Medicaid Waivers & 2024 Election Impacting Behavioral Health Costs In Corrections: From Policy & Ballot Initiatives To Operations

Highlighted Story

Editor's Note

Bringing Medicaid behind the walls of corrections can have many unanticipated implications. The first two highlighted stories from Sonoma County, California, and Whatcom County, Washington State, focus on these counties’ mundane considerations about constructing a mental health wing or behavioral health facility for their respective jails. As even the most casual reader of the Weekly Update knows, correctional facilities have become de facto mental health institutions, especially as the opioid epidemic has impacted most communities throughout the nation. So, stories about either a mental health wing or a behavioral health facility in a local correctional institution should not be remarkable – what’s the big deal?

This year, as our subscribers know, both California and Washington State (among other states) had their 1115 waivers approved to allow for Medicaid coverage prior to release. When implementation of these waivers begins, counties like Sonoma and Whatcom will face a more complicated task if Medicaid is to cover services within their mental health wing or a behavioral health facility. Will these projects meet the required health and safety standards of Medicaid, and what services will these counties want to include within the scope of Medicaid coverage? As these stories point out, both the mental health wing and behavioral health facility already come with hefty price tags. How might Medicaid requirements further impact these costs? But more importantly, has anyone in either county even begun to connect the dots and consider Medicaid health and safety requirements as well as evaluate the scope of services they might want to provide?

These considerations in California take on an urgent immediacy in this election year. The third highlighted story concerning California’s Proposition 36, which seems likely to pass, mandates, among other things, that counties must provide behavioral health treatment to those convicted of a third-time drug offense. That article is skeptical that counties have the resources to meet these treatment requirements. As we go forward into this brave new world of Medicaid requirements in conjunction with ballot initiatives, COCHS will attempt to explore in these Weekly Updates what it might mean to translate policy and election outcomes into operations.

Speaking at the policy level, our partner over at HARP has published a very clear and well-organized fact sheet providing a review of 1115 waivers from a reentry lens. Similarly, on the Safety + Justice Challenge website, HARP, with multiple other partners, has provided several resources concerning California’s 1115 waiver.

Behavioral Health Facilities

A behavioral health wing for the Sonoma County Jail is still up in the air. After nearly ten years since the county received a $40 million state grant for the wing, the project has yet to be started. The subject was discussed by the Board of Supervisors as the main issue was funding as the project would now cost $69.5 million . Possibilities brought up included raising additional funds, restructuring the project to possibly include patients outside the jail, or even just scrapping the whole thing and returning the money. There were also concerns over an increase in the jail population should Prop 36 pass, a measure that would increase penalties for some theft and drug crimes.

Whatcom County is likely looking at a higher price for the upcoming jail and behavioral health construction project because of myriad factors, including inflation and rising construction costs. The new cost estimate for the justice facility is sitting around $174 million, up 16% from the initial estimate.

Proposition 36

Proposition 36, the tough-on-crime ballot measure that would increase punishment for certain drug and theft offenses, appears likely to pass with polls showing voter support by large margins. Its momentum has behavioral health leaders across California trying to figure out how they’d actually implement a part of the measure that pledges “a new era of mass treatment for those who need it the most.” As far as they can tell, California counties don’t have the resources to provide what Prop. 36 envisions: behavioral health treatment for people convicted for a third-time drug offense.

Medicaid Resources

A 2-page fact sheet provides at-a-glance information on new reentry policies, including continuity of care requirements for youth and young adults leaving incarceration, states’ work through Medicaid 1115 reentry waivers.

Multiple resources reviewing California' 1115 reentry waiver.

Opioid Epidemic

Expanded treatment options, increased naloxone distribution and targeted education campaigns likely led to a 37% reduction in overdose deaths from opioids combined with stimulant drugs other than cocaine, according to the results of a large federally funded study. The finding came from a planned study of secondary outcomes of the HEALing (Helping to End Addiction Long-Term) Communities Study (HCS), which tested an intervention encompassing data-driven adoption of evidence-based practices for reducing overdose deaths in Kentucky, Massachusetts, New York and Ohio.

Pregnancy & Incarceration

The COVID-19 pandemic disproportionately impacted incarcerated populations, yet few studies have investigated the specific effects on incarcerated pregnant people. This study compares pregnant people’s experiences of pregnancy and parenting in prison before and during the pandemic in order to explore the impacts of COVID-19 on this population.

