JAMA: Co-pays In Corrections Dissuade Health Care Treatment; Medicaid A Game Changer To Help Prevent Co-pays & Care Denial

Highlighted Story

Editor's Note

This week's first highlighted story comes from a study in JAMA which looks at the relationship between prisons that require co-pays from incarcerated individuals to receive health care treatment and the prevelance of a lack of treatment. This relationship raises concerns as there is a high incidence of mental health and chronic physical conditions among incarcerated people.

Also related to the co-payment story is the next two stories from New York City’s Rikers Island and Oregon’s Department of Corrections both institutions have been accused of either denying care or postponing care. As Medicaid permeates our jail and prison system, at least in the last 90 days of incarceration, individuals will not be subject to co-pays, and they will have a right to treatment that may or may not be enforced through plaintiff's attorneys. This is especially true for Oregon which this year had its 1115 Waiver approved for Medicaid coverage within corrections.

The importance of highlighting these stories is again to inform our subscribers about the relatively poor state of health of our nation's incarcerated population and the extent to which correctional health systems do not fully respond to the needs of these relatively unhealthy individuals. Medicaid is a game changer. These stories point out the extensive need for the game to be changed.

Co-payments

Most prisons impose co-payments for at least some medical visits. Co-payments were associated with worse access, especially when the prison’s standard co-payment for a medical visit exceeded 1 week’s prison wage. Decades-old data indicate that people imprisoned in the US have poor access to health care despite their constitutional right to care. A total of 40.1% of respondents reported ever having a mental health condition (up from 24.5% in 2004), of whom 33.0% had received no mental health treatment. A total of 13.3% of respondents met criteria for severe psychological distress, of whom 41.7% had not received mental health treatment in prison. Of state prison residents, 90.4% were in facilities requiring co-payments, including 63.3% in facilities with co-payments exceeding 1 week’s prison wage. Co-payments, particularly when high, were associated with not receiving a needed health care visit.

Care Denial & Treatment Postponement

New York City’s Correction Department has failed to take detainees to medical appointments thousands of times every month, in some cases never notifying them and later saying they “refused care.” Detainees are blocked from medical care in myriad ways, according to the filing. They include lack of transportation to medical appointments and a dearth of staff to accompany them. Since the case was brought in 2021, access to medical care in the city’s jails “has only worsened, and the department lacks both the basic competence and willingness to rectify this situation."

A recent federal lawsuit accuses the Oregon Department of Corrections of a consistent practice of denying or delaying care to people in custody, citing the case of a man who went three years before receiving care despite an X-ray’s confirmation of multiple wrist fractures. Filed last month on behalf of Denis Krivosheenko, the suit claims administrators at the department have a practice of “slow-playing requests for medical care,” which “causes adults in custody to experience unnecessary pain and suffering while waiting for care.”

Studies

Studies linking incarceration records to health care data can improve understanding about health care access following release from prison. This review maps evidence from data-linkage studies about primary care use after prison release. Early contact with primary care services after prison release (e.g. first month) was positively associated with an increased health service use, but an investigation found that a large proportion of individuals did not access primary care during the first month. The quality of care was found to be largely inadequate (measured continuity of care) for moderate multimorbidity. There were lower levels of colorectal and breast cancer screening among people released from custody.

Previous research has found that over 80 percent of people with opioid use disorder (OUD) do not receive evidence-based, lifesaving medications. Although access to these medications is better in New York City than elsewhere in the United States, more than 100,000 people in the United States continue to die from drug overdoses each year. To help close this alarming treatment gap, researchers at NYU Grossman School of Medicine partnered with the New York City public hospital system to investigate if a program offering addiction care to patients with a substance use disorder while they are in the hospital could lead to better uptake of OUD treatment after discharge.

Opioid Epidemic

For years, Baltimore’s leaders gave overdoses little public attention, even as the death rate swelled to unprecedented levels. But for a few weeks this summer, it seemed that the city would respond to its drug epidemic with new urgency. The City Council was about to hold four hearings. But hours before the first hearing, as demonstrators prepared to rally outside City Hall, the council president abruptly canceled the session, at the request of Mayor. Scott’s administration. The administration said that holding any of the public meetings would jeopardize a lawsuit the city had filed accusing numerous opioid makers.

