New England Journal of Medicine Examines Carceral Healthcare; Recommendation: Medicaid and Community Linkage

Highlighted Stories

Editor's Note

This week’s Highlighted Stories come from two very different sources, The New England Journal of Medicine and a Fox News affiliate in San Antonio, Texas. A strange juxtaposition, perhaps, but as many of our subscribers know, COCHS has long recognized that understanding healthcare in corrections requires more than just insights from national journals; local reporting is often just as—if not more—essential.

The New England Journal of Medicine article reviews research on the health of incarcerated individuals in the U.S.—which, to put it bluntly, is abysmal. It underscores the need for stronger community linkages and expanded Medicaid coverage within corrections to drive meaningful improvements in health outcomes.

Meanwhile, the Fox News San Antonio story focuses on Bexar County Jail, where a recent audit found technological failures in the intake process, creating significant gaps in addressing the health needs of people being processed into the facility. Intake challenges were previously discussed in the Editor’s Note of February 11, 2025, which examined the death of an incarcerated homeless man in Sacramento, California.

The difference between that story and this week’s reports is a growing emphasis on technology—explicit in the Texas article and implicit in the NEJM piece’s discussion of linkages. As 1115 waivers for Medicaid coverage in correctional settings take effect, upgrading technological infrastructure will be critical.

The April 2023 Dear State Medicaid Director letter, which laid the groundwork for these waivers, outlined several technology-related recommendations to support implementation, including:

• Data-sharing agreements between corrections, Medicaid, and providers
• Electronic Medicaid enrollment systems for pre-release applications
• EHR and Medicaid system interoperability to track care transitions
• Secure Health Information Exchanges (HIEs) to facilitate record sharing while maintaining HIPAA compliance
• New billing and operational practices for carceral settings

These "recommendations" are, in theory, optional, yet how Medicaid coverage can be implemented without them remains difficult to fathom.

Of course, all of this hinges on what Congress decides about Medicaid funding. Will the 1115 waivers move forward as envisioned, or will they be halted by budget cuts? For now, that remains very hard to predict.

To summarize: Incarcerated individuals often enter jails and prisons in poor health, and conditions such as solitary confinement, overcrowding, and extreme temperatures further worsen their well-being. Chronic illnesses, substance use disorders, and mental health conditions are far more prevalent in carceral settings than in the general population, yet access to adequate care remains limited. Drug overdose is a leading cause of death post-release, with mortality rates in the first two weeks after incarceration nearly 13 times higher than for other community members. Cancer, now the second leading cause of death in state prisons, remains understudied, underscoring the need for further research into evolving health challenges. Throughout the article, emphasis is placed on the importance of community linkages, expanded Medicaid coverage during incarceration, and improved transparency and oversight to strengthen carceral health care systems.

A new study revealed a host of inefficiencies at Bexar County's Justice Intake and Assessment Annex which processes all individuals arrested in Bexar County. Researchers from UT Health Houston's School of Public Health in a report highlighted issues such as outdated technology, prolonged processing delays, and poor communication across government departments. Many processes at the facility, such as paper-based bond processing, have remained unchanged for decades. Researchers have developed a 90-day action plan to streamline booking. The plan includes updating technology, fast-tracking certain inmates for release or diversion, and improving infrastructure at the facility.

Follow Ups

Editor's Comment: No surprise that this week’s Follow Ups include yet another update on Wellpath’s bankruptcy. The Appeal highlights the all-too-familiar tactic of correctional healthcare providers using bankruptcy to evade liability for those individuals harmed under their care. Meanwhile, Bloomberg Law reports that—for now—Wellpath is not requesting executive bonuses but will revisit this request at a later date.

In Oregon, The Oregonian continues its investigation into the alleged actions by former Chief Medical Corrections Officer, Dr. Warren Roberts. One egregious reported example of his tenure: he humiliated a gynecologist by relegating the doctor to work in a mailroom. The article also aims criticism at the governor and legislature, who played ostrich despite multiple claims of abuse that had been widely reported.

