End Our Medicaid 1115 Waiver, Pennsylvania Legislators Ask RFK Jr.; The Role of Medicaid In The Grievance Process

Highlighted Stories

Editor's Note

This week’s first highlighted article, from the Detroit Free Press, underscores just how ineffective traditional carceral grievance processes can be. It also illustrates how corrections systems may create alternate channels that undermine legitimate complaints. A federal judge recently castigated the Michigan Department of Corrections (MDOC) for subverting its formal three-step grievance process by directing prisoners to an informal alternative known as the warden’s forum. As the judge noted, this maneuver effectively blocks incarcerated individuals from pursuing grievances through the proper, formal channels.

In multiple Editor’s Notes (see Weekly Update of October 22, 2024), COCHS has expressed skepticism about the effectiveness of internal grievance processes in carceral settings, particularly regarding medical care. As we've pointed out, these processes are often inadequate.

However, with Medicaid coverage now being extended behind the walls in some jurisdictions, a new and independent grievance mechanism is emerging. Incarcerated Medicaid beneficiaries—like all Medicaid beneficiaries—have the right to file grievances when they believe a healthcare provider or payer has made decisions contrary to their health and well-being. This Medicaid grievance process would operate outside of carceral systems, offering an alternative and potentially more accountable path.

But as we have noted since the election of Donald Trump—and with Republicans now in control of both chambers of Congress—the anticipated changes to correctional healthcare through Medicaid coverage behind the walls could be severely curtailed by potential budget cuts to the program. In the second highlighted article, Republican state legislators in Pennsylvania have written to Health and Human Services Secretary Robert F. Kennedy Jr., urging him to reconsider their state’s 1115 waiver as too costly. Only time will tell whether other state legislators will follow suit.

Grievance

A federal judge has blasted the grievance process for state prisoners as one that obstructs, deflects and improperly rejects legitimate and timely complaints. U.S. Magistrate Judge Elizabeth Stafford issued a 38-page report in a lawsuit filed by prisoners at Women's Huron Valley Correctional Facility who allege damp and humid conditions there, along with poor ventilation, produced persistent mold that damaged their health. The Michigan Department of Corrections argued the lawsuit should be thrown out because the women did not properly "exhaust their administrative remedies," by completing a three-step grievance process that is required under the federal Prison Litigation Reform Act before prisoners can take most lawsuits to court. Though the case relates to Michigan's only prison for women, Stafford's criticism of the department's grievance process is broader, prompted largely by testimony from Richard Russell, the hearings and grievance administrator for the entire department. Stafford said that Russell testified during an evidentiary hearing that MDOC directs similar grievances from multiple prisoners away from the three-step process to instead be addressed at "warden's forum" meetings between the warden and prisoner representatives. Stafford said Russell was "plainly wrong" when he testified that prisoners could become eligible to sue by going to the warden's forum, rather than completing the three-step grievance process.

Revoke 1115 Waiver?

State Senate Republican leaders are lobbying the Trump administration to rescind Medicaid waivers that expand social services for low-income mothers and children, the homeless, and individuals set to leave incarceration. The debate over the specific policy, known as a Medicaid Section 1115 waiver, is wrapped up in two broader issues: President Donald Trump’s attempt to drastically downsize federal government, and Pennsylvania Republicans’ budget struggle with Gov. Josh Shapiro, a Democrat. In a letter dated Feb. 21, Senate GOP leadership in the state Senate wrote to U.S. Health and Human Services Secretary Robert F. Kennedy Jr. asking for his “review and reconsideration” of the approvals.

Follow Ups

Editor's Comment: In this week’s Follow Ups, the first article—unsurprisingly—returns to Wellpath’s ongoing bankruptcy. The report offers a glimpse into Wellpath’s business practices. In a lawsuit filed by attorneys for Cobb County, Georgia, it is alleged that Wellpath was required to carry its own insurance to cover settlements in the event of bankruptcy. The company appears not to have done so, and some are calling this a case of fraud.

We also return to San Jose, California, where, in the Editor’s Note of March 11, 2025, COCHS commented on Mayor Matt Mahan’s proposal to arrest homeless individuals who refuse shelter. The second Follow Up article suggests a significant lack of coordination between the city and Santa Clara County. County officials have reportedly said that individuals arrested under San Jose’s policy are likely to be released.