A proposed bill, from Washington D.C. council member Christina Henderson (I-At Large), affirms and clarifies who can support someone during labor and guarantees specialized health care and privacy in the delivery room. A majority of D.C. Council members have signaled support for the bill, which would limit corrections officers’ presence during labor and in delivery rooms and allow people in custody to have a loved one by their side while they give birth.

Dementia

A research effort at Northwestern University hopes to learn more about how incarceration can be a risk factor for dementia. The university was recently awarded a grant for a study on how incarceration affects health, age-related conditions and risk factors for Alzheimer’s disease and other dementias. The grant from the National Institutes of Health totals $20 million over five years. No one has counted how many people in American prisons have dementia. One study estimates that more than half of the 400,000 incarcerated elderly will develop dementia by 2030.

Skin Diseases

Understanding the common types of rashes seen in the correctional environment is very important for effective management and prevention. This post, this post review four common skin conditions encountered by correctional nurses in their practice: contact dermatitis, scabies, fungal infections, and impetigo.

State Roundup

Alabama

Under Alabama prison rules, there are thin lines between work incentives, forced labor and “involuntary servitude” — which reforms to the Alabama Constitution in 2022 banned. Work-release inmates housed at the lower-security camps generally live in fear of being sent back to the state’s more dangerous medium- and high-security prisons. The U.S. Justice Department sued the Alabama Department of Corrections in 2020, accusing it of unsafe conditions of confinement, failing to protect prisoners from violence, excessive force by guards, overcrowding and understaffing.

Florida

As many as 28,000 people incarcerated in central and southern Florida jails and prisons were in mandatory evacuation zones for Hurricane Milton, but many officials reportedly refused to evacuate them. Some who were moved to more secure facilities ahead of the storm report having been left in lockdown with no power, updates or access to prison staff.

Illinois

Prisons in Illinois are currently facing a staffing crisis, according to a new report from the prison watchdog group the John Howard Association. It found understaffing greatly increases the amount of lockdowns and staff overtime and impacts the overall health, safety and well-being of staff and incarcerated people. There was a 28% deficit for security staff and 23% overall deficit from authorized facility-based staffing as of Sept. 1, 2024, according to the Illinois Department of Corrections.

Louisiana

The La. Department of Corrections (DOC) confirmed another inmate has preliminarily tested positive for tuberculosis, but it remains unknown if this case is connected to the drug-resistant strain allegedly brought into correctional facilities by a foreign detainee. Earlier this week, Louisiana officials filed a lawsuit on behalf of the state against U.S. Homeland Security, U.S. Immigration and Customers Enforcement (ICE), and several agency leaders. The lawsuit claimed a detainee from China who tested positive for tuberculosis was transported to holding centers across the state.

Maryland

The U.S. District Court for the District of Maryland ruled on October 21, 2024 that the State of Maryland is obligated to make major changes to Baltimore jails to comply with a 2016 settlement agreement reached in a class-action suit on behalf of detainees at the Baltimore Central Booking and Intake Center. This marks the third time that the court has had to extend the agreement because of the state’s persistent failure to come into compliance with the agreement and make necessary improvements to its facilities. Patients with serious health care needs may not be able to access the care they need, and that some people with mental illness are forced to live in isolation, with almost no time outside of their cells. (Concerning correctional intransigence see the Editor's Notes of 10-01-2024 and 09-10-2024.)

Oklahoma

Oklahoma lawmakers on Monday were told resources for jail diversion programs are less available for rural counties in comparison to major cities in the state. The Oklahoma House Criminal Justice and Corrections committee hosted an interim study on county jail services and diversion programs. Spokespeople from various criminal justice and diversion programs told lawmakers that diversion programs are a cheaper alternative to incarceration, reduce the number of people in jails and lower recidivism rates.

New Mexico

A corrections officer at a New Mexico county jail is accused of orchestrating attacks in the shower on two inmates who suffer from mental illness, according to a police report. The Bernalillo County Sheriff's Office incident report obtained says that security camera footage showed inmates “attacking other inmates while under the supervision” of the officer, Nathan Shpiller.

Oregon

An Oregon corrections officer sanctioned the attack of a man serving time in 2022 at Eastern Oregon Correctional Institution in Pendleton. After the attack, the Oregon Department of Corrections failed to meet the standards of medical care to treat "extreme and debilitating injuries." The Oregon Department of Corrections now must provide a bevy of specialized medical care, including a chronic pain assessment and surgical consultation, to Richard Michael Fay following a violent assault more than two years ago in the prison that left him unable to move and ultimately hospitalized.