Now turning to New York, where the murder of Robert Brooks at the Marcy Correctional Facility prompted Gov. Kathy Hochul to address conditions in the state’s correctional system—sparking a correctional officers’ wildcat strike statewide. The correctional officers complain of understaffing and limits on solitary confinement. The governor has since deployed the National Guard to prisons as temporary staffing, and while a tentative deal is in the works to bring officers back, it remains to be seen if the standoff will really end. Since the strike began five incarcerated people have died.

Finally, returning to the Sacramento story mentioned in this week’s Editor’s Note, The Sacramento Bee reports that plans to build a new intake annex for the jail have been suspended. Consultants from CGL Companies determined that the proposed annex would be insufficient for the jail’s projected needs and recommended further operational analysis.

Delays like this are not uncommon when jurisdictions consider brick-and-mortar upgrades to correctional facilities. However, from COCHS’ perspective, the key issue isn’t the Board of Supervisors’ hesitation to commit to new construction—it’s that Sacramento County remains out of compliance with the Mays Consent Decree, which it agreed to in 2020.

Wellpath Bankruptcy

Wellpath, the country’s largest private medical contractor, provides healthcare to hundreds of facilities across dozens of states. The company generated more than $2 billion in revenue in 2023. It is also the latest firm to employ a new tactic to evade accountability: In November, Wellpath filed for bankruptcy, halting more than a thousand cases—many by people who say they were harmed by the company’s medical abuse and neglect. Not only will this process delay or deny people from getting vital compensation—it could also leave local governments holding the bag for Wellpath’s inhumane treatment in these cases. One reason Wellpath and its ilk have such harrowing track records: The legal system lets private companies dodge accountability in ways public entities cannot. Filing for bankruptcy is an increasingly common tactic for multi-billion dollar companies to evade responsibility for civil rights violations.

Wellpath Holdings Inc. won court approval of its key employee retention program worth up to $3 million, but the prison health-care company’s proposed incentive bonuses for executives are on pause for now. The company withdrew its incentive plan worth up to $4.6 million for 12 executives after lenders agreed to revisit the bonuses once a judge approves Wellpath’s proposed reorganization. The lenders are providing up to $55 million in equity financing to aid the company’s turnaround efforts. Despite holding the executive bonus proposal for now, the company secured court approval of a retention program for 31 mid-level employees.

Oregon

A gynecologist at Oregon’s women’s prison was assigned to work in the mailroom after clashing with the chief corrections medical officer, Dr. Warren Roberts — an unprecedented sanction that an outside investigator later concluded was an attempt to humiliate her. Another gynecologist was fired after she said she refused Roberts’ direction to perform exams on male prisoners because her medical training limited her to taking care of women. A third physician who worked at a prison in Portland was sent home after questioning Roberts’ competence and leadership. The doctor was so alarmed that he raised his concerns with the then-corrections ombudsman. Gov. Tina Kotek and the Legislature have been slow to act despite a record of prison health care failures spanning years and including multimillion-dollar payouts, rebukes from judges and a sobering accreditation report last year that spotlighted poor care for women prisoners. Even now, after the release of the recent damning report, lawmakers said they have no plans to hold oversight hearings during the session currently underway.

NY Correctional Officer Wildcat Strike

Striking corrections officers could lose their health insurance and face legal consequences for walking off the job, Gov. Kathy Hochul warned this morning — a public escalation of threats as she tries to resolve a nine-day crisis engulfing the state’s prison system. The crisis at the prisons is also taking place against the backdrop of the death of Robert Brooks, an inmate fatally beaten by guards at Marcy Correctional Facility. His death has been ruled a homicide and 10 corrections officers have been indicted. Hochul has been deeply critical of the guards’ actions, which were caught on bodycam footage. Hochul has deployed 6,500 members of the New York National Guard to replace the protesting corrections officers. Legal summonses are also being issued for the workers who are participating in the strike.

Dozens of corrections officers gathered around a burn barrel outside Otisville Correctional Facility on Feb. 25, marking the seventh day of a wildcat strike that many fear could cost them their jobs. They cite severe staffing shortages, forced overtime, and increasingly dangerous conditions since the 2022 passage of the HALT Act. Their demands include revising HALT, repealing the 70% staffing directive, ending excessive mandatory overtime, implementing salary increases and body scans for visitors, and securing the resignation of Commissioner Daniel Martuscello. They also insist on no retaliation for striking officers.

