Nature: Integrate Public Health With Correctional Health; Trump’s CMS Approves Three 1115 Reentry Demonstrations

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Editor's Note

Already this year, we have highlighted the role of public health in correctional healthcare. In our August 4 Editor's Note, we discussed a resource developed by the Association of State and Territorial Health Officials (ASTHO) emphasizing for State Public Health Officers the importance of continuity of care for people reentering the community with sexually transmitted infections

This week, we are drawing your attention to another public-health-focused article, this one from Nature. Its central argument will be familiar to COCHS readers: the health of the public suffers when the healthcare of incarcerated people is treated as something isolated from the larger healthcare system. As we have often pointed out, incarcerated people are community members who have been temporarily displaced from their communities. Their healthcare does not cease to be a public health concern when they enter a correctional facility.

The consequences of treating correctional healthcare as something separate from public health are particularly obvious with communicable diseases. Tuberculosis does not stop at the walls of a jail or prison. And the reason ASTHO developed a resource for public health officials on connecting people with STIs to care upon reentry can be seen in the two highlighted reports on STIs from the CDC and Infectious Disease Advisor. The Nature article puts the point succinctly: “Governments must integrate correctional health into mainstream health planning.” We could not agree more.

As our subscribers well know, COCHS has long advocated extending Medicaid coverage to incarcerated people as a means of integrating correctional healthcare with the broader healthcare system. We were therefore pleased to see CMS, under the Trump administration, approve Section 1115 reentry demonstrations for Louisiana, Minnesota, and Nevada and renew Washington, D.C.'s demonstration with reentry services. We certainly have reservations about how effective that integration will be once the Medicaid work requirements imposed by the One Big Beautiful Bill Act take effect, even with the 90-day exemption period following release. Nevertheless, these approvals are an important continuation of the effort to connect correctional and community healthcare.

And we are happy to give the administration credit for taking that step.

But if improving health and continuity of care is the objective, we might suggest that another part of the administration—the Department of Homeland Security and ICE—get on the same page.

As readers may remember, last week we continued following the dispute in Colorado over a tuberculosis case at the ICE detention facility in Aurora. The Colorado Department of Public Health and Environment has sought access to the facility and information necessary to determine who may have been exposed. GEO Group, which operates the facility under contract with ICE, has resisted the state's efforts to conduct its public health investigation.

Which brings us back to the Nature article: “Governments must integrate correctional health into mainstream health planning.”

Public Health

Prison health continues to be treated as a marginal correctional issue rather than what it fundamentally represents: a major public health concern. This framing is deeply flawed. Prison health is not a subsidiary of public health; it is integral to it. The health of incarcerated populations is inseparable from community health, equity, and sustainable social development. Prisons are not isolated from society: communicable diseases affect incarcerated people, staff, and visitors, while the health consequences of imprisonment extend well beyond release. The implications are unambiguous. Governments must integrate correctional health into mainstream health planning.

Studies

Since 2017, syphilis cases have increased substantially across the United States, including in Alaska. Nationwide, prevalence of syphilis tends to be higher among incarcerated persons than among the general population. During 2023–2025, opt-out screening for syphilis in Alaska correctional facilities (i.e., routine testing unless a person specifically declines) found reactive rapid plasma reagin (RPR) results, which often indicate a past or current syphilis infection, in 240 (4.6%) of 5,163 persons screened.

A systemwide screening initiative in Puerto Rico’s correctional facilities identified substantial numbers of HIV and hepatitis C virus (HCV) infections and facilitated connections to treatment. Correctional populations experience a greater burden of HIV and HCV infection than the general population, while incarceration can disrupt continuity of medical care. Researchers conducted a large-scale screening initiative to characterize HIV and HCV infection within Puerto Rico’s correctional system and connect patients with positive results to appropriate care.

1115 Reentry Demonstrations

On September 23, CMS approved new Section 1115 reentry demonstrations for Louisiana, Minnesota, and Nevada and renewed Washington D.C.'s demonstration. The approvals allow Medicaid to pay for a targeted set of healthcare services for eligible individuals shortly before their release from correctional facilities. Although each jurisdiction requested up to 90 days of prerelease coverage, CMS approved coverage for up to 60 days. The covered services vary somewhat, but generally include case management, substance use disorder treatment, physical and behavioral healthcare, medications, and assistance connecting individuals with care after release.

• Louisiana Reentry Demonstration
• Minnesota Reentry Demonstration
• Nevada Reentry Demonstration
• Washington D.C Reentry Demonstration Renewal

Included in this announcement, CMS also released an Frequently Asked Questions (FAQs) concerning the Section 1115 reentry demonstrations. The final question in the FAQ addresses how the demonstrations are combined with states' requirements under Section 5121 of the Consolidated Appropriations Act, 2023.

