Weekly Update: April 23, 2024
HRSA PIN: FQHCs Allowed in Corrections, Pre-Trial Detainees Excluded, COCHS Seeks Public Comment; Colorado & Massachusetts 1115 Waivers


Highlighted Stories

Editor's Note
This week’s highlighted selection comes from the Health Resources and Services Administration (HRSA). HRSA released a draft of public information notice (PIN 2024-05) that proposes to routinize the ability of Federally Qualified Health Centers (FQHCs) to extend their care into our country's jails and prisons. This proposal has a relevant connection to the very origin of COCHS. COCHS was started in 2005 to replicate a model that had been established in Hampden County, Massachusetts by Sheriff Mike Ashe who had replaced the proprietary provider with practitioners from community health centers to create continuity of care. An evaluation from the National Institute of Justice found that post release formerly incarcerated individuals reported a decline in health problems, both physical and mental. In 2006 COCHS was approached by the Mayor of Washington DC who was interested in bringing the Hampden County model to the District of Columbia.

COCHS was able to negotiate a contract between Unity Health Center and the district’s DOC for Unity to become the health provider in the jail. This created a model of continual care that enabled people in custody to see the same practitioner in the community that was seen within the jail. After Unity’s success, HRSA had concerns about FQHCs being extended to correctional systems. After much policy education on how this model both protected public safety and increased health status particularly for individuals with behavioral health disorders, HRSA released PIN 2024-05.

COCHS shares the excitement of our subscribers in this opportunity to increase access availability and quality to our nation's most vulnerable. However, there's a critical gap: the current policy excludes pretrial detainees. This oversight means that individuals who are incarcerated short-term, awaiting trial, do not benefit from these enhanced health services. Given that pretrial detainees can make up a substantial portion of jail populations, this exclusion poses significant challenges, not only for the detained individuals' health and well-being but also for public safety and public health at large.

Addressing this oversight, COCHS has submitted comments to HRSA, urging them to reconsider the scope of their new policy. It is crucial that health services be accessible to all incarcerated individuals, regardless of their trial status. As our subscribers know all too well, the typical pre-trial detainee with a serious mental illness often discontinues their community-prescribed medication and is incarcerated due to publicly disruptive behavior resulting in criminal charges. Most jails lack the means to identify the specific pharmaceuticals that stabilized these individuals in the community. Furthermore, even if such medications are identified, they are likely not included in the jail's formulary. This gap typically results in unnecessarily prolonged stays and increases the likelihood that patients, once released, are poorly stabilized and more likely to reoffend. Allowing FQHCs to continue the care of individuals who likely had been their patients in the community would, as already mentioned, benefit both public safety and public health.

HRSA’s PIN 2024-05 is open for public comment. We encourage all our readers to engage with this issue and advocate for inclusive health policies that cover pretrial detainees. To do this, navigate to https://hrsa.my.site.com/support/s/ and, under the “Policy” section, click on "Comment on Draft Policy." You will be directed to a site with a dropdown menu where you can select “Submit Draft JI-R Individuals PIN Feedback.” After registering, you will be able to comment on specific sections of the PIN. The exclusion of pretrial detainees is addressed in Section II. While COCHS talking points are included in this PDF, we encourage you to personalize your comments to reflect your concerns.

Finally, we would like to remind our readers of the relationship between FQHCs and the 1115 Medicaid waivers that are being approved and submitted to CMS to allow for Medicaid coverage within corrections (Massachusetts has just had its waiver approved and Colorado has submitted its waiver --see stories below). Integrating FQHCs as the providers in jails along with Medicaid reimbursement has begun to lay the foundation for health care connectivity between corrections and community. Excluding pretrial detainees needlessly impedes ending corrections as a health care island.

PIN 2024-05
HRSA: DRAFT Health Center Program Policy Guidance Regarding Services to Support Transitions in Care for Justice-Involved Individuals Reentering the Community
Please comment on Section II that excludes pre-trial detainees: "This policy does not apply to care provided to JI-R individuals in the care and custody of the Federal government nor to individuals in pre-trial detention." Inform HRSA that this exclusion could be detrimental to public safety and public health. See COCHS Talking Points PDF.

