Weekly Update: April 16, 2024
Determining Medical Necessity: How Medicaid & Corrections Differ; Deep Dive: Indemnification & Correctional Health Care Contracts


Highlighted Stories

Editor's Note
As Medicaid begins to permeate the criminal justice system, the question of medical necessity and provider qualifications will quickly come to the forefront. The first highlighted story from Oregon discusses at length how that state's Department of Corrections has a process for defining medical necessity that is quite different from the traditional community definitions. The story continues by describing judicial concerns about how the physician in charge defined medical necessity, leading to a judge releasing a prisoner because the physician refused to provide the treatment deemed medically necessary by the judge. Moreover, the physician's history and qualifications are troubling.

This story forebodes a much deeper challenge as Medicaid enters the correctional system. With the recent 1115 waivers mandating care in the last 90 days of incarceration to be paid by Medicaid, the decision about what services are medically necessary will transition from the Department of Corrections to a healthcare insurer or provider with community roots. This transition will pose cultural and economic challenges. It is too early in the process to know how these challenges might be resolved, but as the Oregon example shows, the current process seems to neither benefit the incarcerated patient, the Department of Corrections, nor the state’s judicial system.

Turning to the next three stories, we once again return to YesCare (formerly Corizon). As our subscribers will remember, YesCare was created through a bankruptcy strategy known as the Texas Two-Step, which involves splitting a company into parts—one with most of the assets and the other with the bulk of the liabilities—and then filing the debt-laden company for bankruptcy. This resulted in Corizon becoming Tehum Care and YesCare taking over the assets of Corizon. Tehum Care, as the former Corizon, declared bankruptcy to decrease financial settlements from the multiple lawsuits brought by former and current incarcerated patients. The second story from Reuters continues the saga. The judge in the bankruptcy case has declined to end Tehum’s bankruptcy, but Tehum needs to submit a new bankruptcy deal if restructuring is to continue.

However, all these convoluted business relationships to minimize legal settlements did not prevent Louisville, Kentucky, from selecting YesCare as the new provider in that jurisdiction’s jail. YesCare has received a $47M contract and is no stranger to Louisville, having previously been the provider there up to 2013, when it did not have a particularly stellar record. What draws the editor’s attention to this story is the indemnity wording of the contract that holds the jurisdiction harmless against negligence in treatment by YesCare. Officials should be aware that in the day-to-day running of a correctional environment, the health care requirements of incarcerated people can blur the distinction between the actions of correctional officers and medical providers. In Centre County, Pennsylvania, the last story, both the jurisdiction and PrimeCare Medical had to settle a multi-million dollar lawsuit to a formerly incarcerated man who was paralyzed in the jail due to both the actions and inactions of correctional staff and medical staff. Centre County has to pay the gentleman $2.75 million. PrimeCare’s payment is undisclosed. Of course, the editor does not just want to single out just YesCare or PrimeCare. As always, if you scroll down to the end of this Weekly Update, there are more stories about other proprietary correctional health care vendors.

Medical Necessity
American Prospect: Decider MD
In May of 2020, an Oregon prisoner named Anthony White had an unusual request: He asked if he could be “indebted” to pay for a new wheelchair, which he needed because he was a paraplegic. "I have no family or friends in the community to help me with this," White wrote. White’s request went to a committee within the Oregon Department of Corrections (DOC) known as a Therapeutic Levels of Care Committee. And the committee, White was told in a short note, denied the request. Many of these critical decisions are made by a single person: Dr. Warren Roberts, chief of medicine for the Oregon prison system. In White’s case, Judge Robert Collins ruled in 2019 that the DOC had “failed to provide adequate medical treatment” by suddenly withdrawing White from multiple medications. But even after the initial ruling, the DOC would go on to deny various forms of medical treatment, including his request for a new wheelchair. Two years later, in 2021, the judge had had enough. “The Court has held nine hearings … regarding [the Department of Corrections’] non-compliance with this Court’s orders,” the Judge wrote. Judge Collins then ordered that White be released from prison.

