In Case of Emergency—Break Glass: Alternative Models To Medicaid 1115 Waivers

Highlighted Stories

Editor's Note

This week’s Highlighted Stories come from North Dakota, Alabama, and Indiana, once again returning to the theme of last week’s Editor’s Note: the urgent need for greater connectivity between community and correctional healthcare systems. In the first two stories, we see what happens in the absence of that connectivity.

In North Dakota, a young woman experiencing what appeared to be a substance use–related mental health crisis was taken to a hospital for evaluation, then improperly released. She was subsequently charged with disturbing the peace and died in jail nine hours later. As with last week’s story from St. Louis, this tragic case underscores the consequences of fragmented systems and the failure to coordinate care across institutions.

In Russell County, Alabama, Sheriff Heath Taylor attributes the influx of individuals with behavioral health needs in his jail to state-level reductions in “in-house treatment” for people with mental health diagnoses. Many of these individuals are now diverted to outpatient care, which, from the sheriff’s perspective, often proves ineffective. He argues this leads to self-medication with illicit drugs and a revolving door of incarceration. In his view, these individuals belong in mental health facilities, not jails. As it stands, the system appears to foster treatment gaps that exacerbate serious mental health issues.

Notably, North Dakota, Alabama, and Indiana have not applied for 1115 Medicaid waivers. With the future of Medicaid funding uncertain, COCHS continues to believe that Medicaid remains the most durable path to integrated care. But in the absence of Medicaid, alternative models may need to be explored—though they come with limitations.

That brings us to the two articles out of Vanderburgh County, Indiana, where the sheriff has partnered with a local behavioral health organization, Southwestern Behavioral Healthcare, to create a mental health unit that will serve as a treatment hub. The program will offer group and individual therapy, case management, skills training, and medication consultation. This initiative is partially funded by opioid settlement money. In the community, Southwestern Behavioral also operates a mobile crisis response team that works with local law enforcement to provide immediate assistance to individuals in crisis.

While promising, these localized, ad hoc efforts raise concerns about sustainability and scalability. Partnerships can dissolve, priorities shift, and leadership change. A unified payer like Medicaid—independent of grants or settlement funds—remains the more stable, systemic solution for achieving lasting connectivity between carceral and community healthcare systems.

North Dakota

A $2 million agreement has been reached in a lawsuit over the death of a young woman while she was in custody at a North Dakota county jail in 2020. Lacey Higdem, 19, died of a drug overdose on June 4, 2020, hours after she arrived at the Rolette County Jail in Rolla, according to the lawsuit her mother. A Bureau of Indian Affairs officer found Higdem while responding to a call about a woman yelling for help in the woods near Belcourt, according to the complaint. Higdem, who appeared to be in a delusional state, was taken to a hospital but was improperly discharged and in need of further medical attention, the lawsuit alleged. She was taken to the jail and charged with disorderly conduct and preventing arrest, the complaint said. The two correctional officers did not seek medical help despite obvious signs, and Higdem later was found not moving during a cell check, the complaint said. She was pronounced dead about nine hours after entering the jail, the complaint said.

Alabama

The Alabama Department of Corrections reports more than 4,600 inmates have been diagnosed with mental impairment. Russell County Sheriff Heath Taylor says this is a hard problem to tackle as a correctional facility. “This started 15 years ago when the state was cutting back on in-house treatment for mental health people,” Taylor says. “They went to an outpatient treatment facility, and they started treating mental health patient’s outpatient wise, and it just hasn’t worked." This is due to patients not staying on their medication, Taylor explains. Patients start self-medicating with street drugs ultimately landing them behind bars. Taylor says patients need to be in a mental health institution where they can get the help that they need versus in a county jail. “We will never be a mental health facility. We’re not even a prison, so we’re not intended to be long term care or mental health care, but that’s what it’s turned into.” Taylor says.

