New Guidance: HRSA PIN 2024-05 Includes Pretrial Detainees In FQHCs' Scope of Service; HHS Approves 1115 Waivers For West Virginia & North Carolina

Hgihlighted Stories

Editor's Note

In the April 23, 2024, Editor’s Note, COCHS reported that the Health Resources and Services Administration (HRSA) had released a draft policy information notice (PIN) allowing Federally Qualified Health Centers (FQHCs) to provide care in jails and prisons to incarcerated people 90 days prior to release. This step aimed to expand access to quality healthcare for one of the country’s most vulnerable populations—incarcerated individuals. However, the draft PIN had a significant omission: It excluded pretrial detainees, leaving those held short-term while awaiting trial without access to these expanded services. As those familiar with criminal justice know, a significant portion of individuals held in jails are pretrial detainees.

Concern about the omission of pretrial detainees did not go unheard. In HRSA's recently released guidance, Health Center Program Policy Guidance Regarding Services to Support Transitions in Care for Justice-Involved Individuals Reentering the Community (PIN 2024-05), FQHCs will be able to include pretrial detainees within their scope of services. For a deeper understanding of this new guidance, we encourage you to read Dan Mistak’s Dear Colleague letter, published today.

Turning now to the initial four highlighted stories, they all in various ways talk about how correctional institutions fail to provide safe and effective environment for the delivery of healthcare and are often intransigent to court orders or oversight recommendations.

The first highlighted story from JAMA frames incarceration as a “toxic exposure” that often leads to higher risk of death from overdose post release. It points out that people reentering their community face a dearth of linked services which contributes to this population’s high mortality rate.

The next highlighted story is an investigation by the Los Angeles Times and the Marshall Project, which explores the pervasive and damaging effects of sleep deprivation in correctional facilities. Despite court-ordered mandates to improve conditions, correctional officials often resist change—a recurring theme in the Weekly Update.

Repeating mistakes is just as prevalent as resistance to change. The third highlighted story from Maryland reports that a legislative committee is questioning the Department of Public Safety and Correctional Services about why the current contract with Centurion replicates the same flaw as the previous YesCare contract: a fixed-fee payment structure, which auditors had strongly recommended against.

Maybe the fourth story is a bit more positive. Continuing from last week’s collection of articles about Oklahoma County, much to the chagrin of the Oklahoma County Criminal Justice Authority (OCCJA), after a court rejected the OCCJA’s attempt to prevent the State Department of Health from making unannounced inspections, the State Department of Health finally made an unannounced inspection. The findings from this inspection are expected to be released later this month. Will it make a difference? Past inaction might prove to be a predictor of future inaction.

The last group of highlighted articles switch the focus from correctional environments to policy. These two articles are announcements by the Department of Health & Human Services (HHS). Both West Virginia & North Carolina have received approval of their 1115 waivers to provide Medicaid coverage to people 90 days prior to release.

The question that COCHS has often posed before about these waivers is exactly who might be the Medicaid providers in these institutions? YesCare, Wellpath, Centurion and other proprietary correctional healthcare vendors have generated no small share of controversy –this is even true of university hospitals that provide care in correctional institutions.

Going back to the HRSA PIN, FQHC’s are no strangers to Medicaid requirements and regulations unlike proprietary correctional healthcare vendors. In addition, FQHCs who have been providing care for decades in communities now have the opportunity to step forward and provide care for community members temporarily displaced in the criminal justice system. Bringing FQHCs into corrections could be transformative, the isolated island of correctional healthcare might be finally bridged.

Correctional Systems & Oversight

Incarceration is a toxic exposure, with individuals released from prisons or jails facing a high risk of death, especially from opioid overdose. Factors like healthcare barriers, poverty, and social isolation worsen this risk, with a significant share of overdose deaths occurring post-release. While access to medications for opioid use disorder (MOUD) and treatment linkages is improving, these services remain rare in most U.S. jails. Jail-based naloxone programs save lives but highlight the limitations of take-home naloxone alone, emphasizing the need for comprehensive post-release strategies.

Over the past three decades, more than 30 lawsuits have addressed sleep deprivation in jails and prisons, including a settlement requiring changes at a San Francisco jail. Interviews with incarcerated individuals, guards, and officials from states like Georgia, Texas, and California confirm that sleep deprivation remains a widespread issue. Causes include extreme temperatures, constant noise, lack of mattresses, and lights that stay on all night. In Los Angeles, jail officials have a history of failing to provide proper bedding or sleeping arrangements. Despite a 1970s court order to improve conditions, the Los Angeles County Sheriff’s Department failed to comply, leading to another court finding of “deliberate indifference” decades later.

During a committee hearing, lawmakers expressed frustration that the state’s new correctional healthcare contract with Centurion fails to resolve staffing and documentation issues identified in audits of the previous provider, YesCare. A report from the Office of Legislative Audits, covering 2018 to 2023, criticized YesCare's fixed-fee payment structure, a flaw repeated in the Centurion contract, despite auditors advising against it.