YesCare/Corizon/Tehum Care Bankruptcy
Reuters: Prison health co. may stay in bankruptcy, but needs new deal, judge rules
A U.S. judge on Thursday declined a bid to end Tehum Care Services' bankruptcy, but he said the prison healthcare company would need to come up with a new bankruptcy deal if it wants its restructuring to move forward. Opponents of Tehum's so-called "Texas two-step" bankruptcy, including prisoners who have sued over substandard medical care and the U.S. Department of Justice, had argued that the company's predecessor Corizon Health abused U.S. bankruptcy law when it created a new shell company, Tehum, and placed it into bankruptcy solely to halt lawsuits filed against it. They said the case must be dismissed because it was filed in a bad faith effort to protect YesCare, the new company that inherited Corizon's contracts and business assets.

Louisville Courier Journal: New Louisville jail health care provider gets 3-year, $47M contract. Here are the details
Louisville Metro Government will pay the jail’s new health care provider, the controversial Tennessee company YesCare, more than $15 million a year. YesCare will receive $15 million the first year, $15.6 million the second year and $16.2 million in the third year of the contract. On paper, YesCare is new, having been created after its predecessor Corizon restructured in a controversial bankruptcy move called the “Texas Two-Step” that involved offloading debt onto a new company while Corizon executives formed a third company, YesCare, to do business. Corizon was the health care provider for Louisville Metro Department of Corrections up until 2013. The company departed Louisville after a spate of jail deaths the year before. The contract includes an indemnity clause, with YesCare agreeing to hold Metro Government harmless “from and against any claims against Metro proximately caused by negligence in treatment rendered by YesCare personnel.”

Centre Daily Times: Centre County agrees to $2.75 million settlement with man who left the county jail paralyzed
Centre County agreed Wednesday to pay a $2.75 million settlement to David B. Rossman who alleged that treatment at the county jail left him paralyzed from the upper torso down. Rossman's attorney said the settlement reached with PrimeCare Medical — the jail’s contracted medical provider — is confidential, while the county agreed to settle for $2.75 million. The agreement came three months after Chief U.S. Middle District Judge Matthew Brann found a reasonable jury could conclude the medical care Rossman received during his stay at the Centre County Correctional Facility “does not pass constitutional muster.” Rossman had undergone emergency spinal surgery. His doctor ordered him to wear a brace and cervical collar at all times. Rosssman had requested help from corrections officers with his braces on four consecutive days, but assistance was refused each time. Two nurses and a corrections officer, Brann wrote, required Rossman to walk to a wheelchair from his bed unassisted.


CMS: Ohio Section 1115 Demonstration Waiver for Substance Use Disorder Treatment Extension Request
On April 1, 2024, Ohio submitted a request to extend its section 1115 Substance Use Disorder (SUD) Demonstration. The demonstration authorizes Ohio to enhance residential treatment services as a crucial component in the continuum of SUD benefits by permitting receipt of federal funding for treatment in Institutions for Mental Diseases. (The Ohio Department of Medicaid (ODM) received several suggestions to expand the waiver to include Medicaid coverage for inmates during the 90 days prior to leaving prisons, jails, and detention facilities. ODM acknowledges that this criminal justice 1115 opportunity exists and is supported by several Ohio organizations. ODM is examining and considering this opportunity but will not be requested as a part of the current SUD 1115 extension application.)

Bolts: “We Need to See the Bigger Picture”: How Cuts to Medicaid Hurt Public Safety
When a state made cuts to Medicaid, depriving people of access to health insurance, the crime rate increased: That’s the finding of a new academic study, supported by the National Institutes of Health and released as a working paper by four scholars who study public health. The study comes at a time when many states are ramping up punishment in response to crime, while leaving public services largely underfunded. A found that the crime rate in the median Tennessee county had increased by almost 17 percent, with large increases observed in both violent and non-violent crime; the study attributes this to the disenrollment from Medicaid through a series of causal analyses. These patterns now risk repeating themselves at a large scale. Just last year, every state in the U.S. experienced a major contraction in Medicaid coverage, as the federal government ended an emergency pandemic policy that had kept millions enrolled in the program.

HARP: Medicaid’s New Role in Advancing Reentry: Key Policy Changes
This fact sheet reviews recent policy changes to promote smother transitions at reentry. For the first time, Medicaid is being authorized to cover some health services for individuals in the period before they are released from incarceration. These policy changes are groundbreaking and ongoing. They have taken place through statutory changes made by Congress and administrative changes made by The Centers for Medicare and Medicaid Services (CMS) via Medicaid 1115 demonstration waivers.