Coordination of care upon release is the deliberate organization and sharing of information between correctional and community-based service providers to ensure the most effective care for each person returning to the community. During incarceration, effective care for opioid use disorder (OUD) includes screening and treatment with medications for OUD (MOUD). Upon release, effective care for individuals with OUD involves linking people to evidence-based care in the community.

Each inmate who enters Crawford County Correctional Facility (PA) goes through a screening to identify any substance use. Anyone testing positive for alcohol, methamphetamines or opioids speaks with a health care professional and goes through detox protocol. Soon, those who enter the facility on an MAT program can continue that treatment, though. Samantha Rhoads, health services administrator at the facility, said that on average, about four to eight individuals each month enter the jail on an MAT program.

Studies show positive results when inmates receive treatment for opioid use disorder while incarcerated, according to Dr. Stephanie Gravning a physician with the North Dakota Department of Corrections & Rehabilitation who was speaking to Ward County Commission. Ward County has banked about $90,000 so far from participation in a class action lawsuit against companies that have manufactured and marketed opioid medications. The county’s opioid task force is developing a plan to use the funds to initiate a program to provide opioid use disorder treatment during incarceration. Currently, inmates who enter the jail can continue an existing medication treatment but there is no mechanism for them to start treatment.

A worker at a federal prison in California has died and investigators are examining whether he was exposed to fentanyl shortly before his death. A mailroom supervisor at the U.S. Penitentiary in Atwater, California, died Friday after he reported feeling ill earlier, the people said. They said he was taken to a local hospital and was pronounced dead. Investigators are examining whether he was exposed to a substance authorities believe was fentanyl while he screening mail at the prison

Corrections officers at Collins Correctional Facility in Erie County responded Sunday morning to a call of an inmate attempting suicide. Responders while doing chest compressions began to feel dizzy. One officer actually had to be relieved from what he was doing to go vomit. Those involved believe they were exposed to a substance and multiple officers were treated with the opioid reversal agent Narcan.

The New York State Department of Corrections is investigating an incident at the Wyoming Correctional Facility that sent six officers to local medical facilities Thursday. The department said they were transported "out of an abundance of caution" after a substance was found on an incarcerated individual. No other details about the substance were available.

State Roundup

California

Gov. Gavin Newsom has been touting a more humane model of incarceration that would emphasize programming and education. But he’s been resistant to reconsidering the practice of confining inmates to small cells for most of the day and isolating them from the general prison population. The state Department of Corrections and Rehabilitation prefers to use the phrase “restricted housing” and balks at the use of the term “solitary confinement” without explanation. And powerful state law enforcement groups, including the California Correctional Peace Officers Association have opposed previous reform efforts.

California stands to gain dozens of new state jobs at California Medical Facility (CMF) in Vacaville, but it comes at the cost of cutting those jobs for people with disabilities who currently have them. CMF is the state hospital housed at Solano State Prison that provides medical care for inmates. PRIDE Industries, an organization with the mission of connecting people with disabilities to meaningful employment, currently has more than 70 employees contracted for custodial work at CMF. PRIDE will see its 70 jobs cut at CMF after local union SEIU 1000 petitioned the State Personnel Board to terminate PRIDE's contract that was valid through 2025. .

Georgia

A new mental health crisis center will soon open in southwest Atlanta in hopes of taking the stress off jails and hospitals in the area. The center will be open 24 hours a day, 7 days a week, for anyone experiencing a mental health crisis, and is expected to save lives. Officials are calling the center a gamechanger for mental health in the metro Atlanta area.

Idaho

An Idaho district judge has narrowly expanded a pause on a new law that bans public money from being used for transgender health care. House Bill 668, "ensures taxpayer dollars are not used to provide medical treatment or surgeries for the purpose of changing the appearance of a person's sex in a way that is not consistent with their biological sex." A group of inmates at the Idaho Department of Corrections (IDOC), filed a lawsuit saying the law greatly impacts their medical care. The court wants to be clear; they are just getting back to the status quo for this group, the ruling specifically states the court does not validate or invalidate the statute, it has merely paused it as the entire court process continues.

