How Medicaid Can Change Healthcare Decision Making and Quality in Corrections

Highlighted Stories

Editor's Note

This week's two highlighted stories come from diverse locations, Nebraska and Vermont, and yet they both tackle the question of when medical procedures in carceral settings are deemed necessary or if the standard of care is harmful to health and well-being. The Nebraska story takes a look at how a change in medical directors at that state’s Department of Corrections decreased the approval for medical procedures of incarcerated people. The Vermont story talks about a lawsuit filed by the former chief medical officer of operations against his former employer the proprietary correctional company, VitalCore (VitalCore is no stranger to these Editor's Notes, see Weekly Update 01-30-24). He claims his signature was forged on a more than 500-page policy and procedures manual submitted to state officials by VitalCore and that VitalCore “failed to comply” with the policies on which it forged his signature, providing “sub-standard levels of care.”

Both of these articles point out how the decision-making within correctional facilities totally disempowers those receiving medical care, incarcerated people. In states like Vermont which have had their 1115 waivers approved for Medicaid coverage within their correctional institutions, some of the incarcerated will soon be Medicaid beneficiaries. Medicaid coverage raises substantial questions about medical care within correctional health facilities.

Part of why COCHS has been such an advocate for Medicaid within corrections is that Medicaid beneficiaries have a grievance right that protects them when either their payer or provider makes decisions that they believe are contrary to their health and well-being. As these two articles point out, without Medicaid and without a grievance rights, outside of the carceral setting, there are no checks and balances on the delivery or quality of correctional healthcare whether that be by a medical director or a proprietary correctional healthcare vendor.

Access & Quality of Care

The denial or deferral of essential medical procedures, such as cancer screenings and heart tests, is increasingly common within Nebraska’s prison system under the new medical director, Dr. Jerry Lee Lovelace Jr., according to inmate requests for medical procedures and consultations with specialists received by the prison system’s medical directors between January 2021 and June 2024. Lovelace’s willingness to deny specialists’ recommendations marks a departure from the previous director, Harbans Deol, who could not recall ever denying the recommendations of outside specialists.

A doctor employed by Vermont’s former prison health care provider,Dr. George Zazzali, is suing the company alleging it forged his signature on policy documents and fired him after he raised concerns regarding the conditions inside Vermont’s prisons. Zazzali served as VitalCore’s chief medical officer of operations in Vermont in 2021. In the suit, filed in U.S. District Court of Vermont, he claimed VitalCore “forged his signature” on a more than 500-page policy and procedures manual submitted to state officials. Zazzali alleges that VitalCore “failed to comply” with the policies on which it forged his signature, providing “sub-standard levels of care.” Vermont Defender General’s Office determined that VitalCore staff did not seem to know how to perform CPR and other lifesaving procedures, after an investigation of the death of an inmate.

Opioid Epidemic

Is buprenorphine/naloxone associated with lower risk of treatment discontinuation and mortality compared with methadone? Individuals receiving methadone had a lower risk of treatment discontinuation compared with those who received buprenorphine/naloxone. The risk of mortality while receiving treatment was similar between medications. In this population-based retrospective cohort study that included 30 891 individuals initiating treatment for the first time during the study period, the risk of treatment discontinuation was higher among recipients of buprenorphine/naloxone compared with methadone.

People reentering the community from incarceration experience fatal overdoses, with studies showing that they are at a highest risk of an overdose or even death during the first 48 hours after release. Evidence-based practices can be implemented to support safe and successful transitions. This guide outlines four best practices that reentry professionals can implement to reduce overdose risk during reentry. This guide outlines four best practices that reentry professionals can implement to reduce overdose risk during reentry.

Although 3.7% of US adults required treatment for OUD, only 25.1% of those individuals received medications as part of their treatment, according to the CDC’s population estimates of treatment for OUD based on the 2022 National Survey on Drug Use and Health. Significant gaps in the availability of OUD medications have been analyzed, with 42.7% of individuals not recognizing their need for treatment and 30% undergoing treatment without access to medications like buprenorphine and methadone. Racial disparities in treatment access were also evident, with non-Hispanic White adults more likely to receive OUD treatment compared with non-Hispanic Black or African American and Hispanic adults.