Mental Health

New York Times: What Martin Luther King Jr. Knew About Crime and Mental Illness
Alvin Bragg, Manhattan district attorney, writes: In September 1958, the Rev. Dr. Martin Luther King Jr. was stabbed with a seven-inch steel letter opener. He had been autographing copies of his first book in Blumstein’s department store in Harlem. The woman who stabbed him was named Izola Ware Curry. When Dr. King found out she was schizophrenic, he harbored no ill will toward her. King recognized that people in crisis need mental health care to be healthy and safe. Mental illness isn’t a crime, and jail isn’t the answer for those experiencing it.

KPBS: Advocates urge jail reforms, citing neglect and abuse for mentally ill inmates
Relatives of those who have died in custody or have loved ones grappling with mental health issues behind bars, gathered outside the central courthouse in San Diegoy. They were voicing their concerns over the inadequate mental health care and growing number of in-custody deaths in San Diego County jails. A survey found that 40% of San Diego County arrestees reported being diagnosed with a mental or psychiatric disorder. And about 25% use psychiatric medication. Advocates said that detention officers with minimal training are responsible for the health and safety of detainees, and that can have fatal consequences.

WIVB: Surge in inmates with mental health issues spurs the need for more beds at ECMC
Correctional facilities have become the largest providers of mental health services in the country, and the Erie County Sheriff’s Office is no stranger to this shift away from sending the seriously mentally ill to psychiatric institutions. The sheriff’s office said about 60% of inmates are treated for some type of mental illness, which is above the national average. An American Psychiatric Association poll in 2022 found 20% of Americans believe incarcerated people are not getting the mental health care they need. In addition, the poll found 75% believe mental health services should be provided to inmates.

Gazette: News Track: ‘Challenging, rewarding’ first year of Johnson County mental health court
The Johnson County Attorney’s Office and the Abbe Center for Community Mental Health in Iowa City last May started the first civil mental health court in the state, which monitors mental health outpatients and connects them with treatment and care to help them live independently. Participants for the program are outpatients who have a primary diagnosis of a mental illness. This court doesn’t accept individuals with previous criminal charges or convictions. The number of psychiatric hospitalizations for each of the participants have decreased by 81 percent, according to court data.

Daily Texan: Travis County announces mental health jail diversion program
Travis County officials introduced the county’s new mental health diversion program to the city of Austin’s Public Health Committee on April 3. Travis County Judge Andy Brown said the county will participate in the three-year pilot program, called the Crisis Care Diversion Pilot Program, alongside the city of Austin and Integral Care, the county’s mental health authority. He said 44% of the county jail’s 2,300 inmates face “significant unmet mental health needs,” an amount nearly double pre-pandemic statistics.

NewsChannel5: Despite mental health crisis, many beds are empty in jails' treatment program
Despite an increased need for mental health care, many beds at a treatment program inside the Davidson County Jail (TN) go unused. Daily jail logs reveal only around 15 of the program's 60 beds are filled on a regular basis. Some days the program had as few as 10 participants, meaning 50 beds sat empty.

Opioid Epidemic

MedPage Today: No, a Jail Is Not an Opioid Use Disorder Treatment Facility
This "jail as treatment center" ideology often centers anecdotes of recovery in carceral spaces while ignoring the incredible amounts of trauma, suffering, and premature death inflicted upon most who are detained. The focus on jails as a salve to the ongoing crisis of opioid-related overdoses dismisses far better alternatives and likewise ignores the structural harms of incarceration. The endorsement of carceral humanism remains seductive to many but is badly misguided.

PBS: Black people have the highest opioid fatality rate among all other races and ethnicities in Arizona
Black people in Arizona die from opioid overdoses more than any other race or ethnicity, according to the Arizona Department of Health Services. The Opioid Overdoses Surveillance report revealed that Black people in Arizona experience an opioid overdose fatality rate of 32.4 deaths per 100,000 people. Nonfatal overdoses also occur at a higher rate for Black Arizonans than for other groups, at a rate of 67.7 per 100,000 people.

