Medicaid Stays in Play—For Now: What Jail Stories From 3 States Reveal

Highlighted Stories

Editor's Note

This week’s highlighted stories come from Montana, Iowa, and New Mexico, and together they pose a fundamental question: What is the role of correctional facilities in responding to behavioral health needs?

In Montana, lawmakers are planning a new appropriation informed by a clear recognition of the connection between behavioral health services and incarceration. This effort acknowledges that underinvestment in mental health care ultimately places a burden on jails and prisons.

The story from Iowa underscores a similar concern but from a fiscal perspective. It examines the relationship between Medicaid funding and inpatient behavioral health units, warning that if Medicaid payments are withdrawn or reduced, the risk of psychiatric hospitalization closures increases—placing more strain on jails as providers of last resort.

New Mexico presents a different but related issue. A report from the New York Times highlights the dangers faced by people released from the Santa Fe County Jail late at night, without transportation. Several individuals have been killed walking along a dark highway after release. It is a stark reminder of how discharge practices can have life-or-death consequences.

COