Medicaid’s Conditions of Participation: A Tool for Improving Correctional Healthcare?

Highlighted Stories

Editor's Note

This week we are highlighting two stories about the California attorney general suing Los Angeles County over the conditions in its jails. In essence, the attorney general is asking the courts to intervene and require the county to address the quality of care provided within the correctional system. We have seen a similar scenario play out at Rikers Island, where, in response to a class-action suit, Federal Judge Laura Taylor Swain appointed a remediation manager to address the facility’s conditions.

This brings us back to a familiar COCHS theme: Medicaid. California’s 1115 waiver was approved to bring Medicaid (Medi-Cal in California) “behind the walls” for reentry services, and it is now being rolled out—slowly—across three counties. More than two years ago, we noted in the Editor’s Note of June 6, 2023 that participation in Medicaid requires meeting conditions of participation for minimum health and safety standards. One of those conditions is environment of care. Up until the rollout of 1115s, judicial intervention has been the only mechanism to enforce health and safety standards.

We do not yet know how and whether Medicaid requirements can become another cudgel to enforce health and safety standards. How such requirements might apply in Los Angeles County is an open question. Will conditions of participation extend to the entire facility, or only to locations where healthcare is delivered? In his statement, the attorney general specifically called on the sheriff’s department to provide inmates with adequate medical, dental, and mental health care, protect them from harm, and ensure safe and humane conditions of confinement. In many ways, that sounds exactly like what Medicaid’s conditions of participation are designed to enforce.

Los Angeles County

The California Department of Justice will sue Los Angeles County, Sheriff Robert Luna and his department for what Atty. Gen. Rob Bonta called a “humanitarian crisis” inside the county jails. Inmates lack basic access to clean water and edible food, and are housed in unsafe, dirty facilities infested with roaches and rats. There have been over 205 in-custody deaths in four years with 40% caused by suicide, homicides and overdoses. Bonta called for comprehensive reform, and said the county forced his hand by refusing to comply with changes voluntarily. “Knowing that they need to make the changes, they want to spend taxpayer money on litigation, on fighting, on resisting, on foot-dragging,” he said. Bonta called for L.A. County and the Sheriff’s Department to provide inmates with adequate medical, dental and mental health care, protect them from harm, provide safe and humane confinement conditions.

Attorney General Rob Bonta has filed suit in Los Angeles Superior Court against the county, its sheriff’s department and the director of correctional health services. In the suit, Bonta asks for a judge to find that the jail conditions and the defendants’ policies and practices violate the Eighth and 14th Amendments, as well as the Americans with Disabilities Act. He’s asked a judge to order the defendants to provide adequate medical care, protect them from unreasonable risk of harm, and stop them from perpetuating what he called unlawful conditions and policies.

Follow Ups

Larry R. Hill Medical Reform Act

Editor's Comment: This week’s first Follow Up returns to Minnesota’s Larry Hill Medical Reform Act, which we first covered in the Editor’s Note of July 15, 2025. At that time, sheriffs across the state raised a hue and cry against the law, which requires correctional facilities to continue medications prescribed prior to incarceration. Sheriffs warned that their proprietary healthcare providers might walk away. The Minnesota Sheriffs’ Association along with Advanced Correctional Healthcare filed a lawsuit that resulted in a restraining order blocking the law’s implementation.

As the article below reports, a judge has now lifted that restraining order. For the time being, individuals entering correctional facilities can continue to receive their prescribed medications while incarcerated.

A Ramsey County judge this week allowed the enforcement of a new Minnesota law that requires jails to provide inmates the medications they were already prescribed outside of jail. Several jail health care contractors and sheriff’s offices had sued the Minnesota Department of Corrections to stop the Larry R. Hill Medical Reform Act from taking effect, claiming it bars medical staff from exercising their own professional judgment and “exposes them to risks of criminal liability.” The Minnesota Sheriff’s Association, one of the plaintiffs on the lawsuit, worried the ruling could drive medical contractors to stop providing services at Minnesota correctional facilities and “take deputies off the streets.”

San Diego County

Editor's Comment: San Diego County’s jail is back in the news, this time with a story that circles back to an issue we mentioned in last week’s Follow Up: the sheriff’s department’s apparent intransigence when it comes to implementing recommendations. Despite repeated warnings from state regulators, three mentally ill individuals were housed together in a single cell. A fight broke out, leaving one detainee in a debilitating coma.

What makes this worse is that the sheriff’s own documents acknowledge that triple-celling creates an unsafe environment.

