Weekly Update: September 19, 2023
Medicaid Coverage in Corrections: Progress, Detours & Setbacks

COCHS Weekly Update: September 19, 2023

Highlighted Stories

Editor's Note
Much of COCHS’ work has focused on informing policymakers of the harmful effect that the Medicaid inmate exclusion policy (MIEP) has had on individuals and our health systems. With the opportunities created through CMS' guidance on Medicaid 1115 waivers and Congressional changes created by Consolidated Appropriations Act, the federal government has sent a clear signal that the harms created by the MIEP must be undone.

But there are also voices raised at a local level demanding modifications to the MIEP that should not be ignored. In the first story below, multiple organizations in Idaho are requesting that the state’s congressional delegation support expanded Medicaid access in jails. On the other side of the country, in New Hampshire, the realization that local taxpayers are footing the bill for episodic health care within that state’s correctional systems instead of Medicaid, has prompted Congresswoman Annie Kuster to build on her success with the changes signed into law in the Consolidated Appropriations Act to re-introduce legislation to allow people in corrections to maintain their Medicaid coverage.

As our subscribers are aware, the progress we have seen in bringing Medicaid behind the walls is not always consistent --as shown by the third highlighted story. For Medicaid to play a significant role in adult health care in corrections, a state needs to have expanded Medicaid to ensure better coverage and reduce the burden of categorical eligibility determinations. North Carolina, where Medicaid eligibility was slated to expand, is facing a political detour that could possibly jeopardize Medicaid expansion. The governor’s Crime Commission has stated that the expansion of Medicaid is a criminal justice issue as local jails have often become the new hospitals in many jurisdictions. Without expanding Medicaid, North Carolina will not have the tools and funding necessary to tackle the challenges created by the many unmet health needs that often result in involvement with the justice system.

One of the dangers of inviting health systems into correctional settings is evident in the story from West Virginia. West Virginia Senate Bill 1009 would leave the determination of what is medically necessary to the Corrections and Rehabilitation Commissioner, a person who is currently not a medical provider. If a law such as this were on the books, harmonizing Medicaid's clinical decision making of medical necessity with a non-medical professional's assessment would create significant challenges for implementing new opportunities for Medicaid in West Virginia's carceral settings. Ultimately, West Virginia will need to decide whether it wants medical professionals, along with new federal support, to identify the best course of treatment for patients, or whether the state would prefer to pay out of state budget for non-medical decision making to worsen existing health inequities.

This legislation, of course, is a knee-jerk reaction to the issue of malingering within corrections. And as with many knee-jerk reactions it might exacerbate the situation it is trying to correct. There are stories we have highlighted before in the Weekly Update that emphasize how a lack of proper medical care can be criminogenic and costly. Limiting health care in such a manner and possibly preventing Medicaid coverage reinforces correctional health care as an island that makes successful reentry into the community more difficult. COCHS has aimed to bridge the divide between the island of corrections and community care since we were founded back in 2006.

With the passage of the Affordable Care Act, COCHS has consistently identified Medicaid as the vehicle by which to integrate correctional health care into the wider health care system to improve access to integrated care, quality services, and reduced costs. In Nebraska, as reported in the last highlighted article, that state’s legislature recently enacted a bill that requires the Department of Correctional Services to assist incarcerated people nearing release to enroll in Medicaid. COCHS’ long term vision of ending the carceral health care island is slowly gaining widespread traction.

MIEP & Local Jurisdictions
Idaho Capital Sun: Letter to Idaho Congress members supports bills for incarcerated Medicaid access
Eleven organizations, including the Idaho Association of Public Health District Directors, signed on to a letter to Idaho’s Congressional delegation supporting legislation that would expand Medicaid access for people in jail and in prison in hopes of reducing overdose deaths.

New Hampshire Bulletin: Jails, prisons are ‘default’ medical providers, and taxpayers are paying
Over the last several months, the Department of Corrections has needed an additional $6.5 million to keep up with inmate medical costs, including a 176 percent increase in ambulance costs since 2022. It’s not alone among correctional facilities. Congresswoman Annie Kuster has introduced federal legislation several times that would allow inmates to keep Medicaid while incarcerated. She reintroduced similar legislation in May, saying it’s good both for inmates who can maintain their health care and counties and states that are picking up the costs. So far, she’s been without success.

