Is Medicaid the answer to the tangled mess of correctional healthcare? HRSA Announces $52 Million Grant to Health Centers For Reentry

Highlighted Stories

Editor's Note

This week's first highlighted story comes from Nevada, and it poses the question of who will be looking out for the healthcare needs of incarcerated individuals. The story tells about a letter the warden of High Desert State Prison in Nevada wrote to his health care staff, basically saying that it had come to his attention incarcerated people were not being seen by practitioners. In a very odd twist, it appears as if the medical director for Nevada’s Department of Corrections, Dr. Kenneth Williams is ordering his providers to refuse treating incarcerated people for various illnesses. The twist becomes a tangled mess, as it is also reported that Dr. Williams was hired and permitted to work without a medical license for an entire year, a class D felony.

COCHS has previously discussed how the current regulatory framework is inadequate to respond to the health care needs of incarcerated people. As mentioned in a previous Editor’s Note, when Medicaid is brought behind the walls of corrections, Medicaid benefits give incarcerated individuals expanded rights to receive their needed care --how these rights will be interpreted within the context of carceral settings remains to be seen.

On another topic, in these remaining weeks of the Biden/Harris administration, the Health Resources and Services Administration (HRSA) announced nearly $52 million in awards to 54 health centers to enhance primary care access for individuals transitioning from incarceration back into the community (the second highlighted story). Notably, Unity Health in Washington, DC is among the recipients. Back in 2006 the Washington D.C. Mayor’s Office contracted with COCHS to facilitate Unity Health Care, when it became the health service provider inside the walls of the DC Department of Corrections.

Tangled Mess In Nevada

Inmates in Nevada prisons are being denied necessary medical care and medications, according to providers. “It has come to our attention that there have been instances of medical care being neglected for inmates in our care,” Warden Jeremy Bean of High Desert State Prison wrote in an August memo to all prison medical providers. The failure to provide care is worsening, providers contend, under the leadership of Dr. Kenneth Williams, the Nevada Department of Corrections’ medical director. In February, the Current reported Williams was hired and permitted to work without a medical license, a minimum requirement for the job. Williams has terminated two practitioners in the last several weeks — a dentist who says he declined to abide by Williams’ directive to practice on patients without a dental assistant, and a doctor who questioned why Williams was not following his own policy of having an outside provider serve on the Utilization Review Board, a panel that evaluates appropriate care for inmates. Medical professionals say the lack of care they receive while incarcerated can result in a life sentence of navigating health complications.

HRSA Announcement

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), announced nearly $52 million in awards for 54 HRSA-funded health centers to increase access to high-quality primary care for people soon to be released from incarceration and reentering the community. Aligned with the White House Second Chance Initiative, today’s funding enables health centers to implement innovative approaches to support justice-involved individuals before their release to address health risks during reentry, including elevated risk of opioid overdose and the increased risk associated with being disconnected from critical treatment for chronic diseases, including medications.

Medicaid

Starting January 1, 2025, through their Medicaid/CHIP programs, all states need to be able to provide medical, dental, mental health, and substance use disorders screening and diagnostic services to youth 30 days before release from incarceration. States must also provide targeted case management and referrals in the 30 days before and after release. In this context, youth refers to Medicaid-eligible individuals under age 21, and former foster youth under 26, post-adjudication.

A study compared mortality data from formerly incarcerated populations in Rhode Island, a state that adopted Medicaid expansion in 2014, and North Carolina, which adopted it in 2023. Results show that expanding access to Medicaid for people who were formerly incarcerated was associated with lower mortality due to drug overdoses, homicides and deaths from all causes. But those reductions were mostly experienced by white people than in all other racially minoritized groups combined, and Black people experienced no mortality reductions in the health results examined by the researchers.

Mental Health

Types of psychiatric hospitalizations available for those incarcerated in the US include acute civil hospitalization, forensic hospitalization for competency restoration, and long-term hospitalization for those who require civil commitment upon release from custody. Individuals in custody may be transferred from jail or prison to an inpatient hospital if their psychiatric symptoms become too severe to manage in the carceral setting.

With adequate treatment, most children with ADHD go on to live normal lives. But in some cases, for people without access to treatment, the results can be tragic. Undiagnosed or inadequately treated, the trademark impulsiveness, defiance of authority, and thrill-seeking mindset of ADHD often accelerate as a child proceeds through adolescence. These traits frequently become the impetus behind criminal acts. Ignoring ADHD in the prison population can have a grave impact on individual prisoners as well as the communities they return to. People with ADHD are not only far more likely to reoffend after their release from prison; they reoffend more quickly too.