Tennessee

Shelby County Commissioners recently approved millions of dollars to build a new mental health care facility aimed at getting inmates the help they need so they don’t commit more crimes after release. Shelby County Mayor Lee Harris says 2 out of 3 inmates at the jail have or had some kind of mental health diagnosis, contributing to the high number of inmates being re-incarcerated. Shelby County Commissioners approved using money from the American Rescue Plan Act to build the facility. That money was originally earmarked for revenue-loss post-COVID. The money must be spent by the end of 2026.

Wisconsin

A former correctional officer at Waupon, who wished to remain anonymous, reported that there she witnessed cellphones, drugs and weapons being smuggled into the prison by staff. She knew who was smuggling drugs into the prison and who they were being sold to. In March, federal investigators started looking into a suspected smuggling ring involving prison employees. The federal investigation is still ongoing and has resulted in the suspension of nearly a dozen Waupun prison employees, including the warden.

The 125-year-old, maximum-security Green Bay Correctional Institution has been the subject of debate from Green Bay to Madison, with local leaders calling for its closure. Both inmates and former guards describe a number of chronic issues, including food, mental health, staffing, drug abuse and time out of cells. Joe Verdegan retired in 2020. He and Hoffman say many of the prison's issues are due to lower staff numbers and lower staff morale. In late 2023, 41% of correction officers' jobs at GBCI were vacant. That number is now down to 15% of jobs open — since a new pay package was introduced.

Correctional Health Care Vendors

Wellpath

The family of a 26-year-old man who died from drinking too much water at the Santa Rita Jail last year has sued Alameda County and Wellpath, accusing them of showing “deliberate indifference” to his medical needs. It is the latest of numerous lawsuits accusing Wellpath of neglecting inmate it supervises in jails across California. The illness, also known as psychogenic polydipsia, manifests in excessive consumption of water and is often associated with mental disorders. According to the suit, filed in federal court, jail and county officials have refused to provide the man's family with an autopsy or any records of his medical care. Wellpath, owned by the global investment firm H.I.G. Capital, provides health care at 34 county jails in California. Among the many lawsuits accusing the company of neglecting its duties cited in the current suit were two by families of Santa Rita inmates who committed suicide.

A federal judge on Aug. 1 ordered Wellpath, the County of Monterey’s health care contractor in the jail, to submit a report by Aug. 16 outlining how it is complying with the terms of a 2015 settlement. In 2023, a federal judge ruled that issues in the jail remained unresolved and the County and Wellpath were violating the settlement by not being in “substantial compliance” with most of the 44 requirements spelled out in the settlement agreement. Incarcerated people in the jail filed a class-action lawsuit over health care conditions in 2013.

Hudson County officials ignored a directive from the the Office of the State Comptroller. Now the state watchdog agency is hoping a lawsuit gets the county’s attention. The comptroller’s office filed a lawsuit in Hudson County Superior Court asking the court to enforce a directive that the county shall not renew a contract for medical services at the county correctional facility in 2025 without first putting it out to bid. In late March Hudson County defied the Walsh’s orders when it renewed a contract with Wellpath for $13.5 million for medical and mental health care management at the jail, as well as nurse staffing at the Kearny facility. Wellpath took over the task at the jail when the contract with the former provider, CFG Health Systems, was terminated in 2018 after multiple inmates died at the jail.

Here in Colorado, there have been more than 50 lawsuits filed since 2020 due to Wellpath’s deliberate indifference to the medical needs of the incarcerated population they are required to care for and are paid significant sums of money for those services. At Santa Rita Jail in Dublin, California (Alameda County) since the implementation of the Babu Consent Decree (Babu, et al. v. Ahern, et al, Case No. 5:18-cv-7677), 10 inmates died; in Monterey County’s jail, also under a consent decree, many inmates have died at the hands of Wellpath. This list goes on and on.

Southern Health Partners

A Kentucky woman first learned she was having a baby when she was booked into a Tennessee jail, according to a lawsuit. Eight days later, she says, she gave birth alone on a toilet in a cell while in solitary confinement. Alyssia Moulton, 35, filed a lawsuit Tuesday, Aug. 6, against Southern Health Partners, Inc., the medical provider for Montgomery County Jail in Tennessee, citing “deliberate indifference to medical needs and other claims arising from pregnant inmate delivering baby into a jail toilet.” The lawsuit cites her young son as a plaintiff.