisons operate in silos, with little or no data exchange with outside healthcare providers—leaving dangerous gaps in continuity of care.

Without a unified payer covering community health services and correctional health services, there is little structural incentive to coordinate care. COCHS remains hopeful that Medicaid can serve as this unifying mechanism—whether through an 1115 waiver or Section 5121 of the Consolidated Appropriations Act of 2023. Additionally, HRSA’s PIN 2024-05, which allows Federally Qualified Health Centers (FQHCs) to deliver certain health services to incarcerated individuals, could become a crucial linchpin—helping to bridge data systems and ensure smoother care transitions. In sum, these mechanisms could help address the revolving-door dynamic described in the Denver article.

Continuity of Care

A man detained at the St. Louis Justice Center died after he was found unresponsive and rushed to Barnes-Jewish Hospital, according to a statement from the Interim Corrections Commissioner Doug Burris. "The detainee was taken to St. Louis University Hospital (SLUH) on March 22, after CJC staff found him on the floor at the jail," Burris's statement said. The detainee, who wasn't named was discharged from SLUH and returned to the City Justice Center on Saturday. The facility has seen now 19 detainee deaths since 2020.

23,000 people are taken into custody each year in the City and County of Denver, according to Sheriff Elias Diggins, and some of them have already been through the system before. All of them get mental health assessments, and 60% of them receive some kind of mental health treatment, according to Denver Health. The hospital partners with the jail to treat inmates. CEO of Mental Health Colorado Vincent Atchity said he has concerns about what happens when the inmates are released. He called it a "revolving door experience" because inmates lose that consistent access to care, or don't seek it out, and go back into our communities and re-offend. Sheriff Diggins said the jail does try to offer solutions, like letting the inmate leave with a 30-day prescription of the medications they were given, but it's on the inmate to get it filled. Diggins admits that can be challenging.

Follow Ups

Editor's Comment: The wildcat strike in New York State’s prison system may be over, but its repercussions continue, according to a report from the Legal Aid Society. During the strike, access to medical care was severely limited, and in its aftermath, safety concerns remain heightened.

Wildcat Strike (New York)

The Legal Aid Society released a report detailing the ongoing and immense damage inflicted upon incarcerated New Yorkers as a result of the unauthorized strike by New York State Department of Corrections and Community Supervision (DOCCS) staff, which lasted for weeks and impacted dozens of upstate prisons. According to personal accounts from twenty-four New Yorkers incarcerated in prisons affected by the unauthorized work stoppage, conditions in the prisons deteriorated rapidly during the strike, and these facilities continue to be plagued by health, safety, and human rights violations.

Homelessness

Next week, April 10, join the IIP for a webinar, Beyond Criminalization: Homelessness and Criminal Justice, will explore innovative responses to quality of life crimes and homelessness. The webinar will focus on proven strategies that prosecutors and local government stakeholders can employ to scale back punitive measures that criminalize poverty rather than promote public safety.

President Donald Trump is vowing a new approach to getting homeless people off the streets by forcibly moving those living outside into large camps while mandating mental health and addiction treatment — an aggressive departure from the nation’s leading homelessness policy, which for decades has prioritized housing as the most effective way to combat the crisis. White House officials haven’t announced a formal policy but are opening the door to a treatment-first agenda, while engineering a major overhaul of the housing and social service programs that form the backbone of the homelessness response system that cities and counties across the nation depend on. Nearly $4 billion was earmarked last year alone.

ICE

The Trump administration is seeking to bring back juvenile detention centers for unaccompanied immigrant children, just as a critical contract providing legal services to these minors who enter the US without their parents is in jeopardy. These policy changes mark a substantial shift in the way that the US treats unaccompanied children who come to the country without a parent or legal guardian, many fleeing violence and abuse. Immigration lawyers and advocates have long called for the government to stop using the facilities, which they say have “consistently facilitated and invited abusive, punitive, and traumatizing treatment of children.”

State Roundup

Alaska

In Alaska, there have been at least 114 prisoner and inmate deaths from 2015 to 2024, according to new Department of Corrections data. DOC is required to provide prisoners and inmates “essential care,” according to Travis Welch, the DOC Director of Health and Rehabilitative Services. “Essential care isn’t Cadillac care, but it also is not substandard care,” Welch told lawmakers in Juneau earlier this month. Information released this month by the DOC shows that Alaska’s in-custody suicide rate is second highest, only behind Rhode Island, from 2001-2019 for unified correctional systems; that’s a term to describe when state-level prison and jail systems are under a single agency, which includes Alaska and five other states.

The Alaska Department of Corrections has had at least 67 people die in-custody of state prisons and jails since 2020, with at least 17 deaths reported as suicides, according to the department. There were at least 14 deaths last year. Two deaths were reported so far this year, with one investigated by the Alaska State Troopers and reported as a suicide. State officials gave a presentation to lawmakers with the House State Affairs Committee on March 4, describing causes of death from 2015 to 2024, as well as demographics and mitigation efforts.