New York state corrections officers who continue to strike will lose health coverage if they don’t return to work by Monday (March 3rd), according to a warning from the state’s top prison official. The ultimatum from Department of Corrections and Community Supervision Commissioner Daniel F. Martuscello III comes after a mediated deal last week ended the 11-day work stoppage, which was illegal under state law. Gov. Kathy Hochul announced the agreement — reached after four days of state-backed mediation between the state’s Department of Corrections and Community Supervision and the New York State Correctional Officers and Police Benevolent Association — which included key concessions for workers, such as increased overtime pay and a review of staffing shortages.

Gov. Kathy Hochul dispatched the National Guard to help secure state prisons after correctional officers walked out, staging an illegal strike nearly two weeks ago. Terms of a tentative, mediated deal announced late Thursday comes with a demand that officers return to work this weekend, with terms that include increased overtime pay and a continued pause on the previously restricted use of solitary confinement. Striking guards have complained about increased violence against prison staff, and inmate-on-inmate assaults. There have been at least three inmate deaths during the strike.

The State Police are investigating the death of a prisoner over the weekend in a facility near the central New York prison where another inmate was fatally beaten by guards in December. Prison officials said on Saturday that an inmate at Mid-State Correctional Facility, a medium-security prison in Marcy, N.Y., near Utica, was pronounced dead at a nearby hospital earlier in the day. Nine prisoners interviewed said the inmate had been brutally beaten by corrections officers. Their accounts could not be independently confirmed. The latest fatality comes amid a mounting crisis in the New York State prison system, where wildcat strikes by thousands of corrections officers are expected to enter a third week. It is also the fifth death in the prison system since the strikes began.

Mays Consent Decree

Plans for a nearly $1 billion intake and health services facility annex at the Sacramento County Main Jail are suspended as the county considers how to address systemic issues laid out in an external review. The Board of Supervisors previously rejected the project in 2021. CGL Companies found the annex plans insufficient for future jail needs and offered ways for the county to move forward. It recommended establishing a jail oversight committee, a “comprehensive” master plan to improve the facility’s services and consider a population analysis to predict the county’s needs over the next two decades. The current facility does not meet standards of the Mays Consent Decree, which is a result of a 2019 lawsuit against Sacramento County.

Medicaid

Increased eligibility for Medicaid, which typically allows access to prescriptions with little or no cost-sharing, may improve access to care among individuals recently released from prison, but access alone may not improve health if other critical barriers remain. The 2023 SUPPORT Act requires CMS to provide guidance on how states could improve care transitions through Medicaid 1115 reentry waivers. Eleven states have approved waivers, with 13 pending, and all include minimum requirements for case management, a 30-day supply of prescriptions at release, and post release appointment setup assistance.

U.S. Rep. Mike Turner, R-Dayton, along with other U.S. representatives, recently reintroduced a bill that would allow people in jail to retain their Medicaid benefits while awaiting trial prior to being convicted. Turner reintroduced the Due Process Continuity of Care Act with U.S. Reps. Sylvester Turner, D-Houston, John Rutherford, R-Jacksonville, and Paul Tonko, D-Amsterdam. “Our justice system is built on the principle of innocence until proven guilty,” said U.S. Rep. Sylvester Turner.

People leaving Maryland prisons and state-run Baltimore jails often do so with complex medical needs, ranging from substance use disorder to hypertension and diabetes. For more than a decade, a team of navigators at HealthCare Access Maryland have worked across the state to connect those returning citizens with health care access, usually through Medicaid coverage. Congress could shift some of those costs to states. One estimate puts Maryland’s potential loss at close to $1 billion per year — money that the state doesn’t have, given an already tight budget picture. What that may mean for people who use Medicaid remains to be seen.

HIV

In a Yale-led study, published in the International Journal of Drug Policy, researchers have shown that treatment with methadone in patients with HIV and opioid use disorder before they are released from prison resulted in substantially better HIV outcomes during the year following release. The findings, the researchers say, support routinely integrating methadone treatment into prison health care systems to reduce HIV transmission and improve public health.

