Oversight & Statutory Rights In Corrections; Medicaid & Trump Administration; CMS Reentry Grant Announcement; More 1115 Approvals; Section 5121 FAQs

Highlighted Stories

Editor's Note

As regular readers know, we’ve frequently highlighted the limited effectiveness of government regulation over correctional healthcare when one governmental body oversees another. This week’s first two highlighted stories take us to Washington State, where, despite widespread recognition of the need for oversight in jails, the state remains unable to pass legislation establishing a regulatory process for county jails and sheriffs. The second story, an op-ed from the Seattle Times Editorial Board, strongly supports the proposed legislation. We spotlight this situation to emphasize that even when there is widespread recognition on the limitations of current oversight, creating effective structures can often be a political minefield.

And speaking of minefields, our third and fourth highlighted stories returns us to Oklahoma County, Oklahoma City. In last week’s Editor’s Comment, we reviewed the complex history of the Oklahoma County Criminal Justice Authority (OCCJA) and its strained relationship with the State Department of Health (SDH). After a court ruling in December allowed SDH to conduct unannounced inspections, the results have now been made public—and they are not pretty: rat infestations, inmates sleeping on floors, failure to distribute prescribed medications, and even failure to report a death. The findings suggest why the OCCJA may have resisted unannounced inspections. Yesterday, the CEO who had tried to prevent the inspections has announced her resignation.

Both the Washington State and Oklahoma County stories illustrate why COCHS has long questioned whether oversight or proposed oversight is the most effective means of improving healthcare in correctional facilities. Oversight is welcome, but its effectiveness is often limited. By its nature, oversight is reactive—corrections must only prove that it was not deliberately indifferent to the healthcare needs of incarcerated individuals. This reactive environment means problems often come to light only after negative outcomes have occurred.

From COCHS’ perspective, the deeper issue is that correctional healthcare operates as a separate system from community healthcare. However, legislation like the Consolidated Appropriations Act of 2023 (CAA) could begin to challenge this dynamic by establishing statutory rights for certain incarcerated populations, such as juveniles (see the third highlighted article from the Addiction Policy Forum, which includes multiple links to FAQs about the CAA and Section 5121). Equally significant are the 1115 Medicaid waivers for reentry that have recently been approved. Among the articles following the Addiction Policy Forum piece, we highlight Hawaii’s newly approved waiver and Washington State’s expanded waiver, which now includes tribal jails and aligns with the CAA. Additionally, the Highlighted Stories section features Colorado’s submission of a waiver amendment and a CMS announcement of planning grant awards for reentry.

As Inauguration Day approaches, it’s reasonable to ask how the new administration and Congress will impact Medicaid? The short answer: We don’t yet know. However, we direct our subscribers to Dan Mistak’s post-election letter, which notes that many Republicans have supported extending Medicaid coverage into correctional settings, including Vice President-elect JD Vance.

Washington State

After wrongful death claims shuttered one Washington jail last year and threatened another, a lawmaker is again pushing to create an independent oversight board for the state’s 50 local jails. Unlike Washington prisons, which are overseen by the state Office of the Corrections Ombuds, jails—typically run by counties and cities—lack statewide oversight. Since 2022, at least 64 people have died in local jails, according to the state Department of Health, but not all jails report deaths or their causes. Washington is one of 13 states without mandatory jail standards, a 2022 legislative task force found. The proposed legislation would create a board of corrections officials, an attorney, health care professionals, and formerly incarcerated people to set standards, investigate conditions, and report to the state. The Washington Association of Sheriffs and Police Chiefs opposed last session’s bill, citing a lack of corrections representation, but the new version addresses this concern. Dr. Marc Stern, a correctional health care expert, called the bill “a very good start” but warned that improving jails with inadequate health care will require additional funding.

The Seattle Times Editorial Board writes: There have been too many deaths, too many complaints and too many lawsuits against Washington counties over actions or inactions in jails for state lawmakers to look the other way. Sen. Rebecca Saldaña, D-Seattle, has again proposed a bill that would establish statewide standards for jails when it come to treatment of the incarcerated, including health care. The Washington Association of Sheriff & Police Chiefs (WASPC) opposed a previous proposal. The WASPC, however, does not oppose the new bill, but would like to see standards for jails created before the oversight board is established.