Arkansas

A settlement reached between the state of Arkansas and a coalition of groups, including the ACLU of Arkansas, means certain covid-19 protocols in state prisons will be extended by one year from the time of the agreement, according to recent court filings. The settlement is the result of a civil rights lawsuit filed in April 2020 that sought relief “against the substantial risk of covid-19 infection, illness, and death while incarcerated in facilities operated by the Arkansas Department of Corrections.”

California

California has signed a contract worth up to $315 million with Securus Technologies—a company that has sued the state multiple times and faced lawsuits for recording calls between prisoners and their attorneys. The agreement, reached last month with the California Department of Corrections and Rehabilitation, includes $189 million over six years, with four optional one-year extensions. The state originally awarded the tablet contract to ViaPath, but Securus—its main competitor—sued, claiming the bidding process was unfair. A judge agreed, leading to a new process in which Securus secured the deal. The company has previously settled lawsuits in several states over the improper recording of attorney-client calls.

Colorado

A 69-year-old man slowly suffocated to death in a rural Colorado jail after his ribs were broken in an altercation with a deputy and he languished in a cell for a week without medical care, according to a lawsuit announced Thursday. Michael Burch's 2023 death was ruled a homicide. Prosecutors declined to bring criminal charges against the deputy who used a Taser on Burch and wrestled with him in a Huerfano County jail cell. In making the decision, District Attorney Henry Solano cited self-defense laws. An autopsy found six of Burch’s right ribs had broken and his right lung collapsed. He wasn’t taken to a hospital but instead was transferred to another cell where he was found dead seven days later.

Florida

Starting in the 2010s, many of the country’s reddest states began enacting serious criminal justice reforms, culminating on the federal level when President Donald Trump signed the First Step Act in 2018, which reduced excessive federal prison sentences and encouraged rehabilitation. But despite those efforts in places like Georgia, Louisiana, and Texas, the movement largely bypassed Florida, despite the best intentions by lawmakers like former Republican state Sen. Jeff Brandes.

Hawai'i

Hawaiʻi has agreed to open its prisons and jails for inspection by two national experts who will assess the state’s troubled inmate mental health services. The agreement was reached as part of ongoing efforts to resolve a federal lawsuit filed in 2019 over prisoner suicides. There is no agreement yet on financial aspects of the case. Twenty of the department’s 23 psychologist positions are vacant, and one of the three filled positions is held by a provider who has not yet passed the psychologist licensing examination, legislators were told. There were five suspected or confirmed suicides by Hawaiʻi inmates in 2024.

Mississippi

Bryan Bailey, the Mississippi sheriff whose department had been under federal investigation for torturing people, staffed his mother’s commercial chicken farm with inmates from the county jail and used taxpayer-purchased equipment to improve the grounds, according to four former inmates and a former deputy who said they had worked on the farm. The reporting revealed that for most of his 13 years in office, Sheriff Bailey used his position as the highest paid and most powerful public figure in his suburban county in ways that financially benefited himself and his family.

The Mississippi State Auditor’s office said it had launched an investigation into allegations that Rankin County Sheriff Bryan Bailey had staffed his mother’s commercial chicken farm with jail inmates who were in his custody. The investigation follows an article published Thursday by Mississippi Today and The New York Times in which former inmates and a former deputy described working on the farm and using equipment and supplies bought with taxpayer money.

Oklahoma

Nearly one in six Oklahoma prisoners was 55 or older as of Dec. 31, according to Department of Corrections data. While the state has made progress in reducing its overall prison population, this demographic of aging inmates has doubled since 2009 and almost quadrupled since 2000. The Department of Corrections allocated $111 million for health services in its fiscal year 2025 budget, a 91% increase from the $58 million spent in 2015. Total state appropriations to the agency have increased about 15% over the past decade.

Oklahoma Representative Justin Humphrey has introduced HB1343T, a bill that would eliminate the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) and shift its duties to the Department of Corrections (DOC). Humphrey argued that ODMHSAS has failed to provide adequate mental health facilities, especially for inmates, leaving jails unequipped to handle individuals with serious mental health needs. This, he claimed, has led to a surge in lawsuits and puts jail insurance coverage at risk—potentially resulting in higher taxes for residents. He referenced a recent death at the Lawton Correctional Facility, described as a beheading, to illustrate the system’s inability to care for mentally ill inmates.

Pennsylvania

The Philadelphia Department of Prisons (PDP) is proud to recognize and thank members of our correctional staff who have been trained to administer overdose-reversing doses of Naloxone (Narcan) to members of the incarcerated population and have been successful to date. According to PDP Chief of Medical Operations Dr. Bruce Herdman, nearly 70 percent of the PDP population suffer from a substance abuse disorder (SUD) and can experience overdose distress early in their incarceration.