As a point of interest, the San Diego County Board of Supervisors appears poised to pass legislation granting a civilian review board more authority over healthcare delivery in the jail—authority that goes beyond mere recommendations. And, just as we saw in Minnesota, the county’s healthcare provider, NaphCare, is threatening to leave or demand higher compensation if subjected to civilian oversight.

Is this becoming a trend? Is there anywhere else in healthcare that highly compensated providers remain immune from oversight?.

Two men, both struggling with mental illness and drug addiction, had been placed in a cell with a third man at San Diego's Central Jail - even though state regulators had repeatedly told the Sheriff's Office to stop the practice of triple-bunking. The close quarters triggered a fight and one of the men suffered severe brain damage and spent four months in a coma. In an undated document related to jail construction the Sheriff's Office acknowledged that triple-bunking creates "an unsafe environment for both staff and inmates."

Arizona

Editor's Comment: In the Editor’s Note of March 19, 2024, we reported that U.S. District Judge Roslyn Silver was considering holding Arizona’s Department of Correction in contempt of court for failing to follow her order. Fast forward to today: court-appointed monitors have found systemic failures in the delivery of healthcare to incarcerated people. Rather than pursuing contempt, the judge is now threatening to place the entire correctional healthcare system under receivership.

It is worth noting that the current healthcare provider is NaphCare—the same company providing care in San Diego County. We mention this not to single out NaphCare, but to underscore a broader pattern. Whether it is Wellpath, Wexford, VitalCore, Advanced Correctional Health Care, PrimeCare, or YesCare/Corizon it really dosen't seem to matter which proprietary company is supplying the care. As we have observed in the Editor’s Note of January 30, 2024, it often feels like a merry-go-round: these companies deliver care of sometimes questionable quality, with tragic consequences that lead to multiple lawsuits—lawsuits in which taxpayers often end up paying part of the damages.

And as we have noted repeatedly, oversight—whether through bureaucratic agencies, judges, or legislation—is often met with resistance. It remains to be seen whether NaphCare will now warn the court that it will withdraw from Arizona if the judge has the temerity to appoint a receiver.

A federal judge, Roslyn Silver, is considering whether to place the Arizona Department of Corrections, Rehabilitation and Reentry’s health care system under receivership after more than a decade of litigation and two years after the court set a final bar for compliance. The hearing on Sept. 10 came after another report from court-appointed monitors found continued systemic failings in the delivery and quality of health care to the state’s incarcerated population. Since the start of litigation, the department has had a revolving door of health care contractors and most recently contracted with NaphCare. Mary O’Grady, attorney for the department noted an increase in the number of health care providers, expanded programs and added capacity for care for the special needs unit. Sophie Hart, an attorney with Prison Law Office, who represents the plaintiffs, told Silver a receiver would take on duties parallel to those of a similar California prison class action — Plata v. Newsom — which includes authority over staff, contracts and budgets, and a mandate to bring the department’s medical care into compliance with constitutional standards.

New York

Editor's Comment: Now to New York State. The road ahead remains rocky following the murder of Roberts Brooks last year at Marcy Correctional Facility and this year’s wildcat strike. Governor Kathy Hochul has acknowledged that it will take time to bring staffing up to acceptable levels. Some guards who participated in the strike and lost their positions have been reinstated through a grievance process.

Meanwhile, a lawsuit has been filed on behalf of mentally ill individuals being held in solitary confinement at Marcy. Perhaps one bright spot: the Correctional Association of New York (CANY), the official monitor of the state prison system, reports that the requirement for body cameras be worn by correctional officers has seemingly reduced assaults.

It’s been six months since the conclusion of the three-week illegal correction officer strike at New York’s state prisons, and Gov. Kathy Hochul said that it may take at least that long before prison staffing is at an acceptable level. Hochul has maintained that her priority remains getting prisons appropriately staffed. Despite assertions that those who didn’t return in early March would never work for the state again, more than 740 terminated employees have been reinstated since the strike ended through a grievance process associated with their collective bargaining agreement.

It's been six months since the correction officer strike and issues within the New York state prison system persist. The commissioner of the Department of Corrections and Community Supervision (DOCCS) said the department is committed to making improvements that lead to better staffing and conditions. The commissioner of the Department of Corrections and Community Supervision (DOCCS) said the department is committed to making improvements that lead to better staffing and conditions. DOCCS leaders said they're working to safely return both HALT Act and general population programming by improving staffing levels in-part through an aggressive recruitment campaign. The Correctional Association of New York said there have been some improvements since the strike. For example, the use of body cameras seems to be leading to fewer reports of physical assaults.