The Oklahoma State Health Department resumed unannounced inspections at the Oklahoma County jail after a judge dismissed a lawsuit challenging their authority. The jail had twice denied inspectors access, prompting a legal dispute with the Oklahoma County Criminal Justice Authority (OCCJA), which argued state law does not permit surprise inspections at county jails.

1115 Waivers Approved

Under Section 1115(a)(1) of the Social Security Act, West Virginia is granted a waiver to operate the Medicaid Behavioral Health Continuum of Care demonstration. This waiver provides pre-release coverage for up to 90 days before release for eligible inmates in state/local jails, state prisons, and youth correctional facilities. To qualify, individuals must be Medicaid-eligible.

Under Section 1115(a)(1) of the Social Security Act, North Carolina is granted waivers to operate the Medicaid Reform Demonstration. This waiver provides pre-release coverage for up to 90 days before the expected release date for eligible inmates in state/local jails, state prisons, youth correctional facilities, and tribal jails. To qualify, individuals must be deemed Medicaid-eligible through an application submitted before or during incarceration.

Data & Statistics

To address gaps in data about who cycles through the criminal justice system and why, the Prison Policy Initiative and Jail Data Initiative are seeking answers. In 2023, 7.6 million jail admissions occurred, with 25% involving repeat incarcerations. The system disproportionately impacts Black and Indigenous people, often targeting poverty and low-level “public order” offenses. Women make up a quarter of those booked annually, with 80% being mothers, including over 55,000 pregnant at admission. These women face severe consequences like worsened mental health, higher suicide risk, and increased homelessness.

New Administration

President-elect Donald J. Trump has provided few details on how he would execute his promised large-scale deportation effort. Immigration experts say it would be nearly impossible without significant help from jails and prisons. This policy would rely on jail and prison officials granting federal immigration agents access to locate and deport undocumented prisoners. Community arrests by ICE require extensive effort, including tracking addresses, conducting surveillance, and determining legal grounds for deportation.

State Roundup

Colorado

More accusations against the Jefferson County Jail are coming to light days after another inmate died while in custody. Glenn Perdreaux, 64, was found unresponsive in his cell on Dec. 7 during a routine check-up. Perdreaux is the fourth person to die at the jail since Dec. 2023. Other families have come forward alleging that their loved ones had not received proper medical care while incarcerated at the Jefferson County Jail.

Georgia

Georgia's behavioral health agency plans to request more funding from the General Assembly to move mentally ill patients out of jails and into treatment. Backlogs in the state’s mental health crisis system have turned county jails into holding areas for mentally ill individuals accused of crimes. With jails nearly full, sheriffs estimate that 25% to 50% of inmates have mental health conditions.

To improve Georgia’s troubled prison system, the General Assembly should hike correctional officer salaries, consider more private-public partnerships to expand capacity, increase mental health services and move to single-person cells to improve safety. Those are among a slate of recommendations that a state Senate study committee approved

Minnesota

The ACLU of Minnesota has sued Otter Tail County, its sheriff, and jail officers, accusing them of unlawfully punishing a man with serious mental health issues. The lawsuit claims the Sheriff’s Office tried to cover up the abuse, which a jail whistleblower reported to the state. Allegations include that the man was deprived of food for 52 hours and had his cell water shut off, leaving him unable to drink or flush the toilet. (This is a story COCHS' Weekly Upadate has previously convered. See Editor's Note of April 2, 2024.)

New Hampshire

Since 2017, two men with serious mental illness have died in the psychiatric unit of the New Hampshire State Prison after being restrained face down by corrections officers. The state claims the cases are different, but advocates argue they highlight systemic issues in the care of people in custody. In the most recent case, Jason Rothe was brought to the floor, tasered, and punched in the head by an officer. Once cuffed, another officer allegedly pinned him face down with a knee on his back for several minutes, during which Rothe stopped moving. The on-duty nurse testified she saw him lying prone and unresponsive but did not examine him, assuming he was “playing opossum.”

Washington State

Last month, the state agreed to a $960,000 settlement after a man’s mother alleged staff ignored signs of his mental illness before his suicide at the Monroe prison. Anthony Christie, under state Department of Corrections supervision, reported a history of suicidal thoughts in an initial mental health evaluation, according to a lawsuit. Corrections policy required evaluations every six months, but Christie received only one.

Private Prisons

Private prison operator Geo Group urged a Colorado federal judge to deny immigrant detainees' request to show jurors the inside of its detention facility in a trafficking case, including the size of housing units, arguing the facility's size will not be relevant when determining whether detainees performed forced labor. The lawsuit, filed a decade ago, alleges that detainees at the Aurora detention facility were ordered to clean up the facility for free in violation of the Traffic Victims Protection Act, while others earned just a dollar per day in a voluntary work program at the unjust enrichment of Geo Group.

Correctional Health Care Vendors

Wellpath

Wellpath Holdings Inc, which provides health-care to prisons and jails in the US, won court permission to borrow about $362 million while the company tries to sell itself in bankruptcy. At a court hearing in Houston, US Bankruptcy Judge Alfredo Perez approved the loan package, which refinances some older debt and injects about $105 million in cash into the company.