Indiana

Sheriff Noah Robinson of Vanderburgh County jail with Southwestern Behavioral Healthcare officials announced mental health treatment program designed to reduce recidivism. The Sheriff said the program would encompass a ten-bed mental health unit within the jail that will serve as a "treatment hub" once the ongoing jail expansion project, which encompasses a dedicated substance abuse and mental health wing, wraps up in 2026. The program will provide persons housed at the jail with therapeutic services, including group and individual therapy, individual case management and skills training, and medication consultation. Katy Adams, Southwestern Behavioral Healthcare's director, said her organization "learned how to come together" with law enforcement to bolster mental health treatment inside the jail while acknowledging that healthcare providers and police approach their work from "completely different cultures." Motivations for the project trace back to earlier concerns about a lack of available bed space within state hospitals fueling a back log in court cases when defendants were found to be incompetent.

This video features the announcement of the jail treatment program mentioned above, with the sheriff explaining that part of its funding comes from opioid settlement funds.

Follow Ups

Editor's Comment: In this week’s Follow Ups, the aftermath of New York’s wildcat correctional officer strike continues to unfold. As reported by Spectrum News, the state is now considering early release for incarcerated individuals nearing the end of their sentences. These release discussions are also shaping budget negotiations around broader earned-time reforms—another ripple effect of a strike that has upended operations and policy planning across the state.

Our next Follow Up returns to PrimeCare Medical, the healthcare provider at Dauphin County Jail in Pennsylvania. PrimeCare’s has failed in its attempt to avoid a jury trial in the death of Ty’rique Riley. This case connects back to a December 2024 story we covered involving a corruption scandal: former county commissioner Jeff Haste accepted $325,000 from PrimeCare’s founder while serving on the Dauphin County Prison Board—the very body charged with oversight of care at the jail where Riley died. Cozy relationships like these don’t exactly inspire confidence in the quality of healthcare provided to vulnerable populations. (The original article has been included below.)

And once again, the Wellpath bankruptcy takes center stage. First, a letter from Wellpath’s Director of Employer Services notifies Tennessee’s Department of Labor that 64 employees are being permanently laid off. Then, in Pitt County, North Carolina, local officials are weighing whether to renew Wellpath’s contract or go with a competitor—without mention of the bankruptcy in that article. Similarly, a report out of Alameda County, California details how advocates are urging the Board of Supervisors not to renew Wellpath’s contract—though the argument could be stronger.

In both North Carolina and California, coverage seems oddly detached from the broader collapse of Wellpath. Have these counties missed what’s happening in Georgia, where some in Cobb County are accusing Wellpath of fraud for allegedly failing to carry insurance to cover settlements? Or Michigan, where non-payment for EMS services has wreaked havoc across the state? Or Arkansas, where lawsuits detail systemic neglect leading to increased illness, infection, and death? And let us not forget that the founder of Wellpath, Jerry Boyle, pled guilty to federal bribery charges.

Maybe that’s where COCHS’ Follow Ups come in—to keep all these dots tightly connected.

Wildcat Strike (New York)

The New York state Department of Corrections and Community Supervision (DOCCS) is looking at early releases to address a staffing shortage following the recent three-week correction officer strike. The state will look to release those with fewer than four months left on their sentence, and the directive does not apply to those convicted of sex crimes, violent felonies, terrorism or arson. DOCCS Commissioner Daniel Martuscello called the early releases a balanced way to address staffing issues exacerbated by the strike. He defended the move, saying those being released were going to be released in the coming months anyway and already had to be in the process of going through procedures relating to release. He also noted that state law gives him the authority to go even further, up to a year.

Chaos from the illegal correction officer strike continues to spill into state budget discussions. One of the lead sponsors of legislation to expand earned time for incarcerated individuals is raising concerns over a proposal from Gov. Kathy Hochul, which is reportedly tied to efforts to boost prison staffing through budget talks. Hochul is pushing for reforms to address the staffing crisis, including lowering the minimum age to become a correction officer. Assemblymember Anna Kelles noted that the proposal is a diluted version of the Earned Time Act, giving DOCCS discretion over whether to credit or revoke earned time. DOCCS Commissioner Dan Martuscello supports the governor’s plan, saying it would allow him to streamline the process of expanding earned timed.

PrimeCare Medical

The healthcare provider at the Dauphin County Prison conceded a jury should decide whether an inmate received adequate medical care prior to his 2019 death. However, PrimeCare Medical claims the record in the Ty’rique Riley case does not show the conduct by any of the healthcare providers to be so outrageous that it would warrant punitive damages.