Wellpath's Bankruptcy

Two years after her brother died at Eastern Kentucky Correction Complex, Britney Jones sued the facility, claiming medical negligence by prison staff caused his death. Just as the case was nearing settlement, it abruptly stalled when Wellpath—the company insuring the prison—filed for bankruptcy last November. As of March 13, all 471 pending lawsuits against Wellpath across 27 states were paused. Some suits accuse the company of fraud. In Georgia, for example, lawyers allege Wellpath misled county officials about the type of coverage they provided. In addition to handling inmate medical care, Wellpath was responsible for covering settlements related to medical negligence and was supposed to carry its own insurance in case of bankruptcy. But Cobb County, Georgia, claims in a lawsuit filed Feb. 18 that Wellpath had no such insurance. When Cobb corrections officials were sued, Wellpath allegedly failed to cover the costs.

Homelessness

San Jose Mayor Matt Mahan wants Santa Clara County to scale up shelter and health treatment options in response to the city’s renewed crackdown on homelessness. During a City Council discussion on Mayor Matt Mahan’s 2025-26 March budget message, Councilmembers David Cohen and Domingo Candelas sought to involve county officials in the mayor’s “Responsibility to Shelter” initiative — which would allow for police to arrest homeless residents who refuse shelter after three attempts within 18 months. But county officials continue to scoff at the city’s plan to increase the detainment of homeless residents, leaving San Jose with an uphill battle in putting Mahan’s initiative to work. A spokesperson for the Santa Clara County Sheriff’s Office said residents arrested under the initiative would most likely be released.

Medicaid Lowering Crime Rates

President Trump has put Medicaid on the chopping block. Despite the White House’s promises that it would not make any cuts to the program, which provides one in five people nationwide with health care coverage, cuts would be all but certain if Trump’s budget agenda were to be implemented. These cuts threaten to undermine our safety by cutting Medicaid. States that expanded Medicaid as part of the Affordable Care Act (ACA) rollout, saw violent crime decrease by more than five percent. Other studies have found the impact of Medicaid expansion on crime to be even greater. Medicaid expansions also reduce the number of people released from prison who are reincarcerated within a year of their release by 11 percent.

Incarcerated Women

“With this new administration and Congress, we’re really on the precipice of a fundamental shift away from health coverage and health care,” says Gretchen Borchelt, VP for reproductive rights and health at the National Women’s Law Center. “Right now, Congress is debating these massive cuts to the Medicaid program, which will affect low-income folks throughout the country, and, in particular, women in their reproductive years, two-thirds of whom are enrolled in Medicaid. There is an outright hostility right now toward health access and health care. Women in prison are the canary in the coal mine.”

While Tracey Edwards was incarcerated in the North Carolina Correctional Institution for Women (NCCIW), prison officials abruptly cut off Ms. Edwards' medication for opioid use disorder (MOUD) after she gave birth, causing an extremely painful, dangerous, and unnecessary withdrawal. Prison officials also kept Ms. Edwards shackled during and after giving birth – in direct violation of the prison system’s own policy – causing severe pain and interfering with Ms. Edwards’ ability to bond with her newborn child. The ACLU of North Carolina has now joined the ACLU Disability Rights Program, Rights Behind Bars, Tycko & Zavareei LLP, and Kaplan & Grady LLC, in filing an appeal with the U.S. Court of Appeals for the Fourth Circuit on behalf of Ms Edwards.

Mental Health

NAMI has long advocated for the diversion of people with mental illness from the criminal justice system. Stigma surrounding mental illness and violence, along with an under resourced mental health system, has made jails and prisons America’s de-facto mental health facilities. Unfortunately, these facilities are not built, financed, or structured to provide adequate mental health services. Only 3 in 5 people (63%) with a history of mental illness receive mental health treatment while incarcerated in prison, and less than half of people (45%) with a history of mental illness receive mental health treatment while in jails.

Senior U.S. District Judge Kimberly Mueller issued her order March 19, identifying Colette Peters as the nominated receiver. Peters, who was Oregon’s first female corrections director and known as a reformer, ran the scandal-plagued federal prison system for 30 months until President Donald Trump took office in January. During her tenure, she closed a women’s prison in Dublin, east of Oakland, that had become known as the “rape club.” About 34,000 people incarcerated in California prisons have been diagnosed with serious mental illnesses, representing more than a third of California’s prison population, who face harm because of the state’s noncompliance, Mueller said.

A panel of Ninth Circuit judges ruled Wednesday that the state of California cannot avoid paying more than $110 million in fines that it has accrued for not hiring enough mental health professionals to staff its prisons, as ordered by a lower court. The panel concluded that while the state's fines were appropriate, the lower court's explanation of the calculations used to arrive at the $110 million amount was lacking, and the case was ultimately returned to the lower courts to determine a more reasonable amount.

