Weekly Update: June 11, 2024
Correctional Facilities Have Become De Facto Mental Health Facilities. How can Medicaid help? REMINDER: Please Comment on HRSA’s PIN 2024-05


Highlighted Stories

Editor's Note
This week's Highlighted Stories are from Vermont and Ohio. They focus on the efforts that state and local jurisdictions are involved in to address the needs of incarcerated individuals with behavioral health disorders. We are highlighting these articles for two reasons: first, we want to emphasize the extent to which jails and prisons have become de facto mental health facilities resulting in increased state and local expenditures to try to address the needs of those individuals when they're behind bars; second, we want to frame these efforts within the context of unregulated environments where there are no rights given to the incarcerated individual unlike in any other health care setting. Because the funding in these two examples is all state and local, there are none of the federal regulatory requirements in place that would come with a Medicaid 1115 waiver expanding coverage in correctional environments.

It is important to note that Vermont has applied for an 1115 waiver, but that Ohio has not. Ohio requires a bill from their legislature to submit a proposed 1115 waiver. As has been mentioned in a previous Weekly Update (see Editor’s Note of November 21, 2023), COCHS’ Dan Mistak wrote for Center for Community Solutions that “an 1115 waiver presents a compelling avenue for Ohio to improve care for individuals within the justice system and establish more robust care options that save the state money.”

Dan would like to remind our subscribers that HRSA’s PIN 2024-05 is still open for public comment until June 14th. To recap, this PIN proposes to routinize the ability of Federally Qualified Health Centers (FQHCs) to extend their care into our country's jails and prisons (see Editor’s Note of April 23, 2024). But there's a critical gap: the current policy excludes pretrial detainees. Given that pretrial detainees can make up a substantial portion of jail populations, this exclusion poses significant challenges, not only for the detained individual’s health and well-being but also for public safety and public health at large. We encourage all our readers to engage with this issue and advocate for inclusive health policies that cover pretrial detainees. To respond to HRSA’s PIN 2024-05, here is a link to a comment template. In addition, we are including COCHS talking points that reflect our concerns, but we encourage you to personalize your own comments.

Two final items of note, Rhode Island has submitted its 1115 waiver requesting 90 days of pre-release Medicaid coverage and the Marshall Project has an article reviewing the nationwide effort to bring this coverage into corrections in which Dan Mistak is quoted.

VT Digger: Vermont state prisons open door to community-based addiction recovery services
Recovery-coaching leaders are working to set up regular group meetings in all Vermont correctional facilities, after the state Legislature this year provided $1.56 million so people in the corrections system can receive community-based recovery support. A preliminary state report shows that, last year, 231 Vermonters died of an opioid overdose, the second highest count since the state established its current tracking system 15 years ago. On any given day, Vermont’s correctional facilities house 1,300 to 1,400 people who are either serving their sentences or awaiting trial. Of the total population, 70% — nearly 1,000 individuals — are receiving buprenorphine.

Cincinnati.com: Ohio's jails have long been de facto mental health hospitals. Now they look like them
Franklin County Sheriff Dallas Baldwin strolls through the wide, brightly lit hallways of the new $350 million jail and opens the door to a medical wing that looks strikingly like an urgent care clinic. Between 2020 and 2023 in Ohio, at least 220 people died while in jail custody. About one-third of the deaths were drug related and another 29% were suicides. Once completed, the jail is expected to replace two antiquated facilities and hold up to 2,200 people. So far 23 jails have received state money for renovations, expansions or replacements. Now some legislators are talking about earmarking another $250 million for jail construction and renovations.

Office of Governor Daniel J. Mckee, Rhode Island: Letter of support of Rhode Island's section 1115 demonstration waiver application to extend the Rhode Island comprehensive demonstration
On May 23, 2024, Rhode Island submitted an addendum to its extension request for its Medicaid section 1115(a) demonstration entitled the “Rhode Island Comprehensive Demonstration.” The addendum provides updates to the state’s request for pre-release supports for incarcerated individuals by requesting 90 days of pre-release coverage and including additional details about the pre-release services. The state's goals are to improve health equity.