NC Newsline: Opioid use disorder, drug and alcohol addiction in NC prisons
Late last year, an attorney with the U.S. Department of Justice filed a statement in an ongoing lawsuit explaining how the Americans With Disability Act impacted the availability of medications for opioid use disorder in jails and prisons. The Justice Department’s position directly impacts those in North Carolina prisons, Todd Ishee, secretary of the state’s Department of Adult Correction, told members of the Joint Legislative Oversight Committee on Justice and Public Safety.

Detrimental Effects of Criminal Justice

Vera: How The Criminal Legal System Coerces People into Pleading Guilty
Excessive dependence on plea bargaining shows the hand of a criminal legal system that favors efficiency over fairness and expediency over real solutions that can make our communities safer. We need to take a critical look at the conditions and biases that encourage this practice and make changes that further justice and transparency.

Texas Tribune: How Texas’ cash bail system and under-resourced jails can wreak havoc on women who are poor
Like most states, Texas uses a cash bail system that lets defendants pay to get released from jail while they wait for adjudication. But the price of bail is often an insurmountable hurdle. For women, the wait can be harder than for men. County jails, meant for short stays, commonly lack resources women need — like pregnancy care and mental health treatment. Women in county jails are also more likely to have mental health needs. And many are mothers separated from their children.

Northeastern Global News: Almost half of US prisons are likely contaminated by dangerous ‘forever chemicals,’ new Northeastern research shows
Close to 50% of U.S. prisons and detention centers are located near sites that are likely contaminated by dangerous "forever chemicals." Based on a watershed analysis of all 6,118 prisons and detention centers in the country, the researchers found that 5%, about 310, have a known contamination site nearby. However, 47%, about 2,285, are close to at least one presumptive contamination site, with many located near more than one. At minimum, there are 990,000 incarcerated people in those facilities, including at least 12,800 juveniles.

Medical Xpress: High rate of death soon after release from jail is avoidable: Researchers call for coordinated whole government response
In the first few weeks after release, it was found that alcohol and other drug overdoses were the leading cause of death. There are several factors contributing to the high rate of death after release from prison. First, incarceration functions as a filter for poor health and marginalization—a concept referred to as "the sedimentation of disease" —whereby people who spend time in prison typically have much poorer health than those who do not.


Office of US Senator Jon Ossoff: Sen. Ossoff’s Bipartisan Bill to Overhaul Federal Prison Oversight Passes Key U.S. House Committee
Sen. Ossoff’s bipartisan Federal Prison Oversight Act which would establish new, independent oversight of the Federal Bureau of Prisons (BOP), passed the U.S. House Committee on Oversight and Reform in an overwhelmingly bipartisan vote, sending it to the full U.S. House for consideration. Sen. Ossoff’s bill is cosponsored by Senators Mike Braun (R-IN); Senate Majority Whip Dick Durbin (D-IL), Chair of the U.S. Senate Judiciary Committee; Joe Manchin (D-WV); Shelley Moore Capito (R-WV); and Tim Kaine (D-VA).

Washington Post: Bureau of Prisons to close California women's prison where inmates have been subjected to sex abuse
The beleaguered federal Bureau of Prisons said Monday it will close a women’s prison in California known as the “rape club” despite attempts to reform the troubled facility. The announcement of FCI Dublin’s closure represents an extraordinary acknowledgement by the Bureau of Prisons that its much-promised efforts to improve the culture and environment there have not worked. Just 10 days before the closure announcement, a federal judge took the unprecedented step of appointing a special master to oversee the prison.


NIJ: Attitudes of Reporting Officers Extracted From Incident Reports Can Affect Rape Case Outcomes
A responding officer’s written report for a rape investigation, especially how the conclusions are worded, can have a significant impact on the case outcome. In a cross-disciplinary study sponsored by NIJ, data scientists applied machine learning techniques to nearly two decades’ worth of police reports on rape cases to help identify and interpret potential emotion or bias. The data scientists used advanced computational power to support social scientists in a study of how evidence of officer sentiment — meaning opinions and subjectivity — toward victims’ credibility may affect key procedural decisions down the line, such as whether to prosecute a rape case.