Medicaid 1115 Waivers
CMS: CMS Approves Amendment to Massachusetts' MassHealth Medicaid 1115 Demonstration (Pre-Release Services under the Reentry Demonstration Initiative)
CMS is providing expenditure authority to the Commonwealth to provide limited coverage for a targeted set of services furnished to certain incarcerated individuals for up to 90 days immediately prior to the beneficiary’s expected date of release. The state’s proposed approach closely aligns with CMS’s “Reentry Demonstration Opportunity” as described in the State Medicaid Director Letter (SMDL) released April 17, 2023. The Commonwealth will test, and comprehensively evaluate through robust hypotheses testing, the effectiveness of the extended full 90-day period for covered service.

Medicaid.gov: 1115 Waiver Demonstration - Colorado Expanding the Substance Use Disorder Continuum of Care
Colorado's Department of Health Care Policy and Financing (HCPF) is requesting an 1115 waiver Amendment (Amendment) for their Substance Use Disorder (SUD) Demonstration “Expanding the Substance Use Disorder Continuum of Care. The ammendment seeks to authorize: 1) Medicaid Coverage for eligible individuals in the State’s prisons and juvenile correctional facilities; 2) Targeted Benefit Package for these individuals to include case management services, medication-assisted treatment (MAT) for SUD, a 30-day supply of medications upon release, and certain other supportive services; 3) Coverage Period of up to 90 Days immediately prior to the release of the incarcerated individual from the correctional system.

KFF: How States Are Using Medicaid Waivers to Help Incarcerated Individuals Get Care and Transition Back into Their Communities
In a new explainer, KFF examines a new waiver opportunity that allows states to request a partial waiver of the inmate exclusion policy from the Centers for Medicare and Medicaid Services (CMS) to help smooth individuals’ transitions back into the community with “reentry services.” These services aim to improve health care transitions, increase continuity of health coverage, reduce disruptions in care, improve health outcomes, and reduce recidivism rates. KFF explains the current landscape of “pre-release” waivers across states. The explainer also provides background on the demographic characteristics and health needs of people who are incarcerated.

Opioid Epidemic

NEJM: NYC’s Overdose Prevention Centers: Data from the First Year of Supervised Consumption Services
The rise in overdose deaths is driven by the proliferation of fentanyl, which was present in 81% of overdose deaths in NYC in 2022. Overdose prevention centers (OPCs), also known as supervised consumption spaces, have demonstrated international success in reducing overdose deaths and associated harms. OPCs, which opened in NYC on November 30, 2021, are recognized as the first OPCs with supervised use of illicit substances to be formally supported by a governmental entity in the United States. This report summarizes the first year of operations of these two centers in NYC.

Wisconsin Department of Health Services: Law Enforcement Agencies Awarded Grants from State Opioid Settlement Funds
Twelve Tribal nations, county, and municipal law enforcement agencies have received grants from the Wisconsin Department of Health Services (DHS) for projects to prevent and reduce the dangers of opioid use. The projects include community drug disposal systems; programs that keep people with an opioid use disorder out of jail; education and training for staff on the medications for opioid use disorder, including how the medications are used as part of a treatment program; and treatment for jail residents with an opioid use disorder.

Lancaster OnLine: Prison officials stand by handcuffing inmates who receive medication for opioid addiction
Lancaster County Prison officials on Thursday defended their practice of handcuffing prisoners when staff administer medication treatment for drug addiction and withdrawal, but under questioning from a public health advocate they said they may be open to reviewing the practice. Warden Cheryl Steberger and Deputy Warden Joe Shiffer confirmed at a Prison Board meeting that facilitators of the new medication-assisted treatment, or MAT, program, handcuff prisoners while they administer medications to treat opioid-use disorder and the severe withdrawal symptoms that come with it. The warden also said prison staff had found evidence of medication being smuggled back to prisoners’ cells by participants in the MAT program. The county prison began the program in September 2022.