Women In Corrections

In an effort to strengthen communities and help formerly incarcerated women who served their time successfully reenter society, U.S. Senators Jack Reed and Sheldon Whitehouse and U.S. Representatives Seth Magaziner and Gabe Amo today announced that OpenDoors Rhode Island has been awarded $714,958 in federal funds through the Department of Justice (DOJ) Second Chance Act Community-based Reentry Program. The three-year federal grant will help OpenDoors provide services to help former inmates successfully transition from prison to a productive life in the community. OpenDoors offers specialized reentry support to help returning citizens with basic services, such as education, housing, transportation, addiction recovery, and more.

Women are now just as likely as men to be victims of violent crime. They now account for more than a quarter of adult arrests. The rate of women’s jail incarceration has been edging up; the men’s rate has been going down. The incarceration rate for women in prisons and jails increased dramatically (+431%) from 1982 through 2007, and then flattened as the number of incarcerated men began to fall. Between 2010 and 2019, the year before the COVID pandemic jolted the criminal justice system, the female jail incarceration rate went up by 12%, while the male rate fell by 10%.

Opioid Epidemic

The data is clear: MOUD saves lives. Treatment of opioid-use disorder with methadone and buprenorphine — two of the three FDA-approved MOUDs — is associated with a 50 percent decrease in mortality. Denial of MOUD access for incarcerated people is not just wrong—it is also illegal. The U.S. Department of Justice (DOJ) released guidance re-affirming that denial of MOUD can amount to a violation of the Americans with Disabilities Act (AMA), and the DOJ has settled several cases requiring jail and prison facilities to provide access to MOUD.

End of Life

The Nebraska Department of Correctional Services (NDCS) has launched a volunteer-based hospice service for terminally ill incarcerated individuals. The program is part of a wider trend to improve end-of-life experiences as swelling aging inmate populations increase demand. Volunteers in NDCS’ hospice program provide bedside companionship, emotional support and assistance with daily activities of life.

Topics In Corrections

In implementing evidence-based prison policies that focus on skill development, psychological interventions play a crucial role. Through evidence-based approaches with more direct behavioral outcome measures, incarcerated individuals can have the opportunity to change their lives and reintegrate into society. It is also important that policymakers are willing to move away from traditional approaches and collaborate with scientists to actively translate scientific evidence into practical applications for prison policy

Implementing a new corrections philosophy in the United States is challenging because institutional culture is very ingrained. In American prisons, anti-fraternization policies regulate contact between staff and prison residents, either limiting or altogether prohibiting interactions between corrections employees and incarcerated people. The U.S. corrections culture is focused primarily on security and discipline.

Data & Statistics

The types of offenses committed by federally sentenced U.S. citizens varied by educational attainment. For those with less than a high school degree, drug trafficking (42.0%) was the most common offense, followed by firearms (25.2%), immigration (11.5%), robbery (4.2%), and fraud (4.1%). Sentenced individuals with an undergraduate or graduate degree were convicted more often for economic or sex offenses than sentenced persons with less education. Approximately one-third (32.9%) of sentenced individuals with an undergraduate degree were convicted of a fraud offense. Similarly, fraud (42.2%) was the most common offense of conviction among federally sentenced persons with a graduate degree, though medical doctors were equally likely to commit fraud (37.6%) or drug trafficking (36.5%).

State Roundup

Alabama

As the list of plea agreements in connection with inmate abuse and the death of inmate Tony Mitchell continue to grow, Walker County Sheriff Nick Smith and county commissioners remain silent. Community activist Ryan Cagle is again calling for the sheriff to resign. Plea deals from eight jailers and a medical worker, expose a culture that encouraged inmate abuse according to federal court filings.

Alaska

A trial over a woman’s suicide attempt while jailed in a state facility in 2020 recently concluded. The lawsuit came amid increased scrutiny of inmate deaths in Alaska. In 2022, 18 people died in state custody, including at least seven suicides. A huge proportion of the inmates have some kind of mental illness or mental health issue or are in crisis. The state was essentially arguing in the trial, “There’s no way we could have predicted this, and there is no practical way to put every single inmate, or some great proportion of thousands of inmates, on the highest level of suicide, (or suicide) prevention restrictions.”

Arkansas

A health center in Augusta, Arkansas is receiving $1 million federal funding from the Health Resources and Services Administration (HRSA), which is an agency of the U.S. Department of Health and Human Services. ARcare will receiving the funding from the Biden-Harris administration to increase healthcare access for people that will be released from prison and are reentering the community --see second highlighted story.