A federal lawsuit was filed on behalf of nine inmates at a state prison in Oneida County who are allegedly being held unlawfully in mental health units for roughly 24 hours a day and without access to therapy or medical treatment. The lawsuit was filed in U.S. District Court in Albany and accuses state corrections officials, of violating the constitutional rights of the inmates, all of whom have been diagnosed with mental health issues. The complaint seeks to be confirmed as a class-action case and notes that residential mental health units at Marcy generally hold nearly 100 people. The lawsuit was filed by attorneys with Disability Rights New York and Prisoners' Legal Services of New York. It seeks a temporary restraining order and preliminary injunction that would require the Department of Corrections and Community Services to immediately restore the inmates' programming and out-of-cell activities pending the outcome of the case.

Opioid Epidemic

County jail inmates who receive medication to treat their opioid addiction have a lower risk of overdose after their release. Medications like buprenorphine, methadone and naltrexone are known to be effective in helping people break their opioid addiction, but they are available in only about 13% of U.S. jails, “These findings demonstrate the importance of providing medications to treat opioid use disorder in correctional settings,” Dr. Nora Volkow, director of the National Institute on Drug Abuse said. For this study, researchers analyzed data from 6,400 people with probable opioid use disorder incarcerated in seven Massachusetts county jails between September 2019 and December 2020. In 2018, Massachusetts passed a law enacting a four-year pilot program to provide opioid addiction medications to inmates in these jails, researchers said. Results showed that those who got anti-opioid medications in jail were 40% more likely to be actively engaged in addiction treatment six months after their release, compared to those who didn’t get the meds.

To provide more flexible treatment options for opioid use disorder among incarcerated persons, San Mateo County Health’s Correctional Health Services has adopted Brixadi, a long-acting injectable buprenorphine, as part of its Medication Assisted Treatment (MAT) program for at risk individuals in San Mateo County’s correctional facilities. Each month, Correctional Health Services treats more than 125 individuals experiencing opioid withdrawal, representing over ten percent of the monthly incarcerated population.

The Georgetown County Sheriff’s Office has introduced a new technology aimed at preventing overdose deaths behind bars, becoming the first agency in South Carolina to deploy the system. The tool, called OverWatch, is a biometric monitoring system that tracks vital signs in real time, including heart rate, respiration, oxygen levels, stress and skin temperature. If readings indicate a potential medical crisis, staff receive an immediate alert, allowing them to intervene quickly. Sheriff Carter Weaver said the decision to implement the system comes in response to the growing overdose crisis in correctional settings.

BOP

A federal inspection found serious healthcare issues for inmates housed at the Federal Detention Center in SeaTac. According to the acting inspector general, the unannounced inspection found that only three out of nine nursing positions and one of two pharmacist positions at the detention center were filled. At the SeaTac facility, the inspection found half of the detention's health service positions were vacant last winter, including the clinical director position, which had been vacant for nearly two years. It's unclear if the position has been filled since December.

ICE

With detention numbers at a record high, jails have proven to be a quick and convenient way for ICE to expand its detention capacity beyond existing federal and private facilities. Many sheriffs are eager to assist in Mr. Trump’s mass deportation plans — and to shore up their budgets — by offering up their beds. Jails are often the first stop on the way to somewhere else in ICE’s vast detention network, and they fill a geographic hole for ICE in the Midwest in particular, where there are few detention centers.

A New York state judge struck down an executive order issued by the administration of Mayor Eric Adams that sought to allow federal immigration authorities into the Rikers Island jail complex, calling it “illegal.” The judge ruled that the order permitting the Immigration and Customs Enforcement agency to open offices at the jail was barred by an “impermissible appearance of a conflict of interest” between Mr. Adams and President Trump.

Studies

This study, by Penn LDI Senior Fellows Lauren Eberly, Sameed Khatana, and Ashwin Nathan, and colleagues analyzed more than 18,000 cardiac deaths from all 50 states over 19 years and found that nearly one-quarter of cardiovascular deaths resulted from a condition that developed after admission to prison and that most deaths occurred after 10 years served. The researchers examined records from state prison systems to understand how incarceration impacts cardiovascular outcomes. They found increasing rates of cardiac death among prisoners, along with low treatment rates. In 2019, over 30% of those who died from cardiovascular disease had not received diagnostic testing, and more than 25% were not given medications for the condition that caused death.

Aging & Incarcerated

In an op-ed, German Lopez, a journalist, writes: American prisons are fast becoming the world’s worst nursing homes, increasingly filled with aging criminals who can barely walk, let alone commit another crime. The idea that we should lock up people for life, even through old age, is often framed as being tough on crime. In reality, it gives years, if not decades, of shelter, food and health care to convicted criminals and redirects money from programs we know do a better job of protecting the public.