Marshall Project: Officials Failed to Act When COVID Hit Prisons. A New Study Shows the Deadly Cost.
A new national study out of one of these collaborations between the University of California, Irvine and Brigham and Women’s Hospital shows that at the peak of the pandemic in 2020, people inside prisons died almost three and a half times more frequently than the free population. Over 6,000 incarcerated people died in the first year of the pandemic, researchers found, using numbers they collected from state prison systems and the Federal Bureau of Prisons. An analysis of data shows the overall prison mortality rate spiked at least 50%, and potentially exceeded 75%, with roughly 50 or more people dying per 10,000 in prison in 2020.


Washington Post: House bill would shine a light on federal prisons’ dark problems
Congress is working to change the BOP’s noxious reputation with last week’s 41-1 approval of the Federal Prison Oversight Act, by the often partisan House Oversight and Accountability Committee. Under the bill, which must be approved by the full House and Senate before becoming law, the Justice Department’s inspector general would conduct periodic prison inspections. The attorney general would be mandated to ensure the inspectors have “access to any covered facility, including the incarcerated people, detainees, staff, bargaining unit representative organization, and any other information” needed. One new element in prison accountability would be a dedicated prison ombudsman who takes complaints from inmates, employees or others.

Spectrum: Feds push back against judge and say troubled California prison should be shut down without delay
Federal officials are pushing back against a judge's order that would delay the planned closure of a troubled women's prison in California where inmates suffered sexual abuse by guards. Following the Bureau of Prison’s sudden announcement Monday that FCI Dublin would be shut down, U.S. District Court Judge Yvonne Gonzalez Rogers ordered an accounting of the casework for all 605 women held at the main lockup and its adjacent minimum-security camp. The judge's order amounts to “a de facto requirement” for the bureau to keep the prison open, U.S. attorneys wrote. A painstaking review of each incarcerated woman's status would “ensure inmates are transferred to the correct location," the judge wrote in her order.

Racial Disparities

New York Times: Black Prisoners Face Higher Rate of Botched Executions, Study Finds
A new report released by an anti-death-penalty group suggests that the botched execution is also part of a disturbing, nationwide pattern: Executioners have botched the lethal injections of Black people more than twice as often as those of white prisoners. The report was issued by rom Reprieve, a human rights group. Their finding builds on a wealth of research into racial disparities in how the U.S. judicial system administers the death penalty. The proportion of Black people on death rows is far higher than their share of the population as a whole. The group was not able to explain why Black prisoners had suffered botched executions at a higher rate, saying that more research was needed.


NIJ: Sentinel Event Review for Successful Transition and Reentry Together (START) Program in the Eastern District of Wisconsin
Partnering with National Institute of Justice (NIJ), the Successful Transition and Reentry Together (START) program of the Eastern District of Wisconsin undertook a Sentinel Event Review (SER) process to systematically review near-misses and unsuccessful cases of reentry and propose recommendations to improve START program outcomes. A sentinel event is a significant negative outcome that is likely the result of compound errors, may signal underlying weaknesses in the system or process.


National League of Cities: Celebrating Second Chance Month: The Crucial Role of City Leaders in Reintegration Efforts
Second Chance Month is a reminder of the power of redemption and the potential for transformation. It is a call to action for city leaders to lead the charge in breaking down the barriers that hinder reentrants from rebuilding their lives. Many city leaders across the country have already taken significant strides in supporting reintegration. Here are a few impactful ways in which they are making a difference: policy reform, partnerships with local organizations, public awareness campaigns, direct engagement. If you are a city, town or village leader looking to start or strengthen your reentry program, join NLC on April 25, 2024 from 1 PM to 2:15 PM (ET) for the NLC’s Municipal Reentry Leaders Network meeting.

State Roundup

Miami Herald: Jail ignored woman’s illness, causing her ‘avoidable’ death, lawyer says. Daughter suing
Instead of providing medical care to an ailing 60-year-old woman, jail staff in Alabama ignored her worsening illness and released her when she was too sick to recover, according to a new federal lawsuit. The lawsuit details a “common scheme” in which the Dallas County Sheriff’s Department is accused of denying inmates, including Strong, medical treatment before releasing them. The reason, according to the suit, comes down to money and the jail looking to avoid bills related to medical cos

KQED: Prison Workers to Be Excluded From Indoor Heat Protections by California Regulators
California workplace safety regulators are planning to carve out state prisons and other correctional facilities from proposed employer requirements to protect indoor workers from excessive heat. The compromise, unveiled at a state work-safety board meeting, comes after a previous version of the regulations was derailed from final approval last month over projected implementation costs for the California Department of Corrections and Rehabilitation.