Mayor Eric Adams says one of the four new community jails that were being built to replace Rikers will now be dedicated to inmates with mental health issues. The new facility will be part of the solution to closing Rikers Island. Adams has tapped his new First Deputy Mayor Randy Mastro to build the new jail for those with mental health issues. It comes as a new report released this week by an independent commission empaneled by the City Council said a new place is necessary because there's no way Rikers could close by August 2027 as scheduled.

The Cascade County (MT) Sheriff’s Office will receive $1.2 million towards their Crisis Diversion Grant Program, to provide mental health services to inmates. Currently, the Cascade County Detention has limited resources in terms of mental health treatment, but has seen an increase in the need for mental health treatment within the jail. The Health Services Administrator at the Cascade County Detention Center, Jessica Martinez, says, “Just seeing how we've escalated in terms of the substance abuse and the mental health disorders that are coming in, like it feels like we are now, essentially, a psychiatric hospital back there trying to navigate mental health needs in conjunction with the legal system, and it’s extremely challenging.”

Juveniles

The relationship between a child being placed in foster care and ending up in the juvenile justice system is a serious and extremely relevant issue among foster programs today. In addition, a number of foster children have no stability and face several different home placements over the course of their time in foster care. The Juvenile Law Center reports that about "90% of youth with 5+ foster placements will enter the justice system." Foster children are set up to fail in various ways. Due to a lack of proper caretaking or a poor foster home environment, many slip through the cracks. When children lack strong parental or guardian support, they may begin employing survival tactics.

Opioid Epidemic

Seventy-eight Genesee County Jail inmates have been enrolled in a medical treatment program since officials started dispensing prescription drugs as an alternative to detoxing with minimal help while incarcerated. The county Board of Commissioners accepted a $250,000 grant from the Michigan State Police in late October to help start the program and added $62,500 in county opioid lawsuit settlement funds. Through the program, the Sheriff’s Office is increasing inmate access to Suboxone, Sublocade and Brixadi, prescription drugs commonly used to treat opioid use disorders.

People who are incarcerated at the Weber County Correctional Facility and struggling with opioid use disorder now have access to expanded treatment services. The Weber County Commission approved a memorandum of understanding between the county, Weber Human Services and the Weber County Sheriff’s Office for a grant-funded medication-assisted treatment, or MAT, program at the jail. With the expansion into a full-fledged MAT program, the sheriff’s office can achieve an even higher level of care for inmates contending with addiction. Although not an official statistic, Chief Deputy Phillip Reese estimates that more than 25% of the facility’s intake population has some kind of substance on board when they arrive.

Transgender Ban

On Inauguration Day, Trump issued a flurry of executive orders that included a directive to bar federal spending on gender-affirming care in federal prisons and to “ensure that males are not detained” in federal women’s facilities. In response to Trump’s executive order, the Federal Bureau of Prisons issued new guidelines requiring prison staffers to refer to inmates’ “legal name or pronouns corresponding to their biological sex,” and ending clothing requests “that do not align with an inmate’s biological sex.” The guidelines end referrals for gender-affirming surgery but allow inmates already receiving treatment, such as hormone therapy, to continue. However, in a lawsuit filed March 7, a trans prisoner alleged the hormone therapy she had been receiving since 2016 was stopped on Jan. 26.

2,000 transgender people in federal prisons have lost access to medical care or may soon lose access to it because of the Trump administration’s new policies. A class-action lawsuit has been filed against the president and his team. The ACLU and the Transgender Law Center asked a federal judge in DC for a preliminary injunction that would allow trans people in federal prisons to continue receiving hormone therapy or other prescribed medical care as the litigation unfolds. The lawsuit follows other recent suits against the Trump administration by a smaller group of trans women prisoners; those other case are ongoing and primarily seek to stop the women from being transferred to men’s prisons.

Data & Statistics

BJS has released Federal Justice Statistics, 2023, the 37th report in an annual series based on data from BJS’s Federal Justice Statistics Program. This report provides national statistics on the federal response to crime for fiscal year 2023 and some statistics on changes over time. It describes case processing in the federal criminal justice system, including investigations by U.S. attorneys, prosecutions and declinations, convictions and acquittals, sentencing, probation and supervised release, and imprisonment.

State Roundup

Georgia

House lawmakers on Tuesday passed a $37.7 billion state budget for next fiscal year that includes millions of dollars to hire 700 new guards in Georgia prisons. The hiring of 700 new prison guards would add to around 9,000 total staff at the Georgia Department of Corrections, which in recent years has struggled with high turnover and short staffing to supervise the state’s roughly 47,000 prisoners.