NC Newsline: Governor’s Crime Commission connects Medicaid expansion to criminal justice
As the rollout of Medicaid expansion remains delayed as lawmakers continue to negotiate the budget, the Governor’s Crime Commission passed a resolution acknowledging that extending healthcare to about 600,000 North Carolinians is a criminal justice issue. “In rural communities, the biggest treatment facility often is the jail,” Pamela Thompson, a member of the Governor’s Crime Commission, said in a statement. “The jail has become the new hospital. Expansion of Medicaid will help shore up healthcare resources across the state, ensuring North Carolinians have access to critical services.”

Belt Magazine: Making it Harder to Get Health Care in WV Prisons
Senate Bill 1009 bans the use of state funds for any health care for incarcerated people that isn’t deemed “medically necessary.” The policy leaves it to state Corrections and Rehabilitation Commissioner Billy Marshall—a career law enforcement agent who has said incarcerated people are lying when they allege inhumane treatment by the state—to define “medically necessary” and makes clear that this definition can supersede guidance from health professionals. West Virginia already routinely fails to provide basic, essential care in its jails and prisons, several formerly incarcerated people.

Lincoln Journal Star: Nebraska launches Medicaid registration program for inmates nearing release
More than a year after the Legislature passed a bill meant to help incarcerated Nebraskans access health care coverage upon their release from state prisons, two state agencies have partnered to implement the program. The Nebraska Department of Correctional Services is assisting those nearing release from state custody with Nebraska Medicaid enrollment — a practice required by LB921, which took effect July 1, more than a year after the Legislature passed the bill on a 46-0 vote in April 2022.


BMC: Facilitators and barriers to COVID-19 vaccination among incarcerated people and staff in three large, state prisons: a cross-sectional study
For incarcerated individuals, the most common reason for getting vaccinated was to return to normal activities in prison; the most common reason for being hesitant to get vaccinated was “other”, with individuals citing a variety of concerns. For staff, the most common reason for getting vaccinated was to protect the health of family and friends; the most common reasons for being hesitant were disbelief that vaccination is necessary and distrust of healthcare and public health systems.

Bakersfield.com: Detainees, advocates outraged over COVID outbreak at Golden State Annex
Civil rights advocates are up in arms amid an ongoing COVID-19 outbreak at Golden State Annex, an immigrant detention center in McFarland. A letter, signed by 30 people currently detained at the facility, details “dangerous conditions” they attest are the direct result of negligence by Immigration and Customs Enforcement, or ICE, and GEO Group, the private company that runs the detention center.

Solitary Confinement

NC Health News: People who spent time in solitary confinement say it had lasting effects on their mental, physical health
Survivors of solitary confinement recounted their experiences during an Aug. 31 listening session held by Disability Rights NC to raise awareness about the physical and psychological harm experienced by a person subject to such confinement. The group is advocating for ending the practice altogether in North Carolina’s prisons and jails. A 2019 study from researchers at UNC Chapel Hill found that people who spent any time in solitary confinement while incarcerated were 24 percent more likely to die in the first year after their release than those who never experienced solitary.

Los Angeles Times: Bill to restrict solitary confinement in California stalls out in Sacramento
In a blow to criminal justice reform advocates and a win for corrections officials, California lawmakers delayed legislation to restrict the use of solitary confinement in prisons, jails and immigration detention centers, to buy time to negotiate with Gov. Gavin Newsom over safety concerns. Last year, Newsom vetoed similar legislation to restrict solitary confinement.

Racial Disparities

University of Arkansas: Study Finds Probation Associated With Poorer Health for Black Americans
High levels of incarceration has many consequences, including a direct impact on public and individual health. Contact with the criminal justice system has been associated with a number of poor health outcomes, including hypertension, depression and substance abuse disorders, as well as poor mental health, and accelerated aging. New findings suggest that contact with the criminal justice system, particularly probation and probation in combination with incarceration, disproportionately affects the health outcomes of Black Americans.