Former Dauphin County Commissioner Jeff Haste accepted $325,000 from the founder of the county jail‘s healthcare provider when he was in office and making decisions about the jail’s operations. PrimeCare’s founder, Carl Hoffman, gave the money in two payments to Haste in 2017, according to financial documents reviewed. At the time, Haste was chairman of the Board of Commissioners and of the Dauphin County Prison Board, which is tasked with overseeing the care provided to incarcerated people. Haste did not disclose the payments from Hoffman on his statement of financial interest form in 2017. One month after Hoffman gave Haste the first payment, in March 2017, Haste was officially hired as a consultant with PrimeCare to help grow the business in other states. Thirteen incarcerated people, including Ty’rique Riley, 21, Jimmy King, 50, died at the jail while Haste was employed by PrimeCare and serving as a commissioner.

Wellpath Bankruptcy

Wellpath has filed an official WARN Notice with the Tennessee Department of Labor and Workforce Development, notifying the agency of a permanent layoff. Separations will occur between April 30, 2025, and May 14, 2025. The total number of affected workers is 64. The company notified the Tennessee Department of Labor and Workforce Development’s Dislocated Worker Unit.

An eight-person committee is recommending a Charlotte-based company take over the delivery of medical services at the Pitt County Detention Center in July. IMS Correctional Healthcare is one of eight companies that submitted bids to provide health care at the jail. The current provider, Wellpath, also submitted a bid. IMS submitted the lowest bid at slightly more than $3 million, according to agenda materials for Monday’s meeting of the Pitt County Board of Commissioners. Wellpath bid was $4.3 million.

A group of advocates last week called on the Alameda County Board of Supervisors to refuse to renew its contract with Wellpath, a private for-profit company that provides health care personnel and services to inmates in Santa Rita Jail. Wellpath has clearly not been fulfilling the “care” part of its agreement in Santa Rita. More than 70 inmates have died in the facility since 2014, some in an egregious manner. The company is currently facing approximately 1,500 lawsuits in 37 states. Alameda County’s contract with Wellpath expires in 2027. Advocates are calling for the county to directly take over management of health services in the jail, as Contra Costa, Santa Clara and Marin counties have already done.

Pregnancy

Withdrawing “cold turkey” from opioids while pregnant increases the risk of preterm birth, low birth weight, and stillbirth. Opioid withdrawal causes severe pain, nausea, vomiting and in rare cases, seizures. Withdrawing from some substances, including alcohol, can be fatal. Medication-assisted treatment with medicines like methadone or buprenorphine is the standard of care for pregnant people with substance use disorders who are withdrawing because it can drastically reduce these health risks. Yet medicines like buprenorphine and methadone are not always available to pregnant people who are incarcerated.

Juveniles

Los Angeles County has agreed to pay a staggering $4 billion to settle sex abuse claims from generations of children in its juvenile detention and foster care systems in what lawyers said would be the largest payout of its kind in U.S. history. Most of the cases stem from abuse allegations that occurred in the 1980s, 1990s and 2000s at probation and foster care facilities, county officials said. A significant number took place at the MacLaren Children’s Center, a county-run children’s shelter that operated for 42 years east of downtown Los Angeles in the city of El Monte. The settlement arises from a change in California law that widened both the liability of public institutions for sexual abuse by employees and the window for victims to file lawsuits.

Aging

Nearly one in six Oklahoma prisoners was 55 or older as of Dec. 31, according to Department of Corrections data. While the state has made progress in reducing its overall prison population, this demographic of aging inmates has doubled since 2009 and almost quadrupled since 2000. The elderly population, which is more prone to chronic health conditions than the general public, is stretching the state’s corrections budget and prompting officials to rethink core healthcare functions like medication delivery and medical appointment scheduling. Criminal justice reform advocates say there are methods to safely reduce the aging population, including requiring parole boards to consider a person’s age and health as a mitigating factor and making the post-release placement process more efficient.