Oklahoma County

A 72-page Oklahoma State Department of Health inspection report on the Oklahoma County Detention Center highlights deficiencies like missed sight checks, inmates sleeping on floors, and a rodent infestation. The Dec. 11, 2024, report follows months of the jail barring surprise inspections due to staffing shortages. Despite facility upgrades and new leadership, the jail has repeatedly failed inspections in recent years. By law, OSDH must be notified of an inmate's death by the next working day, but the report noted the jail failed to report a May 31, 2024, death, which inspectors only learned of through news coverage. The jail administrator claimed they notified OSDH by email but did not provide proof. Inspectors also found inmates were not receiving prescribed medications, chronic care patients lacked treatment, and some were given incorrect medication dosages.

Brandi Garner, CEO of the Oklahoma County Detention Center, is stepping down. Garner announced her resignation on Friday, just days after the State Department of Health issued an extremely critical inspection report of the jail. The jail has failed more than six surprise health inspections since 2021 – many of which were failed by default because jail administrators barred investigators from entering the premises.

Consolidated Appropriations Act of 2023, Section 5121

As of January 1, 2025, states are required to provide screening and diagnostic services and targeted case management to Medicaid- and Children’s Health Insurance Program (CHIP)-eligible youth and young adults prior to and after their release from correctional facilities. This requirement is part of Section 5121 in the Consolidated Appropriations Act of 2023. To support readiness efforts by states and correctional leaders the following documents have been prepared:

• Key Elements for the Implementation of Section 5121 Youth Requirements in Adult Correctional Facilities;
• Section 5121 Brief Operational Checklist for Post-Adjudicated Youth;
• Section 5121 of the Consolidated Appropriations Act: Frequently Asked Questions for Jails;
• Section 5121 of the Consolidated Appropriations Act: Frequently Asked Questions for State Departments of Correction;
• Sections 5121 and 5122 of the Consolidated Appropriations Act, 2023 August 9, 2024.

1115 Approvals

Expenditure authority is being provided to Hawaii to provide limited coverage for a targeted set of services furnished to certain incarcerated individuals for 90 days immediately prior to the individual’s expected date of release. The state’s proposed approach closely aligns with CMS’ “Reentry Demonstration Opportunity” as described in the State Medicaid Director Letter (SMDL) released on April 17, 2023.

Washington requested coverage for eligible individuals in tribal jails in the state’s initial reentry demonstration initiative application. Today, CMS is approving tribal jails as an allowable facility type. Additionally, expenditure authority was provided to Washington to provide limited coverage for a targeted set of services furnished to certain incarcerated individuals immediately prior to the individual’s expected date of release. This amendment gives the state authority to (1) provide coverage to former foster care youth under age 26, who turned 18 on or before December 31, 2022, who were in foster care under the responsibility of another state or tribe when they "aged out" of foster care at age 18 and were enrolled in Medicaid on the date of aging out of foster care.

1115 Submission

On December 23, 2024, Colorado submitted a request to extend its section 1115 demonstration entitled, "Expanding the Substance Use Disorder (SUD) Continuum of Care," and to rename the demonstration “Comprehensive Care for Colorado.” This waiver includes an amendment for adults and youth transitioning from correctional facilities. The Reentry Initiative will enable Medicaid and CHP+ coverage and federal financial participation (FFP) using Medicaid and Children’s Health Insurance Program (CHIP) matching funds for adults incarcerated by DOC and youth detained throughout the state receiving a targeted benefit package that would ordinarily not be covered under federal law.

CMS Reentry Planning Grants

In September of last year, CMS released a Notice of Funding Opportunity (NOFO), making available $106.5 million for planning grants to state Medicaid and Children’s Health Insurance Program (CHIP) agencies to address operational barriers and promote continuity of care for Medicaid- and CHIP-eligible individuals who are inmates of a public institution, such as a state prison, local or county jail, tribal jail, or youth correctional or detention facility. Yesterday, January 13, 2025, CMS announced the first round of these grant awards to the following 12 states and territories: Alaska, District of Columbia, Kentucky, Maine, Massachusetts, Nevada, New Mexico, North Dakota, Puerto Rico, South Dakota, Utah and Virginia.