Pennsylvania

Fifty years ago, Philadelphia prison officials ended a medical testing program that had allowed a researcher to conduct human testing on incarcerated people, many of them Black, for decades. Now, survivors of the program and their descendants want reparations. Thousands of people at Holmesburg Prison were exposed to painful skin tests, anesthesia-free surgery, harmful radiation, and mind-altering drugs for research on everything from hair dye, detergent, and other household goods to chemical warfare agents and dioxins. In exchange, they might receive $1-a-day in pocket change they used to buy commissary items or try to make bail.

Washington State

In multiple jails across Washington state, low-level nurses who lack the qualifications and legal authority to assess patients are making pivotal medical decisions about inmates. Government, medical and federal court records claim the practice has led to life-altering injuries and unnecessary inmate deaths. Dr. Marc Stern, the former assistant secretary for healthcare at the Washington State Department of Corrections, said he’s seen licensed practical nurses (LPNs) working outside of their scope of practice dozens of times in Washington jails.

Correctional Telecommunications

Correctional telecom corporations such as Aventiv, ViaPath, and ICSolutions, owned by Platinum Equity, American Securities, and H.I.G respectively have long contracted with prisons and jails to provide communications services to incarcerated people. These corporations are notoriously exploitative: A simple 15-minute phone call can cost upwards of $8, and a 25-minute video call $15, not including the litany of head-scratching fees that are often tacked on. For years, the industry has used call rates to cover the cost of the ever-ballooning suite of security and surveillance services. However, the FCC has determined that the vast majority of such services are not necessary for the provision of communications services or useful to those paying for them.

Private Prisons

CoreCivic, the leading private prison company in the U.S,. has spent more than $4.4 million to settle dozens of complaints alleging mistreatment — including at least 22 inmate deaths — at its Tennessee prisons and jails since 2016. More than $1.1 million of those payouts involved Tennessee's largest prison, the long-scrutinized Trousdale Turner Correctional Center, which is now under federal investigation.

Proprietary Correctional Healthcare Vendors

VitalCore & Wellpath

Augusta commissioners are moving the start date up for their new inmate medical care provider- VitalCore Health Strategies. Contracts were slated to start in the new year but the current provider, Wellpath, could be checking out sooner than expected. But as one problem moves out, another might be coming in. Our sister station in Charleston, whose county made the exact same switch in providers, reports VitalCore has more than two dozen federal lawsuits across several states. (The VitalCore/Wellpath merry-go-round was the subject of the Editor's Note of 01-30-2024 .)

YesCare, Corizon, Tehum Care

Staff at a Philadelphia jail killed Louis Jung, Jr., who had type 1 diabetes, by depriving him of insulin for six consecutive days, according to a lawsuit filed today by two of his sons. Jung’s sons are suing, among others, the City of Philadelphia, the former commissioner of the Philadelphia Department of Prisons (PDP), and the jail’s for-profit medical provider, YesCare—formerly known as Corizon Health. (YesCare in its many incarnations was the subejct of the Editor's Note of 10-31-2023.)

Turn Key Health Clinics

The Cleveland County Board of Commissioners in Oklahoma says Sheriff Chris Amason’s office hasn’t been cooperating with an investigation into deaths at the county jail in Norman. At least five Cleveland County detainees have died this year. The Frontier and The Marshall Project published a joint investigation in July into jail health care provider Turn Key Health Clinics. (Turn Key Health Clinics' performance in Oklahoma was the subject of the Editor's Note of 09-17-24.)

This Marshall Project video provides more background on Turn Key Clinics’ record in Cleveland County, Oklahoma.

NaphCare

The widow of a diabetic man who died in San Diego’s Central Jail last year after being denied insulin has sued the county, Sheriff Kelly Martinez and the jail’s medical provider, NaphCare. Cecilia Bach spoke briefly at a news conference Thursday morning in front of the downtown jail about her husband, Keith, a 20-year Navy. Last month, the county Medical Examiner took the unusual step of ruling Bach’s death a homicide, citing neglect. (NaphCare’s practices in other jurisdiction was the subject of the Editor’s Note of 10-15-2024)

Prime Care Medical

Bucks County’s for-profit corrections health care provider paid $250,000 to settle claims in the first wrongful death lawsuit filed against the company shortly after it took over inmate health care at the county jail. For eight years, though, the settlement details that PrimeCare Medical Inc. reached with the mother of 29-year-old Vallia Karaharisis in her 2013 death, were kept secret under a federal court seal.

COCHS Weekly Update Will Not Be Published Next Week On Election Day