Kidney Disease

This article addresses the healthcare disparities and potential impact on mortality among incarcerated patients with chronic kidney disease (CKD). Incarcerated individuals are more likely to suffer from acute and chronic health conditions and have inconsistent access to healthcare services. Demographic trends, behavioral health trends, and lack of insurance coverage are major contributing factors to healthcare disparities among incarcerated individuals.

BOP

The Officer Blake Schwarz Suicide Prevention Act of 2024 (HR 9929) would specifically require the Justice Department and Bureau of Prisons to establish grant programs to enable mental health screenings for corrections officers at federal prisons and jails, as well as detention facilities that are under contract to a federal law enforcement agency and refer them to mental health care providers. Rep. Mariannette Miller-Meeks, R-Iowa, introduced the legislation named for a correctional officer at Thomson Federal Prison in Illinois who in 2023 died by suicide.

Issues in Corrections

The “Perceptions of Primary Challenges Facing Jails” survey included both closed and open-ended questions. 55 correctional leaders responded to the survey. The most common response, ranked by 55% of respondents as the top challenge, related to staffing. Concerns included recruitment, retention, and pay. Some responses mentioned staffing, while others specified custody and/or health care staffing issues. Mental health – of incarcerated individuals, staff, or both – was cited most frequently; 24% of respondents ranked mental-health issues as the top challenge. Substance use and overpopulation/issues with physical space were each cited by 7% of respondents.

This issue brief on the topic of imposing a moratorium on new prison construction or expansions is part of a series examining a variety of controversial local and national issues, focusing on specific policy proposals. Although there are significant fiscal issues associated with prison capacity and construction, the argument between advocates over a moratorium on new or expanded correctional facilities is centered on the role of incarceration in the criminal justice system.

Fees, Fines & Copays

In the video above, we introduce viewers to Mike. He’s not a real person. Mike is our guide to a hidden form of punishment: criminal justice fees. These are levied against people at every turn in their path through the system. They can be big — like the cost of posting bail — or small, like fees to see a doctor in prison. They accumulate quickly and can turn into crushing debt. Regional surveys in Alabama and New Mexico have suggested that at least 38 percent of people with court debt resort to crime to help pay it off.

In a system where incarcerated individuals often earn mere pennies per hour, a $5 medical copay can represent a week’s wages. This stark reality is at the heart of a growing healthcare crisis in American prisons, where financial barriers are forcing inmates to choose between basic necessities and medical care.

State Roundup

Alabama

When patients enter the Taylor Hardin Secure Medical Facility for treatment, facility director Daphne Kendrick wants them to remember that they deserve the same mental health treatment as anyone else. The expansion and facility renovation, which will be complete in 2025, will house 225 people and offer expanded mental health services and reduce the number of patients with mental illnesses who are in jail. The expansionwill add 85 additional beds to the center and make a host of other.

Arizona

Dr. Thornell, the new Director of the Arizona Department of Corrections, Rehabilitation, and Reentry, is working to make sure inmates have access to the mental health resources that are needed. “We don’t want someone to be incarcerated, get released, and then come back a week later. We want them to have a plan, be successful, thrive, and move on with their lives," said Dr. Thornell. For female inmates, this means leaning on community partners like Tara Sundem, creator of Hushabye Nursery. Her agency helps newborns, born with opioid addiction.

Colorado

Denver Health could stop providing health care in the city’s jail and detox facility in 2026 because it says the contracts for those services don’t fully cover the health system’s costs. Denver Health, told a City Council committee Wednesday that the possibility of dropping one or more contracts was “on the table” because the city refused to include some level of payment to cover indirect costs, such as the time the system’s information technology and human resources departments spend supporting workers at the jail and detox center.

