COCHS Weekly Update: April 18, 2023
Highlighted Stories
Editor's Note
As of yesterday, the drumbeat for integrating Medicaid into correction has increased dramatically: CMS has announced The Medicaid Reentry Section 1115 Demonstration Opportunity with an accompanying State Medicaid Director letter. This opportunity would allow state Medicaid programs to cover services that address various health concerns, including substance use disorders and other chronic health conditions for individuals who are incarcerated in the period immediately prior to their release. This guidance comes on the heels of the reintroduction of the Reentry Act and Senator Cassidy's reintroduction of the Due Process Continuity of Care Act.
The relevance of this CMS announcement cannot be overstated. It is very germane considering the publication last week of the Johns Hopkins’ report (cited below) that details the chronic and untreated health conditions of incarcerated populations. For the disease prevalence estimates, the researchers used recent data from U.S. government-sponsored National Surveys on Drug Use and Health. But a major roadblock for research in this area was the lack of health care data transparency collected by correctional health care vendors.
One reason COCHS and its public safety partners have long been enthusiastic about bringing Medicaid into corrections is that there are health data requirements for Medicaid claiming and reimbursement. The data in claims would go a long way in filling health data gaps mentioned in the Johns Hopkins' report. Furthermore, the State Medicaid Director letter includes an extensive information technology (IT) section related to electronic health records (EHRs) and health data sharing to facilitate coordination of care between corrections and community. Implementing these solutions could improve health care and reduce incarceration related to untreated health conditions, possibly lessening public safety's role as the health care provider of last resort.
The relevance of this CMS announcement cannot be overstated. It is very germane considering the publication last week of the Johns Hopkins’ report (cited below) that details the chronic and untreated health conditions of incarcerated populations. For the disease prevalence estimates, the researchers used recent data from U.S. government-sponsored National Surveys on Drug Use and Health. But a major roadblock for research in this area was the lack of health care data transparency collected by correctional health care vendors.
One reason COCHS and its public safety partners have long been enthusiastic about bringing Medicaid into corrections is that there are health data requirements for Medicaid claiming and reimbursement. The data in claims would go a long way in filling health data gaps mentioned in the Johns Hopkins' report. Furthermore, the State Medicaid Director letter includes an extensive information technology (IT) section related to electronic health records (EHRs) and health data sharing to facilitate coordination of care between corrections and community. Implementing these solutions could improve health care and reduce incarceration related to untreated health conditions, possibly lessening public safety's role as the health care provider of last resort.
CMS: HHS Releases New Guidance to Encourage States to Apply for New Medicaid Reentry Section 1115 Demonstration Opportunity to Increase Health Care for People Leaving Carceral Facilities
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is announcing a new opportunity for states to help increase care for individuals who are incarcerated in the period immediately prior to their release to help them succeed and thrive during reentry. The goal of this demonstration opportunity is to help Medicaid enrollees establish connections to community providers to better ensure their health care needs are met during their reentry process.
State Medicaid Director Letter: Opportunities to Test Transition-Related Strategies to Support Community Reentry and Improve Care Transitions for Individuals Who Are Incarcerated
This guidance encourages states to implement an innovative service delivery system to facilitate successful reentry transitions for Medicaid-eligible individuals leaving prisons and jails and returning to the community. Demonstrations consistent with the approach described in this guidance will test innovative approaches to coverage and quality to improve care transitions, starting pre-release, for individuals who are incarcerated, thereby facilitating improved continuity of care once the individual is released. Further, improving care transitions will likely help these individuals access high-quality, evidence-based, coordinated, and integrated care during reentry
Washington Monthly: Expanding Medicaid Coverage to the Incarcerated and Those Recently Released
The reintroduction of the Medicaid Reentry Act has support on both sides of the aisle and in both houses of Congress. In a perfect world, the prison and health bureaucracies would instantly restore Medicaid coverage at the moment of release. During the two weeks after release, former inmates have a death rate 12.7 times higher than other residents of the same state The leading cause is drug overdose. Reactivation of Medicaid during incarceration is the financial carrot that could persuade states and localities to expand addiction treatment for inmates. California took a huge step recently by securing a waiver to become the first state to fund health services through Medicaid before inmates are released.
Johns Hopkins: Analysis of Health and Prescription Data Suggests Chronic Health Conditions in U.S. Incarcerated People May Be Severely Undertreated
This new research emphasizes how chronic diseases in corrections are greatly undertreated. One factor in attempting to learn more about the undertreatment of incarcerated people is the fact that correctional health care vendors do not have transparent data to make an accurate study of this population. Health care provided in jails and prisons is provided by a patchwork of health care providers, most commonly private contractors who do not widely share information about the services they provide.
Data & Statistics
BJS: Opioid Use Disorder Screening and Treatment in Local Jails, 2019
A study shows that at midyear 2019, more than 6 in 10 (63%) local jail jurisdictions reported that they conducted opioid use disorder (OUD) screenings of persons at intake. Fewer than 2 in 10 (19%) jurisdictions said that they initiated medication-assisted treatment (MAT) for those identified as having OUD.