Motherhood

There are about 2,000 babies born each year in the United States to incarcerated women. This separation has been shown to have negative impacts on both the mothers and their children throughout their lives. Numerous studies indicate that the increase in numbers of incarcerated women is largely the result of the “war on drugs,” the governmental policy changes on drug sentencing that include mandatory minimum sentencing laws for low-level drug offenses and the prioritization of drug arrests by law enforcement. As a historically male-focused institution, correctional facilities often fail to address the needs of incarcerated women. These needs include appropriate medical and psychiatric health care (such as reproductive health care, gender-specific substance abuse treatment, and counseling for histories of abuse), family services, appropriate bathroom and recreational facilities, and protection against sexual victimization while incarcerated.

Back in 2022, lawmakers in Missouri passed a law to create the “Correctional Center Nursery Program” to address the issue of mothers being separated from their newborns at birth. At Vandalia Correctional Center a new facility provides postpartum medical care, giving mothers the opportunity to pump and store breastmilk and holding parenting classes. The facility can hold up to 14 infants at a time, which may not equal 14 moms, as the nursery is expecting a set of twins. Each mother will be given a separate room with state-of-the-art baby gear, such as cribs, a pack and play, a rocking chair, colorful rugs on the floor and art on the walls that doubles as soundproofing.

Aging

The hardships of prison tend to cause accelerated aging. Research shows that imprisoned people age 50 or older are much more likely to have chronic health problems or a disability than other people their age who have not been incarcerated. That’s why prisons typically designate inmates as “geriatric” at age 50 or 55. The declining physical and mental health troubles of geriatric parolees exacerbates the already bleak job prospects for people with a criminal record. Lengthy sentences also create large gaps in their employment history and all but ensures they have limited – and often dated – skill sets to cite on applications.

Transgender Bans

The question of where transgender inmates should be incarcerated in Minnesota’s prison system was before lawmakers Tuesday. Of the 8,300 people behind bars in the state system, 49 are transgender. Three transgender women are in the state’s only women’s prison in Shakopee, according to Corrections Commissioner Paul Schnell. Other inmates are in the process of being evaluated for the appropriate facility placement. Rep. Mary Franson (R-Alexandria) is concerned for the safety of women in the prison and believes transgender female inmates belong in a men’s prison. To that end, she is sponsoring HF435 to require only inmates born as female, as determined by genetics and reproductive system, to be housed at Minnesota Correctional Facility-Shakopee.

A federal judge shielded more transgender women housed in federal prisons from an executive order that would have transferred them from all-female to all-male units and ended their hormone treatment. In one of a series of orders targeting transgender Americans, President Trump directed the federal Bureau of Prisons on Jan. 20 to house all transgender women according to their sex at birth and halt any gender-related medical treatment. But the order hit legal hurdles after several transgender prisoners sued, arguing that being transferred would place them at a high risk of physical and sexual violence and that ending their treatments would be physically “devastating” and raise their risk of suicide.

State Roundup

Arizona

After more than 10 years of litigation, five reports of inadequate care and unnecessary death and three reports of an unsuccessfully implemented staffing plan, plaintiffs in the long-running class action lawsuit against the Dept. of Corrections Rehabilitation and Reentry are asking the court for a receiver to take over the carceral health care system. Attorneys and corrections reform advocates view receivership as a last resort, but they claim the department has not come any closer to complying with the court’s injunction, making it a necessary next step. A formal response from the department is due on March 4, but in a statement, the department refuted the Plaintiffs’ characterization of the current level of care and deemed a receiver a non-starter.

California

A large majority of people living on the streets in California are not illegal drug users, a study found. But drug use is still deeply intertwined with homelessness, both as a risk factor and an effect of losing housing. Against a public perception that drug use is endemic to homeless camps, service providers and advocates see an exaggerated reaction to open drug use on the street that stigmatizes the majority of homeless people who do not use drugs. Contrary to common perception, only about 37% of homeless people were using illicit drugs regularly, and 25% said they had never used drugs. But drug use is far more prevalent among homeless people than in the general population. Just over 65% reported having regularly used at some point in their lives, and 27% had started after becoming homeless.