Marshall Project: Why Some States are Trying to Get People Medicaid Before They Leave Prison
A bipartisan proposal in Congress would make Medicaid coverage available 30 days before release as a national policy, eliminating the need for states to apply. And federal officials are experimenting with broader waivers that would allow Medicaid to cover “health-related social needs,” like housing and food. These have emerged as “part of a much broader discourse [that recognizes] poverty really makes people unhealthy,” said Dan Mistak, an attorney with Community Oriented Correctional Health Services, a policy outfit that has been advocating reentry waivers for years.


Los Angeles Times: For some incarcerated women, getting ahold of menstrual products is a nightmare
Over the past decade, prisons and jails in California and across the country enacted laws and policies making menstrual products free to inmates. But problems remain. In New York, jail officials admitted last year that they’d stopped giving out free supplies. In Texas, women say that sometimes they get challenged by guards when they ask for more tampons or pads. And in California, after passing one bill to address the problem in 2020, several reports have surfaced where women were still denied menstrual products.

truthout: Survivors of Prison Staff Abuse Say Transfer to New Facilities Hasn’t Ended Harm
Federal prison officials announced the abrupt shuttering of Dublin just 10 days after the appointment of a special master. Within days, Dublin’s 605 incarcerated people were loaded onto buses and transferred to a dozen federal prisons across the country, some as far as Florida and Alabama. Many have reported ongoing mistreatment and retaliation for speaking up about the abuses at Dublin. “The BOP’s choice to abruptly close FCI Dublin and rush transfers under inhumane conditions was a naked attempt to evade accountability and further punish incarcerated people,” said Susan Beaty, senior attorney at the California Collaborative for Immigrant Justice and co-counsel on the Dublin class action lawsuit.

Opioid Epidemic

Stat: Drug treatment that insists on abstinence? Federal agencies are just saying no
With over 100,000 Americans dying of drug overdose each year, the Biden administration appears to be changing its insistence on total abstinence. In recent years, key federal agencies have quietly but significantly opened the door to addiction treatment that, while still oriented toward eliminating substance use altogether, acknowledges that total abstinence may not always be within reach. The changes reflect the fast-evolving climate in addiction medicine, in which harm reduction, or practices meant to limit the most acute harms of substance use among active drug users, is increasingly in vogue.

Data & Statistics

BJS: PREA Data Collection Activities, 2023
BJS has released PREA Data Collection Activities, 2023. This report describes BJS’s data collection and developmental activities during 2023 to measure the incidence and prevalence of rape and sexual assault in adult correctional and juvenile justice facilities.

State Roundup

Press Democrat: Sonoma County jail hunger strike continues, now amid a COVID-19 outbreak
More than a week after inmates began a hunger strike over conditions at the Sonoma County Jail, participants are now contending with a COVID-19 outbreak. On May 22, 45 men started refusing meals in protest of high commissary costs, limited visitation and programming, and alleged unsafe COVID-19 practices, among other concerns. The strike followed the dismissal of an official inmate grievance filed earlier this month that claimed staff were putting people incarcerated in the J module of the facility at risk of COVID-19 exposure.

San Francisco Chronicle: S.F. arrests drug users hoping to lead them to sobriety. The city doesn't know if it's working
Faced with pressure to improve downtown street conditions and address mounting overdose deaths fueled by fentanyl, San Franciscos's Mayor London Breed last year created the Drug Market Agency Coordination Center. The goal was to take a more aggressive” approach with people openly using drugs by getting them off the streets and ideally into treatment. Since then, police have arrested nearly 1,284 suspected drug users and 1,008 suspected dealers. Just 29 of those arrested and booked into San Francisco County Jail on drug-related charges over the past year have requested assistance with addiction treatment. Out of those 29, it is unclear how many actually participated in a treatment program.