Substance Use Disorder

Few formerly incarcerated individuals are able to access sustainable MOUD treatment upon community reentry, missing a critical tool for rehabilitation and incurring a 40-fold greater likelihood of opioid overdose following release compared to the general population. Previous work has shown that in individuals who are released with doses of MOUD, less than half continue use in the community. The most prevalent barriers included lack of interagency collaboration, inability of pharmacists to provide additional OUD services, lack of awareness, lack of insurance, and lack of reliable transportation. A focus on reducing these barriers may be an important and impactful first step in improving access to injectable naltrexone for formerly incarcerated individuals.

Joined by National Council Vice President, Substance Use Continuum, Philip Rutherford, Charlier will share his experiences and provide insight into: the crucial role of deflection programs in reducing incarceration; the scope of SUD among justice-involved individuals and the barriers to treatment; the global impact of deflection on recidivism and recovery; and the ongoing battle against stigma in SUD treatment.

The Biden administration eliminated a major barrier for health providers seeking to offer contingency management, a form of addiction treatment increasingly used to help reduce the use of stimulants, particularly methamphetamine. Contingency management helps drug users curb their consumption by providing financial incentives in exchange for reduced substance use. While it exists in many forms, typical programs may include providing gift cards in exchange for negative urine drug tests. And while it may appear controversial, several studies support its effectiveness.

BOP

Even before the COVID-19 pandemic, prisons across the country faced severe staffing shortages. The Federal Bureau of Prisons (BOP), operating on an $8.3 billion annual budget, has attempted to address these gaps by hosting job fairs, offering retention bonuses, and increasing pay to attract and retain workers. Despite these efforts, federal prison facilities continue to grapple with significant staffing shortfalls. In December 2024, the BOP announced the closure of seven prisons—including six male prison camps—as a cost-saving measure to consolidate operations. Unfortunately, this challenge is not unique to federal institutions.

Data & Statistics

This report examines data from 23 states where juveniles (defined as persons ages 12 to 17) were charged in adult criminal courts between January 1, 2014 and December 31, 2014. Focusing on the 23,553 cases where the most serious charge was known at arrest and case disposition, the report covers cases filed in adult criminal courts against juveniles at several stages throughout the court process, including the most serious charge at arrest, method of disposition, case outcome, and sentencing. It also presents statistics on the demographic characteristics of these juveniles.

One in six people in prison – nearly 200,000 people nationwide – are serving life sentences. This comprehensive 50-state report examines the prevalence and implications of life sentences across the country, highlighting the disproportionate impact of such extreme sentences on people of color and the inefficacy of punitive measures in improving community safety. The large number of people serving life sentences raises critical questions about moral, financial, and justice-related consequences that must be addressed by the nation as well as the states.

State Roundup

California

Nearly 1,000 incarcerated men and women have joined the frontlines in a battle against record-breaking wildfires burning across southern California. The number deployed - now 939 - are part of a long-running volunteer program led by the California Department of Corrections and Rehabilitation (CDCR). Their numbers have steadily increased since Tuesday, the day the deadly fires began spreading uncontrollably through Los Angeles.

The U.S. Ninth Circuit Court of Appeals in Pasadena heard arguments of lawyers from GEO Group, a private prison company, and the federal government over a lawsuit that challenges California’s Assembly Bill 32 that bans private prisons and privately-run immigration detention centers. California legislators passed AB 32 in 2019 hoping other states would follow suit and ban private detention centers, including facilities contracted by U.S. Immigration and Customs Enforcement (ICE) to detain immigrants. AB 32 went into effect on Jan. 1, 2020, intending to close seven privately-run prisons by 2028 and leave California with only one county jail that holds immigrants for deportation. Washington state and New Jersey, among other states, have also moved to ban privately-run immigrant detention centers.

