1115 HIT Requirements and Post-Release Continuity of Care; DeSantis Signs Diversion Legislation

Highlighted Stories

Editor's Note

This week’s first highlighted story discusses the challenges formerly incarcerated individuals face in accessing healthcare. If Medicaid coverage for services behind the wall survives the proposed Senate cutbacks, it could reshape care delivery. The recently approved 1115 waivers for pre-release services include provisions for health information technology that facilitates data sharing—aimed at creating continuity of care between corrections and the community. This secondary benefit could help address the barriers to care that post-release individuals currently experience.

Our second highlighted story comes from Florida, where Governor DeSantis has signed major legislation reforming the state’s approach to mental health and substance use disorders. The new laws support both diversion from incarceration and regular reassessment of treatment plans. These reforms acknowledge that many individuals with behavioral health or substance use disorders do not belong in correctional settings. Historically, there have been few viable treatment alternatives in the community, and in many cases, their incarceration reflects the failure of those systems. We are hopeful that these changes will result in fewer individuals with serious behavioral health needs entering the justice system—and more being directed to appropriate care environments.

Roadblocks To Healthcare

People who are formerly incarcerated are disproportionately jobless, underemployed, or working low-wage jobs. They’re also more likely to be uninsured and have less consistent health coverage than those who haven’t been incarcerated. Even with subsidies, signing up for Obamacare often requires both know-how and money. A national physician shortage makes it harder for former prisoners—like many others—to get timely appointments with specialists for conditions such as asthma, hepatitis, HIV, type 2 diabetes, and mental health disorders. These illnesses occur at higher rates among the formerly incarcerated than in the general population.

Florida

Those suffering from substance abuse will get more frequent updates of treatment plans and mentally ill felons will have more chances to get diverted from jail into treatment under a pair of bills signed by Gov. Ron DeSantis on June 25. The first (SB 1620) puts recommendations from the Commission on Mental Health and Substance Abuse into state law, including requiring facilities to update treatment plans for patients every 30 days. The second bill (SB 168) sets up a way for local governments to divert mentally ill inmates from jail to treatment. The bill requires the Department of Corrections to review each inmate’s physical and mental health before they become eligible for work details.

Follow Ups

Editor's Comment: Picking up from last week’s Editor’s Note, we continue examining accountability—or the lack thereof—in correctional systems. Despite formal oversight structures, serious failures persist, raising ongoing questions about whether these systems are truly being held to account.

We begin in Harris County (Houston, Texas), where ten people have died in custody so far this year. These deaths occurred despite the Texas Commission on Jail Standards issuing 149 notices of noncompliance and referring the jail to the state Attorney General. Readers may also recall that this same commission previously flagged Bexar County (San Antonio) for similar health and safety violations.

Back in January, the Weekly Update reported on calls for a federal judge to penalize Oregon for failing to admit individuals from jail to the state psychiatric hospital within the legally required seven days. That effort has now borne fruit: U.S. District Judge Adrienne Nelson has held the state in contempt and imposed a fine of $500 per person per day for every delayed admission. As of this writing, the Oregon Health Authority is appealing the decision—which has already cost the state $38,000 and counting.

In California, a Santa Barbara County grand jury issued a scathing report on the medical care provided by Wellpath at the county jail, citing repeated failures to follow protocol and communication breakdowns that led to three inmate deaths. This follows an earlier grand jury report that faulted the sheriff’s office for failing to monitor medical staffing shortages.

Oversight may not always be effective, but as COCHS has often noted, it can still exert pressure. Unfortunately, that pressure seems to have lost momentum in Arizona. As we reported in our March 4, 2025 Weekly Update, oversight advocates had called for a healthcare receiver to take over the prison system. Bipartisan legislation to establish an independent oversight office at last passed both chambers—only to be blocked by the Department of Corrections and the governor’s office.

In Dauphin County, Pennsylvania, subscribers may recall a previous Follow Up covering the murky process of selecting a new jail healthcare provider—including financial ties between PrimeCare and former board chair Jeff Haste. That story now has new twists: County Commissioners have overridden the Prison Board’s controversial vote to recommend PrimeCare or Wellpath, despite both companies being poorly ranked by an independent consultant. One board member also failed to disclose a family connection to Wellpath.