Science
NIJ: Emerging Relevance of Neuroscience in Corrections
Neuroscience data and biological and physiological markers have emerged as an invaluable source of data augmenting what correctional officers themselves are reporting about their stress levels. Also it is becoming increasingly clear that many justice-involved individuals may suffer from a past traumatic brain injury (TBI) and that the lingering effects of that trauma may contribute to their criminal justice involvement and act as a barrier to their successful reentry.
Disease Study
Emory’s Rollins School of Public Healt: Tracking Infectious Diseases in Jails Through Wastewater
An Atlanta-based team with members from Emory’s Rollins School of Public Health and School of Nursing are working on a research study focusing on two germs: mpox virus and HIV. The goal of this new study is to learn the best ways to communicate information and use wastewater for detecting germs to help justice-involved persons who might be infected with the disease while incarcerated. We are looking for individuals to interview and hear their opinions.
State Roundup
Arkansas
Arkansas Democrat Gazette: Jail mental illness troubling to Garland County sheriff
The Garland County jail on Wednesday had 29 inmates with mental health issues who were either waiting to be transferred to the Arkansas State Hospital or to be evaluated, which could take up to a year or longer, Garland County Sheriff Mike McCormick reported.
California
Los Angeles Times: Special delivery: Drones are smuggling contraband into California prisons, feds say
Two men are accused of using an increasingly common technology to bypass prison walls: drones. Federal prosecutors in Fresno have charged Jose Enrique Oropeza and David Ramirez Jr. with using drones to drop loads of methamphetamine, heroin, cocaine, tobacco and cellphones into the yards of seven prisons across California.
Connecticut
CT Examiner: History of Ignoring Legal Directives Means Bill to Oversee DOC is Fundamentally Flawed
Senate Bill 957, “An Act Concerning the Oversight of Health Care in Correctional Institutions by the Department of Public Health,” if passed, would establish an office within the Department of Public Health to oversee “the delivery of healthcare services in 13 correctional institutions. But because Senate Bill 957 expects a statute to control behavior of correction officials and staff, it is fundamentally flawed. The Department of Correction has a history of ignoring legal directives.
Georgia
Guardian: Man found dead eaten by bed bugs in Atlanta jail, lawyer says
An Atlanta man died in a local jail after being eaten alive by bed bugs, alleges a lawyer representing the man’s family. The family of Lashawn Thompson, 35, is calling for a criminal investigation into Thompson’s death. On 13 September 2022, three months after being arrested, Thompson was discovered dead inside a dilapidated cell covered in grime and insects.
Mississippi
NY Times: Sex Abuse, Beatings and an Untouchable Mississippi Sheriff
Terry Grassaree was dogged for years by questions about how he did his job as a law enforcement officer in Macon, Miss. Documents detail gross mismanagement at the Noxubee County jail that repeatedly put female inmates in harm’s way. At worst, they tell the story of a sheriff who operated with impunity, even as he was accused of abusing the people in his custody, turning a blind eye to women who were raped and trying to cover it up when caught.
New Hampshire
New Hampshire Bulletin: NH Department of Corrections sees surging overtime, medical costs
The Department of Corrections is reporting significant shortfalls in its overtime and medical budgets, prompting an appeal to the state for help. The DOC is currently experiencing a 51 percent vacancy rate for entry-level corrections officers. Commissioner Helen Hanks said the department continues to face staffing shortages that were “severely exacerbated” by the COVID-19 pandemic.
New York
Post-Journal: Report On Jail Deaths, Corrective Action Should Have Been Discussed Publicly
A pair of state reports issued in the wake of two 2021 deaths in the Chautauqua County Jail raise serious questions about the way care is provided in the jail. Corrections Department Medical Review Board has recommended the county look at the way medication was administered in both cases as well as other aspects of the way medical and mental health care is provided. One of the recommendations that Sheriff Jim Quattrone said has happened is the use of integrated records.
Pennsylvania
Daily Review: Mental health better treated outside of prison, state says
A significant portion of Pennsylvania’s 38,000 inmates live with a mental health condition, but often don’t belong in prison, state officials say. Department of Corrections Acting Secretary Laurel Harry told lawmakers this week that 36% of incarcerated men and 66% of women are diagnosed with mental illness – and the state has made significant strides to provide treatment.
Utah
KSL: 'Culture of noncompliance' contributing to health care problems at Salt Lake prison, audit finds
Most of the problems highlighted in a 2021 audit of how health care is administered to inmates in Utah's prisons are still occurring — particularly in the state's main prison in Salt Lake City. That's according to a new state audit released and concluding that despite the efforts from the Clinical Services Bureau only four of the 13 recommendations made specifically for the bureau in the last audit have been fully implemented.
Vermont
VT Digger: Under investigation for misconduct, head of Springfield prison placed on leave
The superintendent of Southern State Correctional Facility is under investigation for misconduct and has been placed on paid administrative leave. Last week, Vermont State Police said it was investigating two assaults of corrections officers at the Springfield prison. The Department of Corrections dismissed leadership at the Springfield prison in both 2017 and 2018.