Santa Clara County jail deaths reached a 20-year high in 2024. Ten people died in the custody of the Sheriff’s Office last year across the main jail, Elmwood Correctional Facility and county hospitals where deputies transported incarcerated people for medical care. More than half of the total deaths happened at the Elmwood facility in Milpitas. The number of deaths doubled from five in 2023.

Georgia

The Glynn County Finance Committee will consider an increase of $700,000 to pay for jail inmate medical and prescriptions. The original budget of $400,000 for medical and $200,000 for prescriptions has already been exhausted. The sheriff’s office estimates it will need $500,000 for medical and $200,000 in prescription funds to complete the fiscal year which ends June 30. Any money that is not spent will be returned to the undesignated fund balance at the end of the fiscal year.

Florida

Palm Beach County commissioners voted unanimously Tuesday to help fund a $60 million mental health and substance use crisis center. The center will be primarily funded, built and operated by the Health Care District of Palm Beach County. The behavioral health facility will include primary and 24/7 care, and in-patient and outpatient services. The 60,000-square-foot facility is part of a years-long, countywide effort to address and build adequate support for adults and children experiencing mental distress without heavily relying on jails or the state's Baker Act.

Maryland

Maryland health regulators on Friday said they had ordered an addiction treatment provider, PHA Healthcare, to stop seeing patients after an investigation by The New York Times and The Baltimore Banner showed it had placed some of them in apartment buildings where drug use was rampant. The article revealed that the company collected millions from Medicaid providing online group counseling sessions. It offered free rooms to people who enrolled, but some of its buildings were effectively government-funded drug houses, where many patients relapsed and sometimes died, the reporters found.

Mississippi

Five years after a gang war and unrest at Mississippi’s prisons left a dozen dead from homicides and suicides, officials say these prisons are different places. They pointed to the Mississippi State Penitentiary at Parchman, which has long been regarded as one of the nation’s worst prisons. The facility has been remodeled, and all the units except for Unit 29 have air-conditioning. Air-conditioning has also come to a third of the South Mississippi Correctional Institution. The Mississippi Department of Corrections is hoping to stave off litigation from the Justice Department, which concluded in a 60-page report that these two state prisons, along with the private prison, Wilkinson County Correctional Facility, fail to “adequately supervise incarcerated people, control contraband, and investigate incidents of harm and misconduct."

Ohio

The Summit County Jail will be changing the way it houses people with mental health and addiction issues this year. The jail is creating a new unit for people struggling with mental health issues, as well as those on suicide watch or with other medical issues, to provide better treatment and the support they need to get back on their feet when they’re released. The new unit will also help the county's deputies focus on people incarcerated in the general population units, instead of often having to worry about health issues for those struggling with mental health or detoxing.

Oklahoma

Oklahoma County’s ongoing jail saga highlights government ineptitude at its finest. Taxpayers and business owners were promised a $260 million jail project, but costs are now projected to exceed twice that amount. Oklahoma Attorney General has further muddied the waters by issuing an opinion that counties can overrule city zoning laws, complicating an already contentious lawsuit between Oklahoma City and the county. In June 2022, roughly 61,000 voters approved the $260 million plan, yet over two years later, no ground has been broken. After months of indecision, county commissioners settled on a 60-acre site, despite clear opposition from the Oklahoma City Council, which refuses to rezone the land for a correctional facility.

Oregon

An advocacy group has asked a federal judge to hold the Oregon Health Authority in contempt over what it calls its lack of urgency to the mounting human toll from the state’s worsening mental health crisis. Lawyers for Disability Rights Oregon filed the motion asking U.S. Judge Adrienne Nelson to bring sizable financial penalties against the health authority while compelling it to overhaul its management of the state’s mental health resource. The development represents a major potential escalation of the decades-old litigation over Oregon State Hospital admissions. And it comes as Nelson in recent court hearings has been bringing up the idea of a contempt order against the state.