And in New York, the New York Times asks whether Governor Kathy Hochul’s recent actions have truly improved prison oversight. While she has increased surveillance funding and removed the warden of a troubled facility, she has declined to support legislation that would expand oversight or reform disciplinary policies.

But returning to COCHS' skepticism about oversight: the usual accountability mechanisms in corrections remain largely reactive. Oversight bodies can scold, grand juries can expose, legislators can tinker—but from COCHS’ perspective only Medicaid brings both the carrot and the stick that might finally deliver real accountability.

Harris County, Texas

Three Harris County Jail (San Antonio, TX) inmates died during a recent 48-hour span, marking a total of 10 in-custody deaths reported in Harris County so far this year. The three deaths were first reported to the Texas Commission on Jail Standards. The Harris County Sheriff’s Office had reported Winstel’s death on its website. Information about the other two deaths were reported later in the day following. The Texas Jail Project has yet to see a meaningful plan from the county to remedy issues within the jail — with the exception of calling for a bigger jail or a mental health facility. From 2023 through 2024, the state commission issued 149 notices of noncompliance and referred the Harris County Jail to the Texas Attorney General's Office earlier this year after repeated violations. The Texas Jail Project is calling on the AG’s office to file an injunction against the Harris County Jail as requested by the Texas Commission on Jail Standards in its last two quarterly meetings.

Oregon

The Oregon Health Authority is appealing an order that held the state in contempt for taking too long to admit people in jail to the state psychiatric hospital. The order, delivered by a federal judge this month, opens the state up to serious fines. Previous court orders require that these patients, known as "aid and assist" patients, be admitted to the Oregon State Hospital within a week. The term refers to criminal defendants who have been found by a mental health assessment to be unable to aid and assist in their own defense. Under the contempt order, the state owes $500 per person per day every time someone waits in jail longer than seven days. Oregon has struggled to comply with its constitutional obligations for people with severe mental health conditions for decades. In Washington state, a similar contempt order forced the state to make major investments in its mental health system, ending its own problem of aid and assist patients waiting in jail.

Santa Barbara County, California

In a fiercely detailed report, the Santa Barbara County Grand Jury excoriated the medical care provided in the county jails (California Forensic Medical Group, Inc. (Wellpath), is the contract healthcare provider), blaming the failure to follow established medical protocol combined with repeated failures of communication for the deaths of three jail inmates this past year.

Arizona

A proposal to create an independent oversight office to monitor and report on the Arizona Department of Corrections, Rehabilitation and Reentry hit a wall at the governor’s office despite broad bipartisan support throughout the session. Oversight advocates and a slate of lawmakers have long been pushing for another set of eyes on the state’s carceral system, and this year, they came closer than ever before. However, reservations from the governor and the Department of Corrections stalled the bill’s momentum, resulting in two chamber budget proposals that lacked the $1.5 million appropriation to create the office.

Dauphin County, Pennsylvania

The Dauphin County Commissioners will consider all five proposals for the county jail’s medical services, not just the two companies recommended by the prison board. During the meeting, the commissioners unanimously voted to consider all the companies that submitted proposals to provide healthcare services at the Dauphin County Prison, effectively ignoring a controversial vote last week by the seven-member prison board. The prison board disregarded an independent consultant’s rankings of the proposals and instead advanced two low-ranked companies, PrimeCare Medical and Wellpath, despite a history of medical negligence claims directed at PrimeCare and a board member’s undisclosed family connection to Wellpath. Lower Paxton Township Supervisor Pamela Thompson said she was “shocked” and “appalled” the county was still considering PrimeCare, likening it to returning to an abusive relationship. Thompson and a handful of other residents also spoke out against Wellpath.

New York

In response to crises inside New York State’s prisons, Gov. Kathy Hochul said this winter that swift action in Albany would hold corrections officers accountable and keep inmates safer. In the legislative session, the governor directed $400 million to increase camera coverage in prisons. She replaced the head of the prison where an inmate had been savagely beaten to death and ordered reviews of “safety gaps” in several lockups and assessments of their operating cultures. But she has not committed to signing a package of bills meant to increase prison oversight that originated with reform-minded lawmakers. Criminal justice advocates and some legislators were also left disappointed that she has not championed measures that would increase the chances for inmates to gain early release and make it easier to discipline officers.