Yahoo: California to examine medical staffing at state prisons and hospitals. Here’s why
California will evaluate the outsourcing of medical and mental health care services at state prisons and hospitals with an audit request suggesting it costs the state up to three times more for contracted medical staff compared to using state employees. The state’s reliance on outsourcing of the care “has reached an alarming point of abuse,” Assemblyman Josh Lowenthal noted in his audit request to the Joint Legislative Audit Committee, adding that while utilizing private contractors is commonplace, California’s reliance hit an all-time high during the COVID-19 pandemic.

District of Columbia
Washington Post: Workload concerns fuel labor fight at D.C.’s largest health clinic
The front-line doctors and nurse practitioners at the District’s largest community health center say widespread staff shortages and safety concerns at clinics across the city, including the jail, have forced dozens to quit, putting their vulnerable patients at risk. Unity Health Care workers say a grueling schedule forces them to run late or rush appointments, shortchanging patients grappling with complex issues and creating a chaotic environment that has led to 25 resignations since Jan. 1.

Baltimore Sun: Lawyers for people held in Baltimore City jail ask court to extend health care settlement
A month out from when a federal judge ordered the Baltimore City Booking and Intake Center to finish overhauling its health care system, lawyers representing people held in the facility say it’s poised to miss the deadline — yet again. The lawyers asked the court to give the Maryland Department of Public Safety and Correctional Services, which operates the city jail, two more years to improve the medical and mental health services it provides and make the facility more accessible for people with disabilities. In the motion, the lawyers asked the court to impose interim deadlines before a final deadline of June 30, 2026, to keep the state “on track” in reaching compliance with each of the nine provisions laid out in the 2016 settlement agreement with the American Civil Liberties Union.

Michigan Public Radio: Medically frail parole bill passes Michigan Senate
Michigan’s medically frail prisoners could see a greater chance at parole under a bill passed in the state senate Tuesday. That could include people who are deemed a low risk to society because of medical conditions like permanent physical disabilities that prevent them from walking, standing, or sitting without help.

New York
Corrections 1: Western N.Y. prisons wait to see if their facilities will close
Among the thousands of pages in the state budget passed in April was a provision that would allow for the closure of up to five of the state’s 44 prisons in the coming fiscal year, a measure that did not get much fanfare during the sausage-making process. Now, with the state making no announcements on which prisons will be closed or when the announcements will come, staff members, members of prison host communities and the lawmakers who represent those areas of Western New York are watching with interest to see which of the seven prisons in the region, if any, will close.

AFSCME: New York’s corrections officers pressure state lawmakers for safer facilities
New York State Law Enforcement Officers Union state that making corrections facilities safer requires a three-pronged approach — station trained medical professionals at every county jail to distribute and administer prescription medications, expand post-traumatic stress disorder (PTSD) coverage under the state workers’ compensation system, and reexamine New York’s segregated confinement law. The Humane Alternatives to Long-Term Solitary Confinement, or HALT Act, severely limited corrections officers’ ability to separate violent individuals from the rest of the prison population.

Columbus Dispatch: Gov. Mike DeWine: Jail deaths should be investigated by an outside agency, not sheriffs
Gov. Mike DeWine said every death in county jails should be investigated by an outside agency, not the sheriffs who run the jails, and Ohio needs to do more work to divert people with mental illness or drug addiction to treatment, rather than lockups. Currently, sheriffs investigate most of the deaths that occur in their jails but have the option to ask the Ohio Bureau of Investigation to investigate.