Data & Statistics

NACJD: Criminal Justice Dataset Releases
This August, the National Archive of Criminal Justice Data (NACJD) at the Inter-university Consortium for Political and Social Research (ICPSR) released 3 new studies. Newly released data cover topics such as inter-partner violence, elder abuse, statistical models, and more. Please click on the study titles linked below for more information about a particular study.

State Roundup

San Diego Union Tribune: Bill by Toni Atkins to curb jail deaths, improve oversight wins passage and moves to governor
After twice being amended in the wake of opposition from law enforcement groups, a bill aimed at reducing the number of people who die in California jails passed the Legislature and is headed to the governor’s desk. Senate Bill 519, introduced by Senate President Pro Tem Toni Atkins, D-San Diego, in response to the escalating death rate in San Diego County jails, would create the position of director of in-custody review inside the Board of State and Community Corrections, the panel that oversees county jails.

Santa Cruz Local: Santa Cruz County leaders explore potential new jail
On the heels of three recent civil grand jury reports on problems at the 42-year-old Santa Cruz Main Jail at 259 Water St., Santa Cruz County Sheriff Jim Hart said one option is to build a new jail on county land. Some advocates for inmates and the Santa Cruz County Civil Grand Jury said the county first should invest in alternatives to incarceration.

KHQA: Early release more common as money saving method with Illinois incarceration
Adams county states attorney Gary Farha says it has become more of an occurrence to see individuals booked in the Illinois Department of Corrections serving less time than their sentence. He says this is due to efforts at the state level to cut costs related to incarceration.

KFF Health News: Some Illinois Prisoners Remain In Jail Despite New Medical Release Law
AP reports that although it's been over a year since the Coleman Act went into effect, an investigation found fewer prisoners have been released than expected, thereby remaining in jail even though they are dying or disabled.

PBS: More people are dying in Louisiana prisons, some before getting a trial
The Incarceration Transparency Project at the Loyola University Law School says there's been a 50 percent jump in deaths from 2019 to 2021. There has been a significant spike in deaths due to drugs, suicide and violence, all reaching new highs. One in four people killed in Louisiana jails had not been tried yet. Black people made up nearly 58 percent of deaths.

Guardian: Louisiana ordered to remove teens from ‘intolerable’ conditions at state prison
Louisiana has until September 15 to remove children from its notorious state penitentiary at Angola after a federal judge found they were being held in “intolerable” conditions that included prolonged solitary confinement, punishment with mace and handcuffs, and inadequate education and mental health care. The ruling brings to a climax a year-long battle between civil rights groups and the state of Louisiana, which has one of the highest incarceration rates in the world.

WAFB: Program in EBR gives certain people option to seek treatment instead of jail time
The Pre-Trial Diversion and Recovery Program in East Baton Rouge Parish is giving certain people the option to seek treatment instead of time behind bars. According to officials, the program aims to seek out non-violent offenders in jail who face a mental health or substance abuse challenge. Potential program participants are identified and then assessed. If officials think a participant is a good fit for the program, that person is released from jail to begin a four to six-month treatment plan.

Baltimore Banner: State officials tell judge they’re still years away from fixing health care in Baltimore jails
State attorneys told a federal judge this week that Maryland’s corrections department won’t meet the court’s December 2024 deadline to fix health care and mental health in Baltimore jails. Recent reports by court-appointed monitors who track medical and mental health care in city jails have documented people with severe mental illness languishing in solitary confinement, error-prone medical records, missed medications and people with disabilities not being properly identified.

Federal News Network: Drinking water testing ordered at a Minnesota prison after inmates refused to return to their cells
State officials have ordered additional tests on drinking water at a Minnesota prison after concerns about the water’s quality and other issues were raised when dozens of inmates refused to return to their cells during a heat wave earlier this month.

Star Tribune: After protest, Stillwater prison inmates get bottled water; more testing is ordered
A week after a peaceful protest by inmates objecting to conditions including the quality of drinking water, Minnesota corrections officials have changed course and are offering bottled water to inmates at Stillwater prison and have ordered the water tested.