Maryland

he U.S. Drug Enforcement Administration has taken rare enforcement actions against Maryland correctional officials, not just at the Baltimore jail, but also at the state’s women’s prison in Jessup, public records revealed. After issuing warning letters to both facilities in 2021, the DEA visited them last year and performed “accountability audits” that uncovered violations of the federal Controlled Substances Act, namely through inadequate record keeping. At the jail, officials could not account for some 92,500 methadone pills over a three-month period — an astonishing tally.

Minnesota

The Minnesota Department of Health began investigating the Rush City state prison after inmates claimed they had been served rotten chicken and other spoiled food — allegations that were denied by Corrections Department officials. The complaints were circulated in a news release from the national advocacy group Incarcerated Workers Organizing Committee (IWOC). According to the IWOC, incarcerated kitchen workers on Feb. 14 thawed a newly delivered batch of frozen chicken that they said smelled bad and looked yellow, brown and pink. The prison’s cooking supervisor was said to have agreed the food was rotten but was overruled by the food services director.

New York

In 2025, “I feel as though I’ve seen more [incarcerated] people than I have in previous years with scarring on their faces from having been cut. Freshly healed wounds on people's faces and necks where they've been assaulted by other incarcerated people,” says Jennifer Scaife, executive director of the Correctional Association of New York (CANY), an organization that conducts independent monitoring and oversight of state prisons in New York. Correctional officers have said that understaffing has created unsafe conditions for them and for incarcerated residents. Earlier this year, officers went on a 22-day strike in part to protest grueling schedules, including consistent overtime hours that leave them exhausted.

Washington State

A member of the Lewis County Public Health and Social Services Advisory Board and the CEO of Valley View Health Center, testified during a public hearing in front of the House Civil Rights and Judiciary Committee in support of a bill, HB 1743, that would enable community medical providers to provide medical care in jails and prisons. HB 1743 tries to solve the problem by essentially allowing the state to act as an insurer for community health providers. Similar to how anyone wronged by a federal employee can sue the federal government, this would allow people harmed by one of these providers to get compensation from the state. The bill has missed the deadline to be passed by the House of Representatives and advance to the Senate. That means it's unlikely it will be passed into law this session.

Rikers Island

New York City will not meet its legally mandated goal of closing Rikers Island by 2027 and replacing it with smaller jails in four boroughs, according to the independent commission responsible for charting the notorious jail complex's future. In an over 100-page report, the Independent Rikers Commission said the city had failed to sufficiently advance the borough-based jails envisioned last decade when then-Mayor Bill de Blasio and the City Council announced the closure plans. Reports of corruption, sexual assault, physical violence, incompetence and death on Rikers have only grown since then. A federal judge has signaled the complex may need to be taken over by an outside entity known as a receiver, with the matter remaining in court.

New York City Mayor Eric Adams and NYC Health + Hospitals President and CEO Dr. Mitchell Katz today continued “Mental Health Week ” by announced that the city has connected more than 1,000 medically-vulnerable New Yorkers leaving Rikers Island with smartphones as part of its smartphone access program, enabling them to remain engaged in health care, mental health treatment, connect with job and housing resources, and stay connected to loved ones upon returning to their communities.

Correcitonal Healthcare Providers

Wellpath

A lawsuit filed in federal court Friday alleges that systemic failures by the City of Issaquah (WA) and the South Correctional Entity (SCORE) led to the death of 36-year-old Ismail Mamatov, who died of a drug overdose just hours after being transferred between jails. The complaint references a 2019 national investigation that documented widespread failures at Wellpath facilities, including allegations that medical staff failed to treat life-threatening conditions and falsified records. One former Wellpath nurse who worked at SCORE described the facility as “the most unprofessional place” she had ever worked, alleging that she was pressured to rush through medical intakes and that inmates suffering from severe withdrawal were neglected.

Quality Correctional Health Care

The family of a man who died while in custody of the Hamilton County Jail (TN) for allegedly shoplifting less than $50 worth of baseball trading cards has filed a federal lawsuit against the sheriff's office and the county. His sister, Stacey Williams, filed the lawsuit Friday against Hamilton County, Sheriff Austin Garrett and medical provider Quality Correctional Health Care and its staff. The lawsuit alleges Johnson's death was preventable. He was in obvious medical distress, but the defendants showed deliberate indifference to his serious medical needs and failed to provide quick and adequate medical attention, the complaint said.