Virginia

Richmond Sheriff Antionette Irving has reached a wrongful death settlement with the family of a man who died of an overdose in the city’s jail during 2023. It’s one of at least three federal cases Irving is facing over in-custody overdose deaths that occurred in 2022 and 2023. Steven Carey died from a fentanyl overdose at the Richmond City Justice Center in January 2023. The lawsuit alleged violations of Carey’s constitutional rights and that Irving was negligent for allowing him and others “unfettered access” to fentanyl, claiming the sheriff “seemingly promoted, or at least permitted an inhumane environment to fester without taking any remedial or mitigating actions.” The Carey family’s lawsuit claimed three people held at the jail, including Carey, died from fentanyl between March 2022 and January 2023.

Washington State

At a Renton City Council committee meeting last week, Devon Schrum, the director of South Correctional Entity (SCORE), defended her record and her staff at the jail, which is owned by six cities in south King County. Schrum said the deaths at the jail were “hard. It is awful. And [that’s] why we have invested so much in our staff, in the facility and our training and the equipment to try to prevent the next death.” During her presentation, Schrum noted that SCORE’s medical and opioid treatment programs are accredited by the National Commission on Correctional Health Care and that SCORE spent at least $7 million, more than a fifth of its budget, on health care. SCORE nurse Lisa Rogers, who told PubliCola she was fired for speaking up about substandard conditions at the jail, said she was the only staff member qualified to give full medical care during the night shift to more than 400 residents in custody at SCORE.

Rikers Island

The young detainee who appears to have died of a ruptured appendix and infection began showing serious medical issues in the city jails as long as three days before he collapsed on Rikers Island and was rushed to the hospital, the Daily News has learned. Ariel Quidone, 20, collapsed March 13 at the Robert N. Davoren Center and was taken by medics in grave condition to Elmhurst Hospital where he needed to be revived 14 times before he died March 15. But on March 10, three days after he entered the jail system after being arrested on robbery charges, he was already throwing up and exhibiting extreme distress. Yet, he was not taken to the hospital at that point.

Voices Of Incarcerated People

Dying in a maximum security correctional facility is not a proposition that anyone looks forward to, but it happens way too often here at New Jersey State Prison. And when one person passes away, it directly impacts others, from their close friends and neighbors, to the officers and medical staff who have to handle their body. Adding to the collective stress is how little we prisoners know about what’s happening in real time. When you’re locked in a cell, you have to rely on obstructed views, surrounding sounds and chatter to fill in the gaps.

Correctional Healthcare Providers

Wellpath

Several groups advocating on behalf of people incarcerated at Santa Rita Jail are calling on the Alameda County Sheriff’s Office to end its contract with Wellpath, the private company that provides health care services in the jail. In October 2022, the Alameda County Sheriff’s Office entered into a $252 million, five-year contract with Wellpath, one of the nation’s largest for-profit healthcare providers for incarcerated people. Based in Nashville, Tennessee, and owned by the private equity group H.I.G. Capital, Wellpath has made headlines in recent years for being the target of more than 1,500 lawsuits from multiple states. The push to replace Wellpath in the jail follows a series of audits that were critical of Wellpath’s performance.

In 2023-24, the Santa Barbara County Grand Jury found that Wellpath, the private contractor responsible for providing medical and mental health services in the county's jails, was not meeting staffing requirements outlined in their contract. The shortcoming, the Grand Jury found, led to the county overpaying Wellpath by approximately $500,000. “One of the key discoveries was that Wellpath had not staffed the jails according to the terms of the contract. The Sheriff’s Department didn’t notice, and as a result, the county was paying more than it should have,” said Dale Kunkel, grand jury foreperson. The shortcoming, the Grand Jury found, led to the county overpaying Wellpath by approximately $500,000.

NaphCare

The family of Isaiah Trammell is suing Montgomery County and the county jail’s medical service provider. The 19-year-old suffered serious injuries while in police custody in June 2023, dying three days later. His death was ruled a suicide, but his family says they want accountability. Following Isaiah’s death two years ago, the Trammell Family is suing Montgomery County and NaphCare — the healthcare company that provides medical services to people in custody at the Montgomery County Jail. The lawsuit claims that actions by the defendants led to Isaiah seriously injuring himself and subsequently dying, something legal counsel for the family says could have been avoided.

Wexford

The Alabama Supreme Court recently ruled that the case of a man who died by suicide in Limestone Correctional Facility will remain in the Montgomery County court system. From 2017 to 2018, Timothy John Chumney was undergoing regular mental health evaluations after he was beaten and raped by a group of six inmates a few days into his six-year sentence at Easterling Correctional Facility, court documents state. Wexford began providing health-care services to Alabama’s correctional facilities on April 1, 2018. Nurse practitioner Deora Johnson and counselor Shari Barfield reported Chumney as a moderate suicide risk and ordered him to undergo mental-health observations with suicide precautions.