State Roundup

Alabama

A report published last month estimated that Alabama spent $5 billion on the state’s prison system in the past five years. Corrections for decades has taken the second-largest chunk out of the state’s General Fund. Cost to operate the state’s prisons has increased dramatically in the past several years.Part of the reason for the increased funding is meant to address years of underinvestment in the prison system. The additional allocations also deal with the problems that ADOC currently has recruiting and retaining corrections officers and the medical costs because of an aging prison population.

Missouri

Algoa Correctional Center, is one of four Missouri prisons with no air conditioning in any of the housing units. In Jefferson City, where Algoa is located, the first 90-degree day of the year arrived in May. The following month, a blistering heat wave torched the Midwest, bringing temperatures in the mid-90s for a week straight. Similar bouts of extreme heat continued into July and August, following a pattern of record-breaking temperatures that has become increasingly common in recent years. The MacArthur Justice Center filed a class action lawsuit alleging that prison conditions constitute cruel and unusual punishment for those forced to endure dangerous temperatures with little to no relief.

Mississippi

At least 42 people have been killed inside Mississippi prisons in the past decade, leaving scores of grieving families questioning a system that fails to protect people in its custody or hold anyone accountable. The perpetrators haven’t faced justice in most cases. Just six of the 42 homicides have led to convictions. And the killings show no sign of ending. In the first half of this year, there were five homicides in three Mississippi prisons. Most of the 42 killings throughout the state prison system involved beatings or stabbings, sometimes involving multiple assailants.

Hawai'i

There is a price to be paid for suicides in Hawaiʻi prisons and jails, and state taxpayers are on the hook. Six cases active in state court are connected to inmate suicides at state-run jails and prisons, and lawyers who represent families of deceased inmates say at least two additional lawsuits over suspected suicides are in the works. The state has already paid out nearly $2 million to resolve similar lawsuits in recent years, and a scathing new report on mental health care in the Hawaiʻi correctional system suggests the state is at risk for more losses.

Severely mentally ill prisoners in Hawaiʻi are being cared for in dismal understaffed facilities and receive inadequate treatment, according to a pair of outside experts who inspected two jails under a class-action lawsuit settlement. The psychiatrists’ grim report identified inmates who were so severely ill they clearly should have been moved to Hawaiʻi State Hospital for treatment. The inspectors also flagged overuse of pepper spray to control inmates as a problem in an OCCC module for mentally ill prisoners, and reported staff at Hālawa deliberately made inmates on suicide watch endure harsh conditions as a strategy to discourage malingering.

Vermont

While issues like rising crime and criminal justice reform tend to attract more legislative and media attention, the bureaucratic underpinnings of the legal and carceral systems, like prisoner transports, have a quieter but daily impact on those navigating them. Spurred by Covid-19 practices and fewer transport resources, the state has increasingly relied on virtual court hearings as a solution. Valerio and others have decried that switch as jeopardizing the rights of criminal defendants.

Correctional Healthcare Vendors

NaphCare

A man experiencing excessively high blood pressure and a medical emergency was kept overnight at the Clackamas County (OR) jail on a TriMet fare violation rather than sending him to a hospital emergency room, leading to a fatal brain hemorrhage, a new lawsuit claims. Twice in the previous three months, jail health staff had referred Robert Hight III directly to the hospital instead of admitting him, in keeping with its policies, according to the suit filed in U.S. District Court in Portland. But on December 14, 2023, he was kept in jail, and he died three days later. The suit is just the latest to allege inadequate medical care at the Clackamas jail, and the latest to raise questions about Naphcare, the private contractor handling the jail’s constitutional obligation to provide care for people admitted there.

VitalCore

Two Charleston County Jail inmates claim in lawsuits that the jail’s former medical director sexually assaulted them during exams and promised medications in return for their silence. VitalCore, the jail’s medical provider, hired Dr. John Pfeiffer to work as the facility’s physician and medical director. In two lawsuits, a former and a current inmate accused Pfeiffer of inappropriate sexual touching. They claim the doctor required that what occurred in the examination room to not be shared with anyone else. The lawsuit stated if the inmate shared what occurred, Pfeiffer would have them sent to lock-up. Both lawsuits claim it was VitalCore’s responsibility to have performed a proper background check on Pfeiffer. VitalCore was hired as the jail’s medical provider in July 2023 after its former provider, Wellpath, faced allegations of malpractice. The lawsuits come as a Department of Justice investigation into the county’s jail is still ongoing.