North Carolina

In an attempt to reduce the cost of prison health care in North Carolina, the GOP-run legislature in 2023 passed changes that make early release for medical reasons less stringent. Governor Roy Cooper, a Democrat who just left office at the end of December, signed it into law. The changes lowered the age at which prisoners can be released for medical reasons from 65 to 55. To qualify, the prisoner must be so terminally ill, disabled or geriatric that they are medically incapacitated and determined by officials to pose little to no risk to public safety. However, no individual or board is tasked with identifying eligible prisoners for medical release, meaning people must find a way to apply on their own. Aside from the challenges of seeking release, the new law will only benefit a fraction of the prison population. Its limitations exclude younger prisoners, even those with enormous medical needs.

Texas

Lawsuits alleging mistreatment and neglect inside the Tarrant County jail have cost the county more than $4.3 million. Deaths have spiked under Tarrant County Sheriff Bill Waybourn. Since Waybourn took office in 2017, nearly 70 people have died in the county’s care, some under allegations of neglect and abuse. Waybourn has blamed the increase in deaths on people’s preexisting health problems. There’s not much he can do about someone who gets arrested and sent to jail when they have stage-four cancer, he’s argued.

Virginia

After six inmates partially burned themselves last year to call out what they say are “intolerable” conditions at a Virginia maximum security prison, staffers weighed whether to charge the inmates “thousands of dollars for the hospital and medical treatment.” Red Onion State Prison’s chief of security suggested charging the inmates for their care after the burns, while an assistant warden suggested prosecuting them for setting fires in their cells, adding that they could be charged for their hospital visits if they are convicted for the self-injuries.

Reentry

In July, after 20 years in prison for attempted murder and a gun enhancement, Coleman, 47, became one of three dozen prisoners at the Central California Women’s Facility in Chowchilla to graduate from a peer support specialist program. Lt. Monique Williams, the prison’s public information officer, said the women doing peer support are making a tangible difference. The peer support specialists at Chowchilla have provided more than 10,000 one-on-one counseling sessions and 430 group sessions, according to the corrections department.

Correctional Diets

Incarcerated people have extremely limited choices when it comes to what they are served from the prison kitchen. You don’t have to attend every meal, but if you can’t afford to purchase alternatives from the canteen, you don’t eat—and canteen items aren’t cheap. At the Eastern Kentucky Correctional Complex the diet follows a usual pattern: breakfast is biscuits and gravy; lunch is nacho chips, rice, and a cookie; and dinner is smoked sausage, potatoes, bread or a roll, and cake. In American prisons diabetes is a chronic health issue. Needed interventions for imprisoned people with diabetes is rare.

Correctional Architecture

Correctional facilities, once designed purely for containment and security, have been undergoing a significant transformation. However, recent research, including findings from the healthcare sector, highlights the profound benefits of biophilic design –an approach that integrates natural elements into built environments. These principles are now reshaping correctional facilities into spaces that promote healing and rehabilitation.

Correctional Health Care Vendors

Wellpath

Bankrupt prison healthcare company Wellpath Holdings received court approval to spin off its behavioral health division to a group of its lenders. The lender group will acquire Wellpath Recovery Solutions, which provides services at inpatient psychiatric hospitals, residential treatment centers, mental health rehabilitation centers and community-based services, in exchange for canceling about $375 million of Wellpath’s debt. U.S. Bankruptcy Judge Alfredo Perez approved the sale at a court hearing in Houston, Texas, after Wellpath said that no outside buyer had offered more than the lenders' debt deal. The company generated more than $2 billion in revenue in 2023, mostly from contracts to provide healthcare in federal and state prisons and local jails. The behavioral health division approved for sale generated $425 million in revenue in 2023, accounting for about 20% of the company’s total income.

An Upper Peninsula community is already facing decreased medical service after raising the alarm on delinquent payments last year. Kinross EMS, which serves Chippewa County, is still out nearly half a million dollars due to nonpayment from a former state of Michigan contractor, which has since declared bankruptcy. “The last few months, we’ve been pretty much living month to month on our funds that we have coming in and going out,” said Renee Gray, president of Kinross EMS. The issue stems from Wellpath, a service that previously contracted with the state Department of Corrections to provide medical care for inmates.

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COCHS Weekly Update Will Not Be Published Next Week