Columbus Dispatch: In Ohio's jails 220 inmates have died in 4 years
The Cincinnati Enquirer, Columbus Dispatch and USA TODAY Network Ohio reviewed lawsuits, inspection reports, autopsies, obituaries, investigative documents, surveillance videos and other records related to what's happening inside Ohio's jails. The Ohio Department of Rehabilitation and Correction provided copies of inspection reports, jail standards and a spreadsheet of reported deaths. We tracked down coroner reports for nearly all 219 deaths that were reported to the state between January 2020 and December 2023.

Policy Matters Ohio: Policymakers can reduce involuntary commitments by filling the crisis care gap
House Bill 249 would expand the circumstances in which a person could be involuntarily committed. A Policy Matters report, Involuntary commitment and the crisis care gap, describes how the practice strains both systems, and how proposed legislation would make matters worse. It also recommends policy fixes, including better funding for non-police care response programs

Journal-News: Man held in Ohio prison cell with no toilet or water for 55 days sues state
A man held in an Ohio prison cell with no water, toilet or mattress for nearly two months filed a federal lawsuit against the state Department of Rehabilitation and Correction. Civil rights attorney Jacqueline Greene filed the case in the Southern District of Ohio, calling the conditions “barbaric, debasing, and utterly inconsistent with the minimum standard o f human dignity to which all humans are entitled.”

19 News: Lucasville inmate swallows batteries, denied medical attention for months
A Toledo man is suing the Ohio Department of Rehabilitation and Corrections for keeping him in a tiny cell and treating him like a dog, torturing him for months. Attorneys say after James Harris, 38, tried to commit suicide by swallowing up to 25 batteries, prison staff refused to get him medical help him for four months. According to the lawsuit, it happened at the Southern Ohio Correctional Facility in Lucasville. Greene says after Harris became depressed, he somehow managed to swallow up to 25 AA batteries.

Oklahoma Watch: State Prison Staff Face Criminal Charges, Litigation For Plotting Prisoner’s Assault
A correctional officer alleged David Coker had sexually assaulted his niece several times. The officer told prisoners in holding cell No. 3 that he wished he could assault Coker and directed the inmates to “handle it,” according to an internal Department of Corrections investigation. When the officer turned his back, several prisoners began striking Coker with their hands, fists and feet. As Coker sat injured on a bench outside the cell, the officer returned to thank the inmates who attacked him.

Yahoo: Concerns over COVID relief money earmarked for mental health facility next to new jail
A group is voicing concerns about the COVID relief money earmarked for a behavioral health center adjacent to what would be a new county jail. The back and forth battle in the planning for a new Oklahoma County jail continues. At a proposed site for the new jail in southeast Oklahoma City Friday morning, the people’s counsel for justice reform voiced concerns with the $50 million in American Rescue Plan Act (ARPA) funds earmarked for a behavioral health center next to the jail.

KGET: Prisoner dies 12 days after Pennsylvania judge granted compassionate release for health reasons
A Pennsylvania man who had been serving life for second-degree murder died over the weekend, 12 days after being granted a medical transfer from prison to a facility that could better treat his condition, including quadriplegia. An aide to Allegheny County District Attorney Stephen Zappala, whose office had opposed the release, said they had no comment on Bozeman’s death.

KSL News Radio: New department prepares inmates for life after prison
There is now a department at Utah’s state prisons that focuses on helping inmates get ready for life after prison. About six months ago, legislation went into effect that allowed the Department of Corrections to get an official re-entry and rehabilitation program. The programs train inmates in culinary arts, horticulture, furniture building, welding, and more. On top of that, many of the products they work on are used by agencies across the state.

NBC: Tarrant County medical examiner rules inmate's death a homicide
The Tarrant County (Fort Worth, TX) medical examiner has completed the autopsy for Anthony Ray Johnson, Jr., ruling his death a homicide. Waybourn said Johnson was pepper sprayed during a confrontation with jailers, then held down and restrained, when he became unresponsive. Waybourn fired two jailers in May over the incident, one for using a technique not approved by the sheriff's department and another for allowing the technique to be used and for failing to respond to the urgency of the situation.