Louisiana

In Louisiana, the final push to do away with those public hospitals came under the administration of Gov. Bobby Jindal, who oversaw the sale and privatization of two of the four remaining state hospitals to cut spending, leaving only two remaining today. This deinstitutionalization has likely pushed more mentally ill people into the correctional system. “We have become the mental [health] institutions for the state, in every parish,” said Cpt. John Mowell, public affairs director at the Lafayette Parish Sheriff’s Office, which runs the local jail.

Maryland

Baltimore jail officials lost track of nearly 92,500 methadone pills — controlled substances that carry a high street value — over a three-month period, investigators with the U.S. Drug Enforcement Administration found during an audit earlier this year. The audit of the Baltimore Central Booking & Intake Center cited findings by DEA “diversion investigators,” according to a “memorandum of agreement” reviewed by The Baltimore Banner, suggesting that employees at the jail could have stolen some of the pills.

A federal judge denied an effort by the state attorney general’s office to extricate the Baltimore jail system from a decades-long health care lawsuit, saying the corrections department’s progress toward meeting the terms of the lawsuit’s 2016 settlement has been “unacceptably slow.” The ruling is a big blow to Maryland’s state government, which has long run city jails and has made exiting the lawsuit a top priority. The Maryland Office of Attorney General recently hired a private law firm known for defending prison systems in states like Alabama and Louisiana.

North Carolina

As Hurricane Helene unleashed a torrential downpour over Western North Carolina, Nick, whose story was relayed by a relative and who requested to go by his first name for fear of retribution, realized his single-occupancy cell in the state prison had begun to flood. Then he realized that his toilet no longer flushed. Family members told The Intercept that their loved ones were forced to defecate in plastic bags after their toilets filled up with feces, stowing the bags in their cells until the North Carolina Department of Adult Correction finally evacuated the facility on Wednesday evening.

Texas

After a year of controversy for the Tarrant County Sheriff’s Office, the department has released a report from the federal government evaluating the physical and mental health care available inside the Tarrant County Jail (Fort Worth). More than 65 people have died in custody since Sheriff Bill Waybourn took office in 2017 – some under allegations of neglect and misconduct. The report recommends that people detoxing should be placed in a different housing option that gives them more out-of-cell time and family visitation. Withdrawal comes with overwhelming mental and physical stress, the report states.

Tarrant County commissioners voted Tuesday to renew their longstanding contract with My Health My Resources to administer mental health care at the county jail despite ongoing public concerns about inmate treatment. My Health My Resources (MHMR) will receive approximately $8.2 million for fiscal year 2025 under the renewed agreement, continuing its role in managing mental health services for incarcerated individuals. However, residents at the meeting raised serious questions about whether the jail and MHMR are doing enough to protect vulnerable detainees.

Proprietary Correctional Healthcare Vendors

Wellpath

Earlier this year, a $5.5 million settlement was signed for the family of Jose Banda Pichardo, a 22-year-old mentally ill inmate in the Imperial County jail who committed suicide. Platiffs contend that Pichardo was refused his medication and was placed in general population “without any designation regarding his medical condition that would alert those in charge of his care that he required monitoring, medical treatment, psychological treatment, and follow-up care. California Forensic Medical Group/Wellpath was the county’s medical contractor in the jail at the time of Pichardo’s death.

A Nevada mother is looking for answers after she says her son died due to the negligence of jail medical staff. Her son was arrested in February of 2022 and booked into the El Dorado County Jail. In just under four months, he died. icholas Overland informed the arresting officers that he was HIV positive and would need his prescribed antiretroviral medication during his detention to ensure his HIV remained in check. But over the next two months plus, they say Wellpath's medical staff ignored his pleas and their own medical files.

Mediko

More than two years after a man died in custody at the Arlington County Jail, family members have filed a federal lawsuit. Paul Thompson was arrested on trespassing charges and died at the jail in February 2022. According to the NAACP, since Mediko took over as the jail's medical provider fewer than three years ago, three people have died at the jail. The NAACP says the family believes Thompson was not given proper care despite being visibly incapacitated, lethargic and spending virtually 24 hours a day in a wheelchair.