KFGO: Company that provided electronic devices to inmates accused of covering up data breach
The company that gave electronic tablets to South Dakota prison inmates under a contract with the state hid a 2020 data breach for nine months and then told only a fraction of affected users about it, according to a settlement filed in late February with the Federal Trade Commission. The FTC’s decision and order in the data breach and fraud case against Global Tel Link (GTL) (rebranded as ViaPath Technologies) was issued on Feb. 27, two weeks before the South Dakota Department of Corrections suspended tablet-based phone calls and text messages for about 3,600 inmates. That suspension is thought to have contributed to multiple nights of unrest last month at the penitentiary in Sioux Falls, including an assault that injured an employee.

Events & Webinars

University of Rhode Island: Professor, prison health expert to deliver URI College of Nursing’s Spring Distinguished Lecture
Dr. Susan Loeb is an expert in end-of-life care and in the health of prison inmates. She will be presenting at the Rhode Island Nursing Education Center on May 1: “Enhancing Care of Older Adults in Prison: Research and Development of Just Care.” Loeb’s research focuses on the health needs of older prison inmates with chronic health conditions, extending through their end of life.

BJA: Enhancing Correctional Practices to Protect Vulnerable People: Technical Assistance and Microgrant Program (April 18, 1:00 PM, Eastern)
This webinar will provide details and guidance for potential applicants to the Bureau of Justice Assistance's FY24 Enhancing Correctional Practices to Protect Vulnerable People: Technical Assistance and Microgrant Program solicitation. The presenter will discuss the purpose and goals of this funding opportunity; review eligibility requirements; and address frequently asked questions. A Q&A session will conclude this webinar.

Providers Clinical Support System Medications for Opioid Use Disorders - Webinar: Treatment While Unhoused: Providing MOUD to Populations Experiencing Homelessness (May 1, 12:00 PM Pacific)
According to the Centers for Disease Control (CDC), more than 111,000 people died from a drug overdose in the 12-month period ending last September. As drug-related overdose deaths continue to rise, the need for innovative, early intervention and harm-reducing services are especially relevant. This webinar will explore a program that is focused on providing life-saving medications and interventions to unhoused populations.

States & Territories Roundup

California Healthline: California Fails to Adequately Help Blind and Deaf Prisoners, US Judge Rules
Thirty years after prisoners with disabilities sued the state of California and 25 years after a federal court first ordered accommodations, a judge found that state prison and parole officials still are not doing enough to help deaf and blind prisoners — in part because they are not using readily available technology such as video recordings and laptop computers.

Guardian: She repeatedly reported a prison guard’s sexual abuse. It took years for officials to believe her
Correctional officers had refused Nilda Palacios' request for a room transfer. Her final hope: begging for help from Tony Ormonde, the sergeant who ran the yard. “I can do the bed move, but you gotta do something for me,” she remembers him responding. In the weeks after the transfer, the sergeant began summoning her to his office and other private locations, where he sexually harassed and assaulted her, Palacios said. The abuse continued for months.

CDCR: Folsom State Prison program battles diabetes
The Geriatric Diabetic Circuit Training Program at Folsom Prison focuses on flexibility, agility, endurance and strength. The 50-minute circuit training program is held rain or shine. In addition nutrition is taught through articles shared with participants where they learn about the harmful effects of sugar, carbohydrates etc. and the benefits of low fat, high protein foods in the forms of meat and vegetables. A diabetic nurse will also spend a day in the education building instructing trainers about nutrition and diabetes.

CDCR: Attempted Homicide of California Health Care Facility Officers Under Investigation
California Department of Corrections and Rehabilitation (CDCR) officials are investigating the attempted homicide of two peace officers at California Health Care incarcerated person (CHCF). While conducting a mass search of the facility, two correctional officers were attempting to place an incarcerated person into handcuffs. The incarcerated person resisted, retrieved a weapon and stabbed one officer twice and sliced another officer’s hand.

New York
syracuse.com: State probe details string of errors in county jail medical care for inmate who died by suicide
A woman who died by suicide in the Onondaga County jail received seriously inadequate medical care including never getting a mental health evaluation ordered by a nurse, according to a state report. The incarcerated woman died after attempting to commit suicide by hanging herself with a bedsheet at the Onondaga County Justice Center jail.

Daily Iberian: Parish Council sends inmate health funding issue to state
The Iberia Parish Council voted to request the local state delegation and governor of Louisiana to reinstate reimbursing parish government for health costs associated with prison inmates. Iberia Parish Government pays for the unfunded mandate through the Health Unit Fund, which brings in about $1.2 million and about $950,000 goes to medical expenses for inmates. With Gov. Jeff Landry’s recent push to focus on crime in Louisiana, it is expected inmate costs will be going up across the state.