To step inside the Older Adult Re-Entry unit, or OAR, at the Middlesex County, Massachusetts, jail is unlike entering any jail in the United States. OAR is designed for inmates who are over the age of 55 and need to get ready to reenter the public, but Koutoujian said older inmates have different needs than younger ones who get released into the community. Older inmates make up about 10% of the jail's population, and entry into the program is voluntary. OAR serves both those who are awaiting trial and those who are set to be released in the next few months or years. There are 20 inmates currently in the unit. OAR helps stimulate inmates minds with different classes and activities to prepare for their reentry into society. The sheriff said he believes the program, with the research and data OAR is collecting, can be replicated throughout the country.

Solitary Confinement

In a 2021 survey of state and federal prison systems, fewer than half of the jurisdictions that responded had any step-down programs for people transitioning out of solitary, despite standards set by the American Correctional Association (ACA), an accrediting body for jails and prisons. Community re-entry presents another neglected opportunity to provide meaningful support. Ten percent of survey respondents were released directly from solitary confinement to the community, a practice that can have devastating effects. Of survey respondents who sought mental health treatment, more than 50% reported that cost was the biggest obstacle. From 2020 through 2024, the Bureau of Justice Assistance distributed over $64 million in grants to re-entry programs across the country. Most reentry programs focus more on reducing recidivism than on improving mental health, overlooking the needs of individuals.

State Roundup

Arkansas

The Arkansas Senate voted 19-10 in favor of a bill that would have given state authority to spend up to $750 million for the prison. The bill needed at least 27 votes to advance to the House. The vote was a setback for the prison that Gov. Sarah Huckabee Sanders and corrections officials have said is needed to ease state prison overcrowding, which has caused a large number of inmates to be housed in county jails. The project has faced a backlash from local leaders who said they were blindsided by the decision last year to purchase 815 acres (330 hectares) for the prison site. Opponents have questioned the viability of the site and how the state will be able to afford the total $825 million estimated cost of the facility.

California

Three correctional officers were injured on Friday after they were attacked by an incarcerated person at California Medical Facility in Vacaville, the California Department of Corrections and Rehabilitation said. Officials said the officers were conducting an "emergency cell extraction" when the prisoner attacked the officers with an improvised weapon. All three officers were taken to an outside medical facility for treatment, CDCR said. They were treated and released.

New Mexico

Five women imprisoned at Western New Mexico Correctional Facility near Grants have filed a civil rights lawsuit over what they say is a “longstanding and ongoing” stomach infection circulating among the prison population. Helicobacter pylori — also known as H. pylori — is a bacterial infection of the stomach lining which, left untreated, can lead to stomach pain, peptic ulcers or even stomach cancer, according to the Mayo Clinic’s website. The lawsuit alleges the infection is caused by unsanitary conditions in the facility’s kitchens and a failure by the prison’s health care providers to treat and test for it.

Pennsylvania

The opening of a full substance use treatment unit at the Allegheny County Jail is another milestone in the jail’s turnaround, as the facility’s leaders have gone above and beyond the requirements imposed by the federal government in a 2023 consent decree. This unit, offering the full spectrum of medication for opioid use disorder (MOUD), will help ensure humane treatment of inmates struggling with substance abuse. And in so doing, it will make the wider community safer.

Texas

Harris County's (Houston) next step in addressing its overcrowded, understaffed jail may be building a facility to provide mental health services to those awaiting trial, but jail reform activists say it's not a viable solution for the sheriff's office. The county is not "heading in the direction" of building a $10 million jail, but rather "a smaller, mental-health focused facility," said Precinct 3 Commissioner Tom Ramsey during Thursday's Commissioners Court meeting. The new facility, he said, also would help reduce the jail's population, which was 9,048, including more than 1,500 inmates the county pays to have housed elsewhere. About 80% of those inside the jail said they experience mental health issues and 30% are on psychotropic medication, county data shows.

Rikers Island

In the first three months of the year, five people have died at the Rikers Island jail complex in New York or shortly after being released from city custody, equaling the number of detainees who died in all of 2024. The fifth death of Dashawn Jenkins, on Monday night, comes as Mayor Eric Adams’s administration is fighting to keep control of the troubled complex and other city lockups that have been plagued by violence and deaths in custody. For lawyers and advocates for those incarcerated at the complex, Mr. Jenkins’s death is the most recent example of why they have pushed for the closure of Rikers Island and for a federal judge to install an outside authority, known as a receiver, to oversee the city’s jails.

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