San Diego County
San Diego Union Tribune: County working to disentangle law enforcement from mental health encounters
Out of nearly three dozen police shootings in the county from 2018 through June 2022, 40 percent involved someone with mental health issues. Critics have long argued against law enforcement involvement in such situations. About 14 percent of the 451 people shot by police or sheriff’s deputies in the county from 1993 through 2017 had documented mental health issues
San Diego Union Tribune: County jails are the largest mental health facility in the region
In San Diego County, about one in every three people in Sheriff’s Department custody is on prescribed medication to treat a mental illness, making the county jail the largest mental health provider in the region. The result has been a stunning growth in both the jail population and the number of suicide attempts, overdoses and deaths in sheriff’s facilities.
Mental Health Initiatives In Corrections
VC Star: Jail mental health unit finally due to open
After more than a decade of efforts, Ventura County officials expect to open a $61-million health unit next month to treat and house jail inmates with serious mental illness and medical conditions. Cells inside the new center reflect the demands of holding inmates with serious psychological issues. They are spare by intention in an effort to keep inmates from using something like a cord to harm themselves.
LGBTQ
NBC: Court orders first gender-affirming surgery for a transgender federal prisoner
In a first, the Federal Bureau of Prisons has been ordered to secure gender-affirming surgery for a transgender prisoner. A federal judge in the U.S. District Court for the Southern District of Illinois ordered the bureau on Monday to undergo a nationwide search for a qualified surgeon to perform the surgery for the inmate, Cristina Nichole Iglesias.
Reentry
HRI Global: Prison Linkage to Community Care: An Effective Harm Reduction Model
Incarceration provides access to a population with an increased burden of disease. Researchers estimated that of the 10.2 million people incarcerated world-wide, 15.1% have HCV, 4.8% have chronic HBV, 3.8% have HIV and 2.8% have active TB. Project START+ ) is a reentry harm reduction intervention for people that require linkage to medical care. Its model has been implemented in multiple countries.
CoreCivic
Montana Free Press: Amendment to send Montana prisoners to Arizona scrapped
A Senate committee on Tuesday voted to scrap plans to send 120 incarcerated Montanans to a private prison in Arizona. The amendment to the Legislature’s main spending proposal from Sen. Ellie Boldman, D-Missoula, removed almost $8 million in funding over the next biennium for the state Department of Corrections to secure bed space from private prison giant CoreCivic at one of its Arizona facilities.
Courier: New agreement keeps CoreCivic in Clifton
CoreCivic announced it has extended its contract to continue operating the state prison in Clifton, Tennessee. The company said last month it was ceasing operations of the South Central Correctional Facility in Clifton by June 30 when its current contract with the state expires.
WABE: Immigrant in Southwest Georgia detention center dies
Advocates are calling for federal intervention after another person died at Stewart Detention Center in southwest Georgia. The private prison corporation that runs the detention center, CoreCivic, has faced scrutiny for years over things like lack of access to proper mental health care, allegations of sexual abuse against women and forced, underpaid labor.
Correction Health Care Vendors
The Appeal: Georgia Man Begged for Medical Care for Months Before Dying in Jail, Report Finds
A 32-year-old man detained at Georgia’s Clayton County Jail begged for medical help for nearly two months before succumbing to testicular cancer. An investigation also found that unhygienic living conditions at the jail, as well as malnourishment and physical abuse Willison suffered while incarcerated had contributed to his death. The Clayton County Sheriff’s Office (CCSO), which runs the jail, had initially stonewalled the medical examiner’s official investigation. CorrectHealth, a Georgia-based company, is responsible for providing healthcare to the jail’s population. Clayton County pays CorrectHealth nearly $1 million a month for its services.
Newsweek: Jails Health Provider Sued After Inmates Left Dead and Disabled
It wasn't Michelle Caddell was bleeding through a menstrual pad every 20 minutes—and passing tissue that she was transported from Tulsa County jail to an Oklahoma hospital to be screened for the cervical cancer that killed her. A federal lawsuit has been filed on her behalf. It is one of 160—30 involving inmate deaths—filed since 2015 against Turn Key Health Clinics, LLC, the private medical provider at the jail where Caddell was detained. The cases came to light in an investigation into private medical companies such as Turn Key that have proliferated across U.S. jails and prisons. The cases highlight questions over how well such providers balance the healthcare needs of inmates against the bottom lines of their businesses—estimated by some to total $4 billion a year.
ABC: Lawsuit claims man with schizophrenia died after kept naked, malnourished in solitary confinement
An Indiana man with a history of schizophrenia died in 2021 due to organ failure following nearly three weeks in solitary confinement at a Jackson County jail. Jailers placed Joshua McLemore, 29, in a windowless, padded isolation cell, where he remained "confined, naked, alone, and in a constant state of psychosis." The suit, filed on behalf of McLemore's estate, is brought against Jackson County, its sheriff Rick Meyer and the company that provides health care services at the facility, Advanced Correctional Healthcare.