ICE

A 68-year-old Mexican-born man has become the first Ice detainee in at least a decade to die while being transported from a local jail to a federal detention center, and experts have warned there will likely be more such deaths amid the current administration’s “mass deportation” push across the US. The death occurred as private companies with little to no oversight are increasingly tasked with transporting detainees. The Guardian asked Ice, TransCor and CoreCivic about the incident – including whether vans and buses transporting immigration detainees are equipped with cameras. ICE and TransCor did not respond.

A private prison facility in eastern Kern County may reopen as a federal immigration processing center if CoreCivic and the government agency known as ICE move forward with a contract. Ryan Gustin, senior director of public affairs for CoreCivic, said in an email on Wednesday that the company has begun some preliminary activation activities in California City, where a 2,560-bed prison facility has been vacant since late 2023.

Between Jan. 1 and June 10, the jail in Orange County (Orlando, FL) housed about 1,500 detainees for U.S. Immigration and Customs Enforcement, the Chief of Corrections Louis A. Quiñones Jr. Reported. That includes 622 who had no criminal charges. Attorney Walker Smith urged the county to "just tell ICE within 90 days we are no longer going to abide by the IGSA," its Intergovernmental Service Agreement to house ICE detainees. (1908x2883, AR: 0.6618106139438086). Amid allegations that immigrants are disappearing after they enter the jail, Quiñones emphasized that they are given the opportunity to make a telephone call and said that "Know Your Rights" posters are displayed in the booking area. But once they are being held for ICE -- and not on local charges -- their names are not publicly listed by the jail. Family members, when they call, are referred to an ICE webpage. Orange county, has an agreement to work with ICE. It also has an Intergovernmental Service Agreement to house ICE detainees.

Women

Most incarcerated women are of reproductive age, facing unique health challenges related to this stage of life. Within this population, women from Black, Hispanic, and Indigenous communities are disproportionately represented, reflecting broader social and systemic inequities. Many of these women were caregivers for children or family members prior to incarceration, adding to the emotional and social impact of their imprisonment.

Women incarcerated at the Shakopee Correctional Facility are dealing with basic health products rationing, according to the Incarcerated Workers Organization Committee. Tampons and pads are among the items being rationed. Inmates said they were informed of the shortages two weeks ago through a memo posted inside the Anthony Unit at the prison.

Resources

This Toolkit for Writing an RFP to Contract for Healthcare Services in a Correctional or Detention Institution (Correctional Healthcare RFP Toolkit) is designed to help correctional and detention facilities—along with local governments—create effective, outcome-focused requests for proposals (RFPs) for healthcare services. This Toolkit promotes collaboration between agency heads, procurement officials, and vested partners involved in the vendor contracting process. Agencies can use this Correctional Healthcare Toolkit and RFP template as a comprehensive guide, following each step closely, or as a reference to improve their existing processes by comparing them against the Toolkit’s suggestions.

State Roundup

Illinois

The family of a man who died in Cook County Jail last year after he was beaten by guards is suing Sheriff Tom Dart alleging civil rights violations and demanding punitive damages. The 73-page suit filed last week in the Northern District of Illinois by the stepfather of Cory Ulmer, who was 41 when he died, accuses Dart of having a “pattern and practice of covering up or turning a blind eye to the use of excessive force.” An additional 30 county employees are named defendants in the lawsuit..

Louisiana

The Supreme Court said that it would decide whether a Rastafarian man may sue prison guards in Louisiana who shaved off his dreadlocks in seeming violation of an appeals court’s ruling about how the state must treat members of his faith. The first four months of Mr. Landor’s incarceration were uneventful. Then he was transferred to the Raymond Laborde Correctional Center in Cottonport, La. According to his lawsuit, he presented a copy of the 2017 decision to a guard, who threw it in the trash. After consulting the warden, two guards handcuffed Mr. Landor to a chair, held him down and shaved his head to the scalp. The question the justices agreed to decide is whether the 2000 religious freedom law allows suits against prison officials for money.

New Orleans jail abandoned stricter supervision in a more secure tier, known as segregation years ago, shortly after Sheriff Susan Hutson took office in May 2022. Federal monitors flagged that decision shortly afterward and have continued to describe it as a critical misstep, one that spawned a subset of detainees who repeatedly do not follow the rules of Orleans Justice Center (OJC)” Though the OJC was built as a $145 million facility just a decade ago under a federal judge’s watch as part of a decade-old consent decree, the Orleans Parish Sheriff's Office (OPSO) has struggled to safely house its highest risk and special needs populations from Day One.