Connecticut

Despite gains in dealing with incarcerated youths following a federal Department of Justice investigation, the state Department of Correction still is relying too heavily on isolation to deal with behavioral issues and isn’t providing enough mental health programming, according to a report. The 58-page report issued by the state’s Office of the Child Advocate calls for Connecticut to develop a plan to remove youths from adult prison settings and provide appropriate rehabilitative services including more educational opportunities and more mental health programming geared toward dealing with trauma in children.

DeVaughn L. Ward, is Connecticut’s interim correction ombudsman. Ward has in the past represented incarcerated people in lawsuits filed against the Department of Correction. Ward wants to ensure people in prison have access to medical care as one of his priorities in the ombudsman role. “At the top of my mind is, what resources is the state committed to putting around medical care in prison?” he said. “How do we provide care to this population?”.

Florida

The Escambia County Sheriff's Office is following through on its promise to change the way it responds to mental health calls. Sheriff Chip Simmons introduced a co-responder unit, made up of a deputy and a clinician from Lakeview Center, that will work together to reduce jail population and break down barriers for help. Since the program was launched, only one person was arrested during a mental health call.

Georgia

State lawmakers are looking for ways to prioritize health and safety in state-run prisons. The Department of Justice recently released a scathing report on Georgia’s prison system. The Department of Corrections Facilities Study Committee met with representatives from the Department of Corrections. The Department of Justice report listed 17 problematic prisons in a dozen counties where they investigated cases of violence, rape, drug overdoses, exploitation and gang intimidation.

Georgia Department of Corrections officials began laying the groundwork Wednesday for an infusion of state funding to beef up staffing, replace aging infrastructure, and improve inmate health care. The state’s workforce of correctional officers plummeted during the COVID pandemic and has yet to fully recover. A 26% annual turnover rate before the pandemic struck in 2020 soared at one point to more than 40% before dropping slightly to 37%

Kansas

Kansas officials have settled a lawsuit over delays in providing mental health evaluations and treatment for incarcerated individuals in county jails. State officials agreed to increase the number of available treatment beds at Larned State Hospital and to address the inadequate staffing levels and underfunding that has led to a facility with hundreds waiting for treatment. The hospital had 140 beds designated for defendants in need of treatment or evaluation, but only 100 of those were usable because of low staffing levels.

New Mexico

Bernalillo County commissioners voted unanimously to appropriate $800,000 to create and fund a corrective action plan for medical services at the Metropolitan Detention Center. Health care at MDC has been scrutinized after almost two dozen inmates have died at the facility since 2020. The corrective action plan is part of a 2015 settlement in a lawsuit. Earlier this year, the county terminated its approximately $15 million per year contract with YesCare, formerly Corizon Health. YesCare was the second medical provider that left MDC prematurely. The first was Centurion Detention Health Services. At the end of July, University of New Mexico Hospital will take over behavioral health and medical care at the detention center.

New York

Erie County officials have understandably balked at the idea of building a new jail for as much as $700 million. One cost-saving idea raised is potentially contracting with a private company that builds and leases jail space. CoreCivic, one of the largest private owners of prisons and jails in the U.S., has been mentioned. But privately operated jails are not allowed in New York State, so the facility would be leased back to the county, once built. A major issue for the county is tat those suffering from mental illness and addiction disorders make up as much as half the populations of the county’s jails.

Ohio

The University of Cincinnati Medical Center is the target of a lawsuit filed Thursday in the U.S. District Court Southern District of Ohio. Attorneys said their investigations have revealed a systemic breakdown of information sharing around the jail which could endanger others. He said the jail doesn't question arresting officers over what to expect from those being brought into the jail.

Federal officials awarded the Erie County Health Department with a $1 million grant to provide health care to jail inmates and suspects who are criminal defendants. “The funding will support innovative approaches to health care delivery for individuals navigating the justice system, focusing on addressing disparities, fostering rehabilitation and promoting public safety,” according to a press release from U.S. Rep. Marcy Kaptur, D-Toledo, who announced the grant award

Oklahoma

The CEO of the Oklahoma County Detention Center, Brandi Garner, wrote a letter to the state's mental health provider, listing the alleged failures by the agency. Garner sent the letter to the Oklahoma State Department of Mental Health and Substance Abuse Services, dated the same day the jail trust formally cut ties with the agency. This comes two months after the jail lost its medical provider, Turn Key Health Clinic. The jail said it is housing incompetent inmates who should be in state custody while they are having their competency restored. But mental health advocates said the problem is still the jail's fault. "As they do every time, it's always someone else's fault," Sara Bana with the People's Council for Justice Reform said --see September 17, 2024 Editor's Note.