13 News Now: Virginia Beach jail's mental health liaison connects with struggling inmates through his experience
Sgt. Brandon Mullen is the Virginia Beach Sheriff’s Office’s first mental health liaison, acting as a go-between with the courts, city services, and the jail. It’s a position he advocated for and got last year after working in the Virginia Beach Sheriff's Office for 12 years. Mullen takes his mental health seriously. "I have my own personal struggles with mental health. I think a lot of people do," he said. "I’ve been diagnosed with bipolar II, PTSD, general anxiety, and ultimately

The Hill: Wisconsin warden and 8 staff members charged following probes into inmate deaths
Guards at Wisconsin’s oldest maximum-security prison failed to provide basic care for inmates who died on their watch, including one who died of dehydration and another who wasn’t found for at least 12 hours after he died of a stroke, authorities said in announcing charges against the warden and eight members of his staff. Waupun Correctional Institution’s warden, Randall Hepp, is charged with misconduct in public office. The other eight face charges of felony inmate abuse.

ABC: Relatives of inmates who died in Wisconsin prison are shocked guards weren't charged in their cases
Relatives of two inmates who died in an aging maximum security prison in Wisconsin say they're stunned prosecutors haven't filed charges in those cases after bringing multiple counts against the warden and other prison employees in connection with two other prisoners' deaths. Dodge County District Attorney Andrea Will opted not to charge anyone in the deaths of Dean Hoffmann, who killed himself in solitary confinement in June 2023, and Tyshun Lemons, who died of a fentanyl overdose in October.


Corrections 1: Telehealth in correctional facilities: Transforming inmate health with wearable technology
In correctional facilities, resource constraints such as limited staffing, medical personnel and allocated healthcare budgets pose considerable challenges. Logistical hurdles arise during in-person healthcare visits due to security protocols, transportation issues and a need for dedicated personnel to accompany inmates. With recent advances in healthcare technology, wearables offer an integral solution to correctional healthcare challenges, including those related to telemedicine in correctional facilities. With wearables, clinicians can remotely monitor inmates’ health in real-time, enabling continuous and proactive healthcare management.

Correctional Health Care Providers

Filter: Wellpath, Fleeing GA Prisons Contract, Fails One Last Bid at Extortion
Wellpath’s arrival in July 2022 was quiet. For many of us, the first sign that something had changed came in August when they refilled monthly prescriptions. Some prescriptions had gotten smaller. Others were missing entirely. Every day there’d be someone asking a supervisor for help getting their blood-pressure medication. The only pain medication we’re likely to get here is acetaminophen, and even those bottles were being dispensed one-third full. Copays were tacked onto prescriptions for chronic conditions.

KSBW: Monterey County Jail sued for 6th time for wrongful death since 2021
A lawsuit was filed Thursday over the death of a King City man who died by suicide in the Monterey County Jail. It is the sixth wrongful death lawsuit related to the jail filed since March of 2021. The six wrongful death lawsuits are being pursued in court, with hearings and trials on these deaths likely to continue through at least 2025. It is still unclear how much the lawsuits will cost. Earlier this year in federal court, U.S. District Court Judge Beth Labson Freeman gave Wellpath and Monterey County more time to fix their many problems. They have a deadline of Aug. 1 to make changes or be fined a million dollars

Broad + Liberty: Mother of prison suicide victim sues Delaware County and prison contractors
The mother of Andrew Little, a 34-year old man who took his own life while in custody at the Delaware County prison two years ago today, filed suit against the county as well as numerous other parties, seeking damages for her son’s death because of “deliberate indifference” and “medical negligence” to Little’s mental state. The federal suit, filed in the Eastern District of Pennsylvania, also names Wellpath and the GEO group as defendants, as well as ten corrections “Jane” and “John Doe” officers.

COCHS Weekly Update Will Not Be Published Next Week
The Editorial Staff Will Be On A Retreat