South Dakota

After all the debates and accusations, it’s hard to know what to think about the project. It’s difficult not to be cynical watching lawmakers get all hopped up about spending $600 million. We’re supposed to think that’s a bargain because the original plan called for spending $850 million. Much of this consternation originates in the way the prison project was initially handled during the Kristi Noem administration. Neighbors of the Lincoln County project weren’t made aware that state land in their county was under consideration until plans were announced for the new prison. When they found out about it, their concerns didn’t matter to Noem, who was known for a my-way-or-the-highway approach to getting what she wanted.

West Virginia

Formerly incarcerated people, lawmakers, and advocacy groups met in Charlottesville today for an event highlighting how incarceration affects lives beyond prison. “Build people, not cages,” said Natasha White, President and Founder of Broken Crayons Still Color, a non-profit group that provides support for women and families impacted by incarceration. Advocates, nonprofits, and lawmakers gathered to discuss jail and prison reform, highlighting medical neglect, mental health treatment, and what the state government can do about it.

Wisconsin

Wisconsin incarcerates more people per capita than the majority of countries in the world, including the United States. Starting in the late 1990s and 2000s, Wisconsin’s “truth-in-sentencing” law, which requires people convicted of crimes to serve their full prison sentences with longer paroles, resulted in both a cycle of reincarceration and a large prison population full of aging inmates with low risk of reoffending. Judges often give out “extraordinarily long periods of extended supervision,” according to Professor Pamela Oliver , at least 25% of the incarceration itself by law and often multiple times that in practice. To her, it is simply a “huge engine in reincarceration.”

As Wisconsin’s prison population climbs toward pre-pandemic levels, Senate Bill 153 seeks to expand alternatives to incarceration. Wisconsin’s Treatment Alternatives and Diversion program was established in 2005 to provide counties with funding to create programs to divert adults with nonviolent criminal charges into community-based treatment for substance abuse. Senate Bill 153 would formally expand the scope of these programs to explicitly include individuals with mental health issues.

Prison reform advocates gathered by Green Bay Correctional Institution, calling for change at a moment when the prison’s future is uncertain. The vigil included prayer for incarcerated people in solitary confinement. The Wisconsin Department of Corrections reports on how long prisoners spend in disciplinary separation, where a prisoner might be sent after committing a violation. GBCI has the longest average length of stay in disciplinary separation of any of the adult facilities listed, at 48.6 days. GBCI was built in 1898. As of June 20, it housed 381 more incarcerated people than its design capacity of 749. Overcrowding puts additional burdens on staff to maintain a facility’s safety and security, a 2020 draft report on the Wisconsin Department of Corrections website stated.

As Wisconsin’s prison population climbs toward pre-pandemic levels, Senate Bill 153 seeks to expand alternatives to incarceration. Wisconsin’s Treatment Alternatives and Diversion program was established in 2005 to provide counties with funding to create programs to divert adults with nonviolent criminal charges into community-based treatment for substance abuse. Senate Bill 153 would formally expand the scope of these programs to explicitly include individuals with mental health issues.

A Dane County Sheriff's Office proposal to end county jail inmates' access to physical copies of their mail has come under fire from community advocates and members of a County Board committee. Eight community members spoke at a recent meeting of the Public Protection and Judiciary Committee, opposing a proposed contract with Smart Communications, a company that provides communication services for residents in jail including SMS messages, emails and video calls. The proposal includes the adoption of mail scanning, in which physical mail is diverted to an outside location, scanned and sent to inmates via tablets.

Rikers Island

Criminal justice advocates and some legislators were also left disappointed that she has not championed measures that would increase the chances for inmates to gain early release and make it easier to discipline officers. The beleaguered jail has been under the supervision of a federal monitor since 2015 because of pervasive problems. Last month, a federal judge appointed a remediation manager to overhaul the jail — which has seen its population grow to more than 7,000 from about 4,000 in 2020.