Follow Ups

Arizona

Editor's Comment: Well, here we are again! The Arizona receivership story is not over. As you will recall, the Ninth Circuit Court of Appeals rejected the state's latest attempt to block the appointment of Annette Chambers-Smith as receiver of Arizona's prison healthcare system. The state has now decided to go to the Supreme Court in another attempt to block Judge Roslyn Silver's order.

The move is not particularly surprising considering how long the state has fought against placing its prison healthcare system under a receiver. Nor is such resistance unprecedented. California provides a useful comparison.

In 2001, the Prison Law Office filed a lawsuit that became known as Plata v. Newsom, challenging the adequacy of medical care in California's prisons. After years of unsuccessful attempts to bring the state into compliance, a federal court placed the prison medical system under a receiver in 2005. Meanwhile a separate case that became known as Coleman v. Newsom involving mental healthcare in California prisons, had been proceeding since 1990. Eventually, the two cases came together before a three-judge federal court, which concluded that overcrowding prevented California from providing constitutionally adequate medical and mental healthcare and ordered the state to reduce its prison population. California fought that order all the way to the Supreme Court, which upheld it in 2011.

Back to Arizona, last week we expressed surprise that the state did not use its own attorneys to block the receiver but instead went the expensive route of using outside council. Reuters now reports that the attorney, Paul Clement, retained by the state to go before the Supreme Court bills at $2,650 per hour.

State officials are asking the U.S. Supreme Court to block a court-appointed receiver from taking over Arizona’s prison health system. In a filing on September 16, attorneys for Ryan Thornell, director of the Department of Corrections, Rehabilitation, and Reentry, said the prison system has made “tangible progress” in improving physical and mental healthcare for inmates. U.S. District Court Judge Roslyn Silver ordered an overhaul in 2023 to correct what she determined were constitutional deficiencies. The changes include doubling spending on inmate health care, adding staff, improving facilities and expanding access to substance-use disorder treatment. In this last-ditch effort, state attorneys retained Paul Clement, a specialist known for handling cases before the Supreme Court — and who, according to Reuters, bills at $2,650 per hour.

Air Conditioning

Editor's Comment: In the past, we have highlighted a number of stories about extreme heat and the need for air conditioning in correctional facilities. This week, we have stories from Idaho and Iowa in which the deaths of incarcerated people have been attributed to extreme heat.

And concerning air conditioning, Judge Robert Pitman, who we reported on back on March 31 as considering whether to order air conditioning in Texas prisons, has made his decision: all Texas prison facilities will need to be air conditioned by the end of 2029.

The case that led to the ruling, Tiede v. Collier, was filed in 2023—hardly any time at all when compared with the Arizona receivership litigation.

All Texas prisons will be required to have air conditioning by the end of 2029, a federal judge ruled Tuesday, marking a major win for advocates in a long-running battle for inmates to be protected from extreme heat. U.S.. District Judge Robert Pitman concluded in a 150-page ruling that the extreme heat conditions the majority of inmates endure in Texas Department of Criminal Justice facilities constitute violations of the Eighth Amendment, which prohibits governments from imposing cruel and unusual punishment.

An Idaho Department of Correction inmate died while working at an outdoor job site during a dangerous heat wave, and now workplace safety investigators are looking into what happened. On July 11, temperatures across southwest Idaho spiked into the triple digits -- 10 to 12 degrees above normal, according to the National Weather Service. That same day, 45-year-old inmate Matthew Henson died while working at a Simplot job site.

On one of the hottest days of the summer, with temperatures in the 90s, Robert Buel, 57, died at the Anamosa State Penitentiary. The official cause of death was arteriosclerotic and hypertensive cardiac disease, or chronic heart disease, according to the State Medical Examiner. But Buel’s sister, Kerensa Buel, of Sioux City, believes the lack of air conditioning in the prison contributed to her brother’s July 15 death. Prisons in Anamosa and Mount Pleasant do not have air conditioning for most cells.

Robert L. Brooks

Editor's Comment: Last week, we reminded our readers that even though articles about the crisis in New York State's prison system were no longer as prominent as they once were, that hardly meant the problems underlying the crisis had disappeared. This week, however, one chapter appears to be closing: the state has agreed to settle the civil lawsuit filed by the family of Robert Brooks, the man who was brutally murdered by correctional officers at Marcy Correctional Facility. The state has agreed to pay his family $24 million.

New York State has agreed to pay $24 million to the family of Robert L. Brooks, an inmate beaten to death two years ago by corrections officers at an upstate prison. The agreement, which appears to be one of the largest of its kind in the state, will settle all civil suits filed by the family, the governor’s office said. Ten corrections officers were charged in February 2025 in connection with the fatal beating of Mr. Brooks, who was kicked in the groin and punched in the chest while handcuffed and pinned to an infirmary examination table at Marcy Correctional Facility.