New Hampshire
New Hampshire Bulletin: Court: Mental health disorders do not automatically qualify as insanity
The state Supreme Court has ordered that a man serving his New Hampshire prison sentence in Montana cannot be transferred back to the state to serve his time in the prison’s secure psychiatric unit simply because he feels he is not getting adequate mental health treatment in Montana. To qualify for transfer to the prison’s forensic hospital, a person must be diagnosed as insane, and the transfer must be conducive to both the inmate’s health and comfort and the public’s welfare, the court ruled.

New York
NCPR: AG Investigation found that a woman was denied abortion care at the
Jefferson County Jail. The investiagtion found that both the health care staff and medical director at Jefferson County Correctional Facility refused to provide abortion care to a pregnant woman. The Office of the Attorney General will be monitoring the Jefferson County Correctional Facility for the next five years to make sure they are compliant.

ABC: Independent jail monitor says staffing crisis at root of Danelo Cavalcante's escape
When Claire Shubik-Richards heard a convicted murderer had escaped from a county-run prison in Pennsylvania, she said one of the first things to cross her mind was whether it had to do with an ongoing staffing crisis at the facility where the inmate absconded. The facility where inmate Danelo Cavalcante escaped from, is severely understaffed. The 2022 survey also found the prison had funding for 243 full-time prison staffers, but only 178 of those positions were filled.

Pennsylvania Press Room: Pennsylvania Commission on Crime and Delinquency Visits Armstrong County Jail, Highlights Program to Help Individuals with Opioid Use Disorder and Reduce Future Justice Involvement
The Pennsylvania Commission on Crime and Delinquency (PCCD) visited Armstrong County Jail to meet with staff and discuss successes within their county jail-based medication assisted treatment (MAT) program, made possible through PCCD's Office of Justice Programs and a partnership with the Pennsylvania Department of Drug and Alcohol Programs (DDAP). Since 2021, just over $1 million in SAMHSA State Opioid Response funding has been sub-awarded to the Armstrong County Commissioners to increase opportunities to provide MAT in combination with Cognitive Behavior Treatment (CBT) to individuals in Armstrong County Jail and upon release to the community.

KSAT: Some people arrested on low level crimes will have their bond paid for Harvard research
Harvard Law School is conducting a new justice study that will pay bail for select nonviolent Bexar County inmates over the next several years. The study is investigating what happens to low-level offenders waiting in jail because they cannot afford to post bail. Researchers will follow up with participants through a series of surveys over several years to see if the early bail leads them toward more success.

VT Digger: 35-year-old incarcerated man dies at St. Albans prison
A 35-year-old man died at Northwest State Correctional Facility in St. Albans. This death is the 10th in a Vermont prison this year and the second in recent months at Northwest State.

OPB: Attorney for two Clark County inmates calls for sanctions on Washington behavioral health agency
As some people in custody wait longer and longer for beds at Washington’s psychiatric facilities, an attorney for two lodged in Clark County Jail is taking the state to court. At the crux of the issue is Washington’s beleaguered behavioral health care system. The state’s two psychiatric hospitals do not have enough beds to help rehabilitate dozens of people in need. Wait times have ballooned for beds. People in custody are often left languishing in county jails or are released back into the public.

Rikers Island

Gothamist: Rikers throws out $40K of instant mashed potatoes due to boxes full of bugs
Department of Correction officials threw out $40,000 worth of instant mashed potatoes this week after a food inspector found live insects in the food, a department spokesperson confirmed. According to an incident report shared with Gothamist, the inspector found insects in 542 cases of instant mashed potatoes at the Rikers Island jail facility.

Gothamist: NYC jails buying accessories for sniper rifles it rarely uses
The city’s Department of Correction has made its third purchase of sniper rifles and accessories in less than a year – this time buying ammunition, scopes and tripods at a cost of about $150,000. The latest addition to the arsenal comes as the department cuts $17 million in training and detainee services from the troubled jail system — and despite the fact that city correction officers are not permitted to carry firearms inside jails.