In San Francisco, attorney Samantha Pérez with the Public Defender’s Office hasn’t been shy about demanding a trial for clients charged with camping. She has one case heading that way later this year. The client is Linda Vazquez, a 52-year-old long-time San Francisco resident who was briefly handcuffed, cited for camping and then released in October. In April, she and her colleagues will go to court and argue that Vazquez’s case should be dismissed because San Francisco’s anti-camping ordinance is too vague to enforce. It will be the first time the ordinance has been challenged on those grounds.

Kentucky

State law dictates that people in Kentucky jails are entitled to the same health care they would receive while outside jail. Kentucky’s Department of Corrections is tasked with ensuring jails across the state comply with minimum health and life safety standards. But those standards become murky when people arrive with a chronic health condition that isn’t immediately identifiable. Sometimes jails don’t know about — or don’t treat the symptoms of — the health problem until a person’s condition has deteriorated.

Nevada

Senate Bill 88, at a Senate Judiciary Committee meeting, seeks to discharge medical debt from those incarcerated once they leave prison. The bill, presented by Las Vegas Democratic state Sen. Melanie Scheible, came from recommendations out of the interim Judiciary Committee. It is the latest effort by lawmakers to bring reforms to the prison system. The Nevada Fines and Fees Justice Center said there is about $13 million in outstanding debt currently owed by formerly incarcerated individuals released from Nevada prisons. People released in 2024 accounted for roughly $2 million of that debt.

North Carolina

The North Carolina Department of Health and Human Services (NCDHHS) has unveiled a comprehensive plan to strengthen community-based support systems for justice-involved individuals. The initiative comes at a crucial time, as state data reveals more than half of incarcerated individuals report mental health needs, while 75% struggle with substance use disorders. NCDHHS Secretary Dev Sangvai emphasized the preventative aspect of this funding, stating that many individuals could avoid justice system involvement altogether with proper community support and services. The investment will expand access to critical mental health and substance use treatment programs across the state.

Oklahoma

A new report from the Oklahoma State Department of Health reveals the Cleveland County Jail is struggling to meet acceptable standards. A surprise inspection on Feb. 4 revealed several violations, including failure to report the serious injury of an inmate earlier this year. During the inspection, inspectors noted dirty cells and showers, and said inmates are rarely given personal hygiene items. Inspectors also said inmates are forced to go two to three weeks without a change of clothing. In one block of the facility, five inmates reported sleeping on the floor because they did not have beds.

Correctional Officers

A new bill in the Washington state Legislature would make it easier for coroners and medical examiners to file claims for post-traumatic stress disorder that cumulates from responding to emotionally intense scenes. Similar bills moving through the House and Senate would add the same ability for correctional workers in prisons and jails. Advocates say it's important to recognize the mental health impacts of these jobs. Correctional workers witness assaults, suicides and threats to their safety.

Correctional Healthcare Providers

Wellpath

Police say a mental health technician physically assaulted a resident at Wellpath Recovery Solutions. Wellpath Recovery Solutions is an inpatient facility that provides mental health treatment for people involved with the criminal court system and have mental illnesses and conditions. The facility provides support services for people found incompetent to stand trial and were not guilty by reason of insanity.

A request for proposals for correctional health services at Monterey County Jail could mark the end of Wellpath’s contract. Formerly known as California Forensic Medical Group (CFMG), Wellpath has faced thousands of lawsuits nationwide for poor inmate care. In Monterey County, multiple inmate deaths and a 2015 class-action settlement mandated improved medical, dental, and mental health services. In September 2023, a federal judge found CFMG in contempt of court for failing to meet 43 required improvements. By October 2024, the company was fined up to $1.3 million for ongoing violations.

The mother of Ramon McGhee is suing the Shelby County Government and the Shelby County Jail’s healthcare provider more than a year after her son died due to severe neglect while in custody. Court records show that Lisa Shahan filed the suit on January 4. Defendants include the Shelby County Government, the jail’s healthcare provider WellPath LLC, and the WellPath staff who were responsible for McGhee’s treatment and care. Shahan alleges that the jail and WellPath staff deprived her son of his Fourteenth Amendment rights by subjecting him to unlawful treatment and depriving him of basic, necessary and immediate medical care.