ICE

Some immigrants detained at Florida’s now-shuttered “Alligator Alcatraz” were confined in outdoor cages only slightly larger than telephone booths for more than an hour at a time, according to a new report by the Department of Homeland Security’s inspector general. The watchdog report marks the first time a government agency has confirmed the existence of the cramped cages at the South Florida Detention Facility. The findings are a rare instance when a federal inspector general has publicly criticized the Trump administration. Since he returned to office in 2025, President Donald Trump has fired at least 18 inspectors general.

Migrant families with children have been detained at a border station in San Diego for weeks at a time, despite federal guidelines limiting such detentions to three days, prompting intervention from a federal judge. Over the past year, immigration authorities have held families and dozens of their children at a Border Patrol station in Chula Vista and the Otay Mesa Port of Entry. In August, Dolly M. Gee, chief U.S. district judge in the Central District of California, appointed a “special master” and independent monitor to oversee facilities in San Diego, among other places, after finding that the length of time kids spent detained likely violated a 1997 legal agreement known as the Flores Settlement.

The security firm GardaWorld has won a $1.2 billion contract from the U.S. government to expand immigration detention in the town of Florence about 60 miles southeast of Phoenix, according to a watchdog group. GardaWorld Federal Services, the U.S. subsidiary of Canada-based security company, GardaWorld, is the same company that was awarded a $313.4 million DHS contract in March to convert a 418,000-square-foot commercial warehouse in Surprise, a suburb northwest of Phoenix.

U.S. Immigration and Customs Enforcement has contracted a Montreal-based security firm again, this time to assist its efforts in Texas. ICE awarded two contracts to the American branch of GardaWorld Security in late August. Together, these contracts have a minimum value of close to US$118 million and could reach a value of over US$1.3 billion.

Rep. Sydney Kamlager-Dove is pushing for greater oversight of immigration detention facilities and stronger protections for people in federal custody. During a conversation at the Congressional Black Caucus Foundation's 55th Annual Legislative Conference, the California Democrat discussed the impact of immigration enforcement in her Los Angeles-area district, medical care for detainees and her efforts to protect people in federal custody. Kamlager-Dove has repeatedly visited the Adelanto ICE Processing Center as part of congressional oversight efforts.

Ending Crime and Disorder on America’s Streets.

The U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), announced supplemental funding to three states — Alabama, Kansas, and West Virginia. In Alabama, the new funding will support regional needs assessments to explore how faith-based prevention shapes youth attitudes, identify where additional resources are needed, and enable Alabama’s certified Faith-Based Support Specialists to reach a new population, youth ages 12 to 17, and create opportunities for young people to connect with faith-based and community leaders.

The Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Department of Health and Human Services (HHS), today announced that it has awarded $42.3 million in new supplemental funding to states and territories through two federal block grants to advance President Trump’s Executive Order on Ending Crime and Disorder on America’s Streets.

State Roundup

Florida

Florida is leaving mentally ill defendants to languish in county jails for months after judges order their transfer to psychiatric hospitals, often locking them in cramped solitary cells, according to a federal lawsuit filed by a coalition of civil and disability-rights groups. Sometimes, those defendants died in harsh conditions before ever making it to a hospital.

Johnson County officials are continuing discussions on a proposed new jail and sheriff’s office, with an emphasis on how the facility could better support people in custody through its design and expanded mental health programming. The proposed jail and sheriff’s office would be built near Melrose and Slothower roads. Plans under discussion call for the facility to open with 120 beds, which county officials say could reduce the need to transfer people to other facilities when space is limited.

Pennsylvania

An incarcerated individual at George W. Hill Correctional Facility in Thornton, Pennsylvania, tested positive Sunday for bacterial meningitis, Delaware County officials. The Delaware County Health Department is working with prison management to identify people who might have had “close” contact with the individual from Sept. 2 through Sept. 12. Contacts that are considered higher-risk include direct exposure to oral secretions through frequently eating or sleeping in the same dwelling as an infected individual, the county said in a statement.

Texas

A federal judge’s blunt assessment of a Bexar County Jail inmate’s condition is drawing attention to the medical care the man received while in custody. “He looks like a Holocaust survivor. I mean, help me understand what went on here,” said United States District Judge Xavier Rodriguez during a July 30 hearing. Escamilla was booked into the Bexar County Jail in August 2023 on charges of assault of a peace officer and assault of a public servant. According to court records, his health deteriorated during his time in custody, culminating in a medical emergency in July 2024.

Vermont

Vermont lawmakers responsible for overseeing the Department of Corrections are taking a closer look at a department policy that has expanded the criteria the department uses to keep people incarcerated beyond their minimum sentence. The policy, known as risk containment, has prompted concern from advocates and lawsuits from incarcerated people.