Justyna Rzewinski, a icensed clinical social worker, writes of here experience at Rikers Island: While I had an orientation about my role and job responsibilities, I wasn’t prepared for what I soon witnessed: the widespread use of a practice known as “deadlocking.” “Deadlocking” was the term corrections officers used to describe how they would lock individuals in mental health units in their cells for weeks or months at a time, usually under the guise of security. Deadlocked patients often went without human contact, sunlight — or their medications, including those to treat their mental illness. While violence against staff is a real problem at Rikers, I saw many people deadlocked due to personal decisions the corrections officers made. An officer would lock an individual in because they felt disrespected by the patient or they looked at him in a “weird way.”

The City Council voted 51-0 Wednesday [June 11] to pass a bill designed to expand access to the overdose prevention drug Narcan in the city jails — a response, in part, to the fallout from the 10 OD deaths behind bars in 2022 and 2023. The bill, Intro 206-B, would require the Department of Correction to provide Narcan training to all uniformed officers, make Narcan training available to people in custody, make sure Narcan is stocked in all housing units, and provide overdose prevention kits to those leaving jail.

Telecommunications

Beginning in early 2020, non-essential visits, including those conducted by linkage to care staff and community health workers, ceased in the Santa Clara Jail (SCC Jail) in response to COVID-19. These restrictions prompted the County of Santa Clara Public Health Department (SCCPHD) to evaluate how to best serve justice-involved individuals who were newly diagnosed HIV. In order to provide HIV linkage services to those newly diagnosed with HIV, a telephonic visits program was created in collaboration SCCPHD and Adult Custody Health Services (ACHS) in January 2021. The telephonic visits program deployed trained social workers from SCCPHD to offer HIV education and short-term case management by contacting individuals with newly diagnosed HIV in the jail by telephone.

Advocates for providing inmates in Florida prisons with one free 15-minute phone call if they display good behavior say they are cautiously optimistic that the proposal, included in the $115 billion budget passed by the Legislature earlier this week, will survive Gov. DeSantis’ veto pen. The $1 million proposal was included in the Appropriations Committee on Criminal and Civil Justice budget chaired by Okaloosa County Republican state Rep. Patt Maney and Miami-Dade County Republican Sen. Ileana Garcia. Their insertion of the funding comes a year after Ron DeSantis vetoed a $2 million request to continue the program, and two years after an initial $1 million pilot program for free calls was enacted.

Correctional Healthcare Vendors

Wellpath

Monterey County has spent the last four months soliciting bids and evaluating proposals for what will potentially be a new health care provider for the Monterey County Jail, as the current $44.3 million, three-year contract with Wellpath ends on Dec. 31. The next provider has been tentatively awarded. According to records personnel from seven health care companies attended a mandatory pre-bid meeting that took place on March 10: Armor; California Health and Recovery Solutions, PC; Correctional Healthcare Partners; NaphCare; Physician Correctional, USA; 22nd Century Technologies, Inc.; and Wellpath. In an emailed statement, company founder Taylor Fithian says that after 40 years providing care in the jail, Wellpath did not make the cut. The other bidders are not without criticism: Armor has been found liable in inmate deaths in Ohio and Wisconsin; NaphCare and Physician Correctional have been sued in cases involving wrongful deaths in custody.

The Kerr County Commissioners Court voted unanimously to approve an amendment to an inmate health services contract calling for an increase of $269,510.05 next fiscal year. Part of the increase reflects a 3% rise in the consumer price index, according to the Seventh Amendment to the Agreement for Inmate Health Care Services. The agreement is between the county and Wellpath. When the court amended the agreement last year to reflect the cost increase, County Judge Rob Kelly indicated the county was in a tough spot. “This is something that is not discretionary,” Kelly said. “We have to provide these services. We are mandated by the Constitution to have a jail in the county, and we have to provide these health care services to our inmates. So we're kind of at the mercy of the providers.”

PrimeCare

The Lehigh County Board of Commissioners tabled a vote Wednesday that would approve a professional services agreement for various health care services for the Department of Corrections. Delaying the vote to the body's July 9 meeting will, they hope, allow for further discussion about a multimillion-dollar contract with PrimeCare Medical Inc. Ultimately, the commissioners expressed the desire to add more reporting and oversight, in part because they've added roughly $500,000 in mental health care services.

The Weekly Update Will Return on July 15
After The Independence Day Holiday