Amazon In Correctional Healthcare: Medicaid and Quality Assurance Analytics; Conflicting Correctional State Health Regulations: Texas & Louisiana

Highlighted Story

Editor's Note

This week's first highlighted story comes from Texas and Louisiana, and again focuses on the weakness of state regulations to address the needs of incarcerated people's healthcare. To alleviate overcrowding, Harris County in Texas transfers people awaiting trial to Louisiana. As the story recounts, a young man arrested in Harris County died at LaSalle Correctional Center in Louisiana, which has healthcare standards weaker than those in Texas. Even Duane Lock, one of nine people Gov. Greg Abbott appointed to the Texas Commission on Jail Standards, criticized the fact that Texas officials have no explicit oversight of out-of-state facilities. It is not the first time that subscribers have read various stories on how state regulations appear to fail.

One of the pluses of the coming Medicaid 1115 waiverss and 5121 programs will be the built-in quality assurances that should come with the Medicaid dollar. In fact, Louisiana may shortly have to meet more than the standards of Texas as Louisiana Department of Health has submitted an 1115 waiver to CMS for Medicaid coverage of individuals 90 days before release, which is detailed in the second highlighted article.

The role of Medicaid in corrections now brings us to the reference made to Amazon in the subject of this Weekly Update. If you think Amazon is just a convenient way to make necessary and unnecessary purchases, you may not be aware that beyond the retail market Amazon offers business solutions to organizations and developers. A vast numbers of companies employ Amazon Web Services (AWS) as their internet technical backbone and data repository. The multiple ways in which AWS is used (and “multiple” might be a conservative description) has now entered the correctional healthcare marketplace thanks to Medicaid coverage expanding into corrections.

The AWS promotional piece, the third highlighted story, explains how AWS will be used by major proprietary correctional health care providers Wellpath and NaphCare. These relationships are touted as a way to “offer correctional medical care solutions, electronic healthcare records, and analytics that help state agencies coordinate care across agencies and manage records.” In other words, AWS may be how the quality assurance metrics that pertain to Medicaid are met.

As wearables enter the correctional health care marketplace, the fourth highlighted article from Correctional News, discusses how these devices are a proactive way to monitor the health of incarcerated people, and the fifth highlighted article from Frontiers explains how telehealth is a critical tool for providing healthcare to incarcerated populations. In the AWS article, it’s clear that AWS sees itself as a crucial component for these technical products, offering data storage and analytics to verify quality assurance metrics.

As with any previously non-correctional business that enters the correctional environment, AWS seems to have limited knowledge of the players in this space and that knowledge seems perhaps to be based on public relations pamphlets. The AWS article describes Wellpath as “a premier provider of localized, high-quality care to vulnerable patients in challenging clinical environments.” Our subscribers should find this description of Wellpath to be rather curious in light of recent articles appearing in the Weekly Update that mention Wellpath, as well as articles that mention NaphCare.

Unfortunately, there appears to have been some delivery issues with last week’s Weekly Update that hopefully has been resolved. If you did not receive it, please check your spam folder or you can always view the August 13 Weekly Update on COCHS' website (along with all the Weekly Updates in our archive). The highlighted article last week was a study from JAMA about how co-pays limit healthcare within corrections.

Clash of State Regulations

Facing overcrowding, Harris County in Texas regularly transfers inmates awaiting trial to out-of-state facilities like LaSalle Correctional Center in Louisiana. Louisiana has weaker healthcare standards for incarcerated individuals than Texas. These weaker standards and lack of oversight create significant risks. These discrepancies have led relatives of Texans who have died at LaSalle to push for answers, while officials in Texas criticize the lower standards that Texans experience in Louisiana.

1115 Waiver

The Louisiana Department of Health plans to apply for an 1115 demonstration waiver from CMS to improve care transitions for Medicaid-eligible incarcerated individuals, providing certain services during the 90-day pre-release period. Partnering with the Department of Public Safety and Corrections, LDH will offer services like case management, medication-assisted treatment, and a 30-day supply of prescription medications. The demonstration will include all state prison facilities and up to 13 parish jails.

Technology

The impact of 1115 waivers allowing Medicaid coverage within correctional facilities has begun to be seen as a business opportunity by companies that have traditionally not been interested in populations involved in the criminal justice system. This publicity piece describes how AWS will manage and analyze healthcare data for several proprietary correctional healthcare vendors.

Wearable technology offers a cost-effective and efficient solution to the challenges of providing medical care in correctional facilities, reducing the need for costly hospital visits and improving response times to medical emergencies. The integration of wearable sensors allows for real-time health assessments, enhancing both inmate health and facility safety while addressing logistical and security concerns.

Telehealth is emerging as a critical tool for providing healthcare to incarcerated populations, addressing significant barriers like limited access to specialists and the challenges of transporting inmates for medical appointments. The use of telehealth allows for more timely and effective care, particularly in managing chronic conditions and mental health issues, which are prevalent in prisons. Despite its benefits, there are challenges related to technology infrastructure and privacy concerns within correctional facilities.

Mental Health

Incarcerated individuals face severe deficiencies in both mental and physical healthcare, with many receiving inadequate or no treatment for serious conditions. Approximately one-third of imprisoned individuals with a mental health condition received no treatment. The lack of care exacerbates existing health disparities and contributes to poor outcomes both during incarceration and after release. This neglect highlights systemic issues in prison healthcare, where resources are limited, and the needs of vulnerable populations are often overlooked.