Virginia

More people are dying in Virginia prisons as the state’s incarcerated population grows older, according to a new report from the Virginia Department of Criminal Justice Services. The agency found 111 people died in state correctional facilities in 2025, up from 97 the year before. The findings come from Virginia’s second annual deaths-in-custody report, which tracks deaths involving law enforcement agencies, prisons, jails and juvenile correctional facilities.

Correctional Officers

I’ve worked for the Federal Bureau of Prisons for nearly two decades. In that time, I’ve lost eight coworkers — eight friends — to suicide. Eight. I remember every one of their names. That list keeps getting longer while too many people look away. Most people have no idea what it is really like to work in corrections. The hours are brutal. The overtime never ends. We’re treated like numbers, not people. Our families see us come home exhausted, but they don’t always know about the trauma we carry: breaking up fights, cleaning up after an inmate’s suicide, enduring verbal abuse and surviving physical attacks. We’re expected to swallow it all, pretend we’re fine and keep moving.

A union of prison guards in New Jersey is throwing its weight behind efforts to roll back the state’s solitary confinement restrictions, continuing a decadelong trend of law enforcement unions opposing limits on how incarcerated people are allowed to be isolated and for how long. A draft version of the legislation provided to Prism, sponsored by Democrat state Sen. and Assistant Majority Leader Linda Greenstein, would amend state law to allow officers to place vulnerable incarcerated people in “isolated confinement,” including without their consent. Currently, incarcerated people who fall into a “vulnerable” category cannot be placed in isolation.

Technology

The Humboldt County Sheriff’s Office announced that, starting October 19, personal mail for inmates, such as letters, photographs and drawings, will no longer be accepted at the Humboldt County Correctional Facility. Instead, such mail will have to be sent to a P.O. Box in Maryland, where a private for-profit company called ViaPath Technologies will scan the materials and deliver them to inmates via electronic tablets.

Telmate LLC, the prison-communications company now doing business as ViaPath Technologies, has agreed to pay $4,225,000 to settle a class action over a 2020 data breach. Telmate runs several services under its umbrella, including GettingOut, VisitNow, Command, Telmate Inmate Telephone, and Guardian. These platforms handle everything from inmate phone calls to video visitation to money transfers for families of incarcerated people, which means the company sits on a large pool of financial and personal data for a population that often has limited options for choosing an alternative provider.

As correctional agencies increasingly adopt biometric sensors, artificial intelligence and connected monitoring technologies, 4Sight Labs is calling for stronger standards governing where sensitive information is stored, who can access it and how the technology protecting it is sourced. 4Sight Labs believes technology handling sensitive information collected from Americans in government custody should follow a simple principle:

Correctional Healthcare Vendors

Armor

This lengthy article begins with the death of Brian Tracey at the St. Johns County Detention Center in Florida, where healthcare was provided by Armor Health. Two retired jail commanders and two physicians with extensive experience in correctional healthcare reviewed Tracey's autopsy report and concluded that he should have been hospitalized. The article then broadens its focus to proprietary correctional healthcare, providing an extensive examination of Armor Health and its history.

Southern Health Partners

The widow of former Knox County deputy Benjamin Hibbert has filed a federal civil rights lawsuit against Union County and several law enforcement and medical employees, saying indifference and neglect led to her husband's death from alcohol withdrawal in the Union County Jail last year. Southern Health Partners, along with the duty physician and nurse, are named as defendants as well. Southern Health Partners is the jail's contracted medical provider.

Wellpath

The family of a man strangled by another inmate at the county jail in Concord in 2022 has entered into a partial settlement with the county and a company that previously provided medical care to inmates. The Delaware County defendants will pay $462,500, and the Wellpath defendants will pay $450,000. Together, the settlements provide substantial recoveries while eliminating the expense and uncertainty of continued litigation against those defendants Michael LaRosa, the attorney representing the son of murder victim Elliot Funkhouser, said claims are still ongoing with respect to the GEO Group, the private, for-profit company that previously oversaw operations at the jail.

The family of a Fresno County inmate who was found hanging days after he was arrested says the county’s medical and corrections staffers failed to provide the care the 22-year-old needed and that is required under the Constitution. Fresno County contracts with California Forensic Medical Group Inc. for the care of inmates, which includes physical and mental health. The company says it works in 61 facilities in California, providing care to 14,550 people in custody. CFMG did not immediately return a request for comment. Note: Wellpath serves as CFMG's management services organization.

A federal judge has rejected Mecklenburg County’s (NC) motion to dismiss a lawsuit stemming from a 2022 death at the county jail. A separate order granted motions to dismiss Wellpath and five of its employees from the case. Those defendants relied on Wellpath’s 2025 bankruptcy proceedings to support their motion to dismiss.