Oregon

A former Oregon inmate filed a lawsuit against the Oregon Department of Corrections, alleging he was sexually abused by a medical doctor while incarcerated at Deer Ridge Correctional Institution. The former inmate, James Watkins, alleges Dr. Leland Beamer, chief medical officer of the prison, abused him during medical appointments and said other prison managers did not do enough to prevent it or investigate the case after he reported it to authorities. Watkins filed a grievance with the prison through the federal Prison Rape Elimination Act but never received notification concerning the outcome of the investigation.

Utah

An auditor found “systematic deficiencies” in how healthcare was delivered at Utah’s prisons. In some cases, auditors found, inmates’ written requests for care were being ignored. Two suicide attempts have occurred at the $1 billion prison that opened in 2022 in Salt Lake City. Neither incarcerated people were in any sort of mental health unit or under suicide watches, their families say.

Vermont

Vermont’s Gov. Phil Scott’s shut down Woodside Juvenile Rehabilitation Center in fall 2020, the 30-bed juvenile detention center in Essex had drawn multiple lawsuits, replete with horrific details describing inhumane conditions and treatment for the facility’s residents. Since then, Vermont has had to make do without a dedicated facility to hold young people involved in the justice system. Now, after years of delays and scrapped plans, state officials are pushing forward with the creation of a new residential facility.

Wisconsin

This is how a long-awaited, independent audit described the Milwaukee County Jail's practices and training around suicide prevention. The audit highlighted systemic issues ranging from "dangerous" suicide watch practices and challenges to administering mental health care as well as poor leadership oversight, the ongoing critical staffing shortage and inmate overcrowding.

Correctional Telecommunications

An order issued by the Consumer Financial Protection Bureau (CFPB) on November 14 requires Global Tel Link to pay $3 million for allegedly freezing and taking funds from accounts belonging to incarcerated individuals, in violation of federal law. Global Tel Link, which does business as ViaPath and operates subsidiaries Telmate and TouchPay, contracts with correctional facilities across the United States to provide money transfer services.

The landmark Federal Communications Commission (FCC) regulations poised to bring down costs of phone and video calls for incarcerated people will move forward as planned, despite an onslaught of lawsuits and delay tactics from the corrections industry. On November 18, the United States Court of Appeals for the First Circuit denied separate petitions from Securus Technologies and Pay Tel Communications, both of which had requested a stay of the new regulations while they fight them in court.

Five years after digital tablets were introduced in Delaware correctional facilities, each inmate will now have their own device. The Delaware Department of Correction (DOC) has deployed more than 4,000 new digital tablets to meet a one-to-one tablet to inmate ratio after a successful pilot program with ViaPath that began in 2019. The tablets were deployed at no cost to Delaware taxpayers, but inmates and their loved ones do pay for phone calls, messaging and entertainment access like games, music streaming and movies.

Prison Contractors

GEO Group, one of the nation’s largest private prison contractors, filed a federal lawsuit last month against California officials to strike down a state law allowing local public health officials to inspect immigration detention facilities. The Florida-based company argued in a filing that California’s law, signed by Gov. Gavin Newsom in August, is unconstitutional because it steps on the federal government’s authority to manage detention centers. By extension, GEO claimed intergovernmental immunity as a contractor.

Correctional Health Care Vendors

Wellpath/VitalCore Merry-Go-Round

Our state sadly enters into contracts with out-of-state, for-profit health care providers. Vermont’s former prison health care provider is Vitalcore, some of whose employees, under the guidance of the mothership, have been accused of providing negligent care to incarcerated inmates throughout our country. Wellpath, a health care company owned by a private equity firm, is at the helm of Vermont’s negligent incarcerative care right now. Our state willingly pays them almost $40 million a year to take care of 1,300 of our fellow Vermonters --see January 30, 2024 Editor's Note.

Wellpath

A federal judge has refused to endorse the Jefferson County sheriff's request to immediately appeal a claim brought against her for a detainee's death, allegedly caused by the constitutional violations of the jail's private medical provider, Wellpath. U.S. District Court Judge Charlotte N. Sweeney held that the sheriff, Reggie Marinelli, could be held liable for Wellpath's constitutional violations under the theory that the sheriff could not delegate to a third party her ultimate obligation to provide adequate medical care. The principle that governments cannot contract out their responsibilities and avoid legal liability is known as the "non-delegable duty doctrine."

PrimeCare Medical

The status of the Medication Assisted Treatment Program at the Clearfield County Jail (PA) was another hot topic at the Prison Board meeting. In September, the board became aware that the group running the MAT program, Meshach of Philipsburg, was not actually distributing the medication and this chore was being done by PrimeCare Medical, the medical provider for the jail. PrimeCare had written the board saying they were going to stop supporting the MAT program.

Happy Thanksgiving!
The Weekly Update Will Next Be Published On December 10, 2024