Spectrum News: Lawsuit raises questions about a coroner's ruling in the death of Nevada prisoner after beatings
The mother of a Nevada inmate who died a year ago after he was beaten by corrections officers has filed a lawsuit accusing prison staff of conspiring with the coroner's office in Las Vegas to cover up the death.

New Jersey
New Jersey Monitor: No dip in correctional costs despite prison closures and stabilized population
The cost to incarcerate someone in one of New Jersey’s nine state prisons is expected to hit $74,254 a year next year — 12% higher than last year, and nearly four times what the state spends per pupil on schools. The jump comes despite the closures of four prisons and a 30% drop in the state’s prison population since 2020.

South Carolina
Yahoo: Paralyzed inmate denied wheelchair, ‘slammed’ around cell by SC jail guards, lawsuit claims
A former Horry County jail inmate paralyzed from the waist down was “forcefully propelled, slammed and thrust” around a booking cell and denied a wheelchair, according to a lawsuit. At the time of his arrest, Gore was in a vehicle and did not have a wheelchair with him, but the lawsuit claims his condition was “readily known” to authorities because of previous incarcerations.

Virgin Islands
Virgin Islands Daily News: Judge lauds BOC progress with compliance measures at prison
A District Court judge largely lauded progress made by the V.I. Corrections Bureau toward attaining compliance with a federal consent decree. On Thursday, representatives from the Bureau and the U.S. Justice Department convened to discuss the findings outlined in a report released by court-appointed monitors in late March. That report noted that the Corrections Bureau attained substantial compliance in environmental health and safety and training for new employees but was downgraded to partial compliance in several areas of mental health care and treatment.

Seattle Times: Jail understaffing is dire. Let counties do their own training
King County (Seattle) officials ought to start planning now to take full advantage of possible new opportunities to get more corrections officers on board and resolve long-term staffing problems. Prosecuting Attorney Leesa Manion last fall asked the state AG’s Office to issue an opinion on whether counties could operate their own basic corrections-officer training academies. Standards would be consistent with the Washington State Criminal Justice Training Commission. The situation is dire. Jail understaffing contributes to King County limiting bookings into its facilities. That has translated into a free-for-all for certain misdemeanors. It has led to troubles in the jail ranging from mandatory overtime to neglecting inmates’ behavioral health challenges.

Rikers Island

New York Times: Former Rikers Employees Are Charged With Smuggling in Contraband
Five people who worked at the Rikers Island jail complex in New York City, as well as a detainee there, have been charged with corruption, including smuggling contraband into the jail, according to three complaints unsealed in Manhattan federal court. Federal prosecutors said that in 2021 and 2022, several former city correction officers, a Department of Correction employee and an employee of a department contractor accepted bribes to smuggle in cellphones, oxycodone, marijuana, fentanyl and a synthetic drug known as K2.

Correctional Health Care Vendors

Noozhawk: Jail Health Care System Problems Highlighted in Community Meeting
Santa Barbara County needs more oversight of its jail health care contractor, which is not meeting basic standards for medical and mental-health services, advocates say. Wellpath is paid about $14.7 million a year for medical and mental-health services to people in county jail custody. The Board of Supervisors has approved two one-year contract extensions, despite concerns about performance. When the civil Grand Jury investigated four in-custody deaths last year, it found that 24/7 mental-health care is badly needed in the jails, and so is crisis intervention training for custody staff.

MEnD Correctional Care
StarTribune: Staff at Anoka jail withheld opioid withdrawal meds from inmate who collapsed, was injured
A 58-page complaint is just the latest lawsuit to take aim at MEnD Correctional Care, an embattled for-profit private health care provider based in Sartell that had been used by other Minnesota counties to provide jail services. According to the suit, contracted medical staffers in the Anoka jail refused to give Deyonta Green his prescribed medication to treat opioid withdrawals. He informed the jail during his intake that he had a Suboxone prescription and had just ingested heroin earlier on the day of his arrest. Green asked repeatedly for the medication. By the time he was rushed out of the jail for emergency medical intervention after a fall, he had multiple brain bleeds, skull fractures and acute kidney failure, among other maladies.