The Ninth Circuit held two hearings in a decades-old case focused on mental health care for California inmates. The state appealed two separate issues in the class action of Coleman v. Newsom. It pushed back against offering patients a minimum of 20 hours of treatment per week. The state also wants the issue of telepsychiatry, and restrictions placed on it, remanded to a lower court.

In a corner of Baltimore’s main pretrial detention facility, those with severe mental illness wait, often for months, to be transferred to a state-run psychiatric hospital for evaluation or treatment. During a tour of the main jail’s mental health unit in December, ACLU attorney Corene Kendrick saw a notebook with handwritten logs detailing how much time each person incarcerated spent outside their cells — or why they weren’t. The logs also painted a different picture than other records produced for the lawsuit by Centurion Health, the jail’s mental health provider. For example, a Centurion-provided record would describe a detainee as refusing to leave their cells, but the handwritten logs showed that they were not allowed to leave due to behavioral issues.

Michigan prison officials failed a woman with a history of mental health problems who committed suicide at the state's prison for women in 2021, a federal lawsuit alleges. Natasha Roark, 39, who had been recognized as a suicide risk both before and after she was sent to Women's Huron Valley Correctional Facility near Ypsilanti, had stopped taking her medications and attending medical appointments and was left alone with a bedsheet inside a handicapped restroom when she died

A groundbreaking ceremony for a new mental health facility is set for next week on the Shawnee County Jail campus in downtown Topeka. In 2023, Shawnee County authorized the issuance of bonds to generate $10 million in funding toward the construction of housing units that are to be designed specifically for management of inmates who are in behavioral health crises, officials said. The State of Kansas has agreed to match Shawnee County funds up to $10 million, said Maj. Timothy Phelps, deputy director of the Shawnee County Department of Corrections.

A program helping inmates deemed incompetent to stand trial is expanding. The Center for Health Care Services just received more than $700,000 from the federal government. Its goal is to get inmates the help they need without clogging up the jail system. The center for health care services plans on expanding the program to serve individuals at the maximum-security list and women at the Bexar County jail.

Opioid Epidemic

The N.C. Department of Adult Correction says it is putting resources into expanding access to medications for opioid use disorder to those who are incarcerated and those who are headed back into the community. Roughly 70 percent of the more than 31,000 people in North Carolina’s prison population is in need of treatment for some kind of substance use. Researchers have found that providing medications for opioid use disorder can help curb overdoses post-release, and giving them to people leaving prison is now considered best practice.

Tuberculosis

An inmate at the Oregon State Penitentiary may be positive for tuberculosis, officials with the Oregon Department of Corrections said. After Oregon State Penitentiary officials said they began to suspect infection, they took the adult in custody to the Salem Memorial Hospital where they were isolated for further testing. The inmate is now in a “negative pressure cell” in the infirmary at Coffee Creek Correctional.

State Roundup

California

Human Rights Watch issued a voluminous report Wednesday castigating local officials and Gov. Gavin Newsom for criminalizing homelessness and failing to observe “an internationally protected human right” to “adequate housing.” The organization, which reports on human rights abuses in some of the most violent places on earth, said the U.S. as a whole, and particularly the City of Los Angeles, have treated “housing primarily as a commodity” while “their primary response on the ground has been criminalization of those without it.” (See August 6 Editor's Note).

Georgia

Georgia's treatment of pregnant women in jails has garnered national attention due to severe consequences, including miscarriages and health complications from inadequate care and neglect. Allegations point to poor medical care and nutrition, prompting legal action and demands for reform. The situation raises serious concerns about the state's correctional system and the need for better standards. Reforms are being called for to ensure the protection and rights of these inmates.

Georgia's prison crisis poses significant risks due to severe understaffing, leading to increased violence, escapes, and contraband. The situation is exacerbated by outdated facilities and poor healthcare, which endangers both inmates and the public. Despite efforts to address these issues, systemic problems persist. The crisis underscores the urgent need for reform in the state's prison system

Louisiana

The Louisiana Department of Corrections is showing a “callous disregard for human health and safety” in its paltry response to a July court order, a federal judge found. At the beginning of July, U.S. District Judge Brian Jackson ordered the DOC to improve conditions for “Farm Line” workers, prisoners laboring in extreme heat in the fields at the Louisiana State Penitentiary at Angola.

Michigan

Corrections officers in the Upper Peninsula are calling on the state to address a "staffing crisis" — they say is creating unsafe working conditions in prisons. According to reports from Michigan Corrections Organization, the union that represents state corrections officers, the staff vacancy rate ranges from 23-33% at the Marquette Brnach Prison, Chippewa, Kinross and Baraga correctional facilities. The Michigan Department of Corrections said it supports a recently introduced bill that eliminates college credit requirements for new officer recruits.

Montana

Inmates at Montana Women's Prison received breast cancer screenings through a mobile clinic, providing essential healthcare access within the facility. This initiative is part of a broader effort to ensure that incarcerated women receive the same preventative care available to the general population. The mobile clinic offers a practical solution to the challenge of delivering healthcare in prisons, particularly for procedures like mammograms.

Texas

More than two months after a judge ordered he be released from Harris County jail to a rehab facility, a 41 year old man died at St. Joseph Hospital after jail clinic staff were unable to stabilize him. (See July 23 Editor’s Note ). It remains unclear what the man's cause of death was. The news of Mota’s death came during the same week that officials announced the jail had passed an unannounced inspection by the Texas Commission on Jail Standards. The inspection reviewed 24 areas of the jail, including health services.