San Francisco Chronicle: S.F. will delay jail reopening after another inmate incident
Five months before San Francisco jails were forced into lockdown this month after a rash of alleged attacks on staff by incarcerated people, nearly 100 deputies attempted to warn Sheriff Paul Miyamoto of increasingly dangerous conditions caused by what they described as “critical” levels of staffing shortages. Deputies at County Jail No. 3 were “mentally and physically exhausted,” said the Nov. 29 letter to Miyamoto, which was signed by 92 deputies. Jail officials, they continued, “have created an unsafe environment, one in which fights, drug use, assaults on staff and blatant disregard for rules and deputies’ orders have increased.”

Axios: Iowa Ombudsman finds that Polk County Jail illegally collects medical costs
Polk County Jail illegally recovers healthcare costs from inmates before they are convicted, according to a recent investigative report by the Iowa Office of Ombudsman. Due process also applies to inmates' funds, yet their money is being taken with little or no notice, and sometimes without going through a court process as required by Iowa law. By state law, county sheriffs are allowed to recover the costs from inmates, but only if they are found guilty and the costs are approved by a court.

Louisiana Illuminator: Extreme heat in Louisiana’s prisons raises risks for incarcerated
People incarcerated in Louisiana prisons, their families and prisoner’s rights advocates allege that the Louisiana Department of Corrections has failed to properly protect prisoners from extreme heat. The department has requested funding in next year’s state budget to install air conditioning in two prisons. People in prison and those connected to them are anxious as climate experts predict this summer may be even hotter than last. Promise of Justice Initiative is suing DOC over the working conditions for prisoners at Louisiana State Penitentiary. The lawsuit singles out extreme heat as a major contributor to brutal conditions that lawyers at PJI say amounts to cruel and unusual punishment.

North Carolina
News & Observer: NC accused in lawsuit of letting people with mental disabilities languish in local jails
Civil rights advocacy organizations filed a lawsuit against the North Carolina Department of Health and Human Services and its secretary, Kody Kinsley. The lawsuit asks a judge to confirm the state is violating the constitutional rights of people who are suspected or found to be mentally incapable of proceeding to trial. The lawsuit also asks a judge to order the state to increase services and develop a remedial plan.

Corrections 1: ‘Our work is making communities safer': Mich. nears record-low recidivism rates
The Michigan Department of Corrections announced Wednesday, April 17, 22.7% of those released from prison since 2020 returned to prison within three years. This mean slightly less than 1 of every 4 prisoners released from prison in the last three years ended up back in prison. Michigan boasts this is the second-lowest rate in state history. The lowest rate Michigan has recorded was in 2019 with 22.1%. Prison officials attribute the lower rate to its staff and the prison system’s focus on evidence-based practices such as ensuring prisoners are properly assessed and placed into programming for things like violence prevention, substance use disorder, and cognitive behavioral therapy.

Jackson Hole News & Guide: Inmate health care cost could rise by 70%
Commissioners may get sticker shock when they see how much health care could cost at Teton County Jail going forward. The physician who contracts with the facility says that a 70% increase is needed to pay a competitive wage and retain nursing staff. Dr. Kennon Tubbs has contracted with the Teton County Sheriff since 2016. Tubbs is a Salt Lake City physician who travels to Jackson several times a year. He originally underestimated nursing wages. Tubbs said he wants to be able to provide quality nursing staff and compensate them adequately. A “well-seasoned nurse” is making $50 to $65 per hour plus benefits.


KIMA: Yakima County looking into enhancing inmate healthcare in local jail
Yakima County Jail director Jeremy Welch asked commissioners this week to move forward with buying medical armbands for inmates. Welch is asking commissioners for just over $85,000 up front to buy 25 armbands. It would cost the jail $55,000 to maintain them. The armbands monitor vital signs, blood oxygen level, heart rate and it can set alerts that will alert my staff that will if the heart rate gets too high, it sets off alerts.