Los Angeles County

Vera: 32 People Have Died in LA County Jails This Year
14 people have died in Los Angeles County jails since June 1. Their deaths bring the total number of people who have died while in the custody of the nation’s largest jail system this year to 32—averaging just shy of one death every week. That staggering number far exceeds that of New York City Department of Correction (NYC DOC) facilities, where the rising number of deaths at the Rikers Island jail complex has led to a mounting crisis that has received nationwide attention.


Criminal Justice Tresting and Evaluation Consortium: Monitoring Technologies for Community Supervision
Four new community supervision briefs outline how monitoring technologies can support community supervision agencies and individuals on pretrial release, probation, and parole. To meet the increasing challenges of both monitoring and supporting individuals on community supervision, these reports, released by NIJ’s Criminal Justice Testing and Evaluation Consortium, offer insights on: monitoring technologies; location tracking systems; alcohol and drug monitoring solutions and smartphone applications.

Correctional Health Care Vendors

Advanced Correctional Healthcare
The Republic: Judge extends deadline for settlement proposal with jail contractor in inmate death case
A federal judge has extended a deadline for the court-appointed estate administrator of an inmate suffering from an acute mental health crisis who died last year after spending 20 days in solitary confinement at the Jackson County Jail to make a settlement proposal to a contractor that provides medical care at the jail. The civil lawsuit names Advanced Correctional Healthcare, Jackson County and several employees as defendants.

Armor Correctional Health Services
The Tributary: $6.3 million wake-up call: Judge finds former Duval jail medical provider liable for COVID-19 outbreak
A state judge found Armor Correctional Health Services at fault for a 2020 COVID-19 outbreak that infected at least 197 inmates and staff at the Duval County jail. Fourth Judicial Circuit Judge Katie Dearing ordered Armor to pay more than $6.3 million in damages and attorneys fees to two former Jacksonville Sheriff’s Office correctional officers and their wives after both men were hospitalized with the coronavirus.

Noozhawk: Despite Serious Concerns, County Supervisors Agree to Extend Jail Health Contract
Over serious concerns, the Santa Barbara County Board of Supervisors agreed this week to extend the contract with Wellpath, the medical and mental health provider in the jails. The supervisors felt they had no choice but to approve another year of the contract, for $14.7 million. Those came after a class action lawsuit settlement between the county, the Sheriff’s Office and disability rights groups for “dangerous and unconstitutional conditions” in the Main Jail. Stan Roden, who served on the Grand Jury writing those reports, urged the supervisors not to extend the Wellpath contract.

Monterey County Weekly: New documents reveal how Monterey County Jail and prison health care contractor Wellpath are still failing incarcerated people.
Five people housed at the jail have died this year alone, according to attorneys representing the county jail’s inmates in a 2013 class-action lawsuit over inadequate health care at the facility. Those deaths – plus other accounts of non-fatal illnesses and injuries – are even more alarming considering that the class-action settlement mandated that Monterey County Jail improve its health care conditions to avoid such outcomes. The documents reveal “the extent to which Wellpath and the County have utterly failed to meet their court-ordered obligations,” according to Van Swearingen, a partner at San Francisco-based law firm Rosen Bien Galvan & Grunfeld.

WCAX: Vt. lawmakers examine quality of prison health care
The health care provided to incarcerated Vermonters is under the microscope at the Statehouse in Montpelier. In a year where the state has seen 10 inmates die, lawmakers are now questioning the quality of prison health care and whether better care might actually help reduce the prison population. Taxpayers front about $33 million annually for the private company, Wellpath, to manage the health care of prison inmates. Vermont lawmakers on Tuesday heard what is and is not working, from inmates getting the wrong medications to inadequate mental health and substance use services.

WRDW: Augusta leaders take steps to change jail health care provider
With WellPath’s contract set to expire on Dec. 31, city leaders are looking at three-year contract with VitalCore Health Strategy LLC for more than $6.67 million for just the first year. News 12 has been investigating WellPath for years on the mistreatment of inmates, particularly in the deaths of Debra Leverett and Ashley Asuncion. Since December 2010, the Richmond County Sheriff’s Office has been contracting Correct Care Solutions, now known as WellPath, as the jail medical provider.

In Observation Of The Jewish Holidays
COCHS Weekly Update Will Not Be Published Next Week