Prison Contractors

LA Progressive: Prison Communications: Increasingly Free, but Prisoners Still Aren’t
Prison communication has been a booming business and is part of a web of industries that depends on society’s propensity to lock people up. As the advocacy group Worth Rises has documented, “private corporations have fully monetized crime and punishment with the help of their government partners.” More than 4,100 corporations extract money from imprisoned people. For decades, profit-based companies leeched off of incarcerated people by charging outrageous per-minute rates. One major corporate player, ViaPath Technologies, “has been tossed between major private equity firms, bouncing from Goldman Sachs and Veritas Capital to, most recently, American Securities, which says its portfolio of companies brings in $46 billion in annual revenue.”

Correctional Health Care Vendors

edhat: Grand Jury Identifies Concerns in Wellpath Contract Services with Santa Barbara County and Sheriff’s Office
The 2023-2024 Santa Barbara County Grand Jury (Jury) has recently released a report highlighting concerns regarding the contract between Wellpath and the County of Santa Barbara and Sheriff’s Office. The report emphasizes the need for corrective measures to address contractual variances, lack of staff, and inadequate reporting systems. The Jury’s findings suggest that improvements in oversight and financial management are necessary to deliver improved and cost-effective healthcare. One significant concern identified by the Jury is the lack of accountability for staff vacancies within Wellpath.

Sun: Contract holes: Santa Barbara County aims to adjust its contract with jail health care provider, Wellpath, to improve service levels
Santa Barbara County isn’t alone in facing jail health care challenges or its issues with Wellpath. Santa Barbara County pays Wellpath $14.7 million annually to provide medical and mental health services, but the contract doesn’t require monitoring to ensure Wellpath is providing those services, nor does it lay out any consequences if Wellpath fails to do so. Monterey County and Wellpath faced a 2013 lawsuit over inadequate care at its jail, which was settled and ordered the Monterey County Sheriff’s Office, the county, and Wellpath to comply with higher medical, mental, and dental health care standards. However, a recent court order found the county and Wellpath were noncompliant with the settlement agreement.

KRCC: Former El Paso County Jail healthcare provider sued by family of teenager who died in custody in 2022
The family of an 18-year-old El Paso County Jail inmate who died by suicide in 2022 is suing the former healthcare company responsible for her care. The civil lawsuit, filed in federal court Monday against the jail healthcare contractor, Wellpath LLC, argues Dezaree Archuleta had repeatedly expressed her suicidal ideations in the days leading up to her death, including multiple incidents of self-harm. According to the suit, the health providers overseeing her “callously ignored” these signs.

Independent: Jail Mistake Leaves Man Suicidal
A Fremont man who suffers from mental illness has sued Alameda County and the Wellpath healthcare company, charging that he nearly took his own life because Santa Rita Jail officials failed to give him his medication while in custody. Julian Martinez alleges in his lawsuit filed March 29 in U.S. District Court in San Francisco that he and his wife told authorities that he required medication, but jail staff and a Wellpath nurse “cruelly called” him a liar and refused to provide his pills. Deputies and Wellpath medical staff, who provide medical care for Alameda County inmates, never moved Martinez to a medical observation unit, the lawsuit claims. Six days after he was booked into the jail, Martinez tried to hang himself.

Southern Health Partners
Mount Airy News: County selects inmate medical provider
Southern Health Partners was awarded a new three-year contract to continue around the clock medical at the jail by the Surry County (NC) Board of Commissioners. Their low bid of $694,020 was accepted and the new contract will begin on July 1. Two other bids from MEDIKO, Inc. and Wellpath, LLC were received featuring price tags including seven instead of six digits, $1.72 million and $2.93 million respectively, that were deemed too expensive by the selection committee. Dr. Challie Minton, owner of Surry Rural Health Center, Scenic Urgent Care, and Scenic Pharmacy, had the second lowest bid of $952,248. Dr Minton commented that: “The contract was awarded to a known company facing multiple lawsuits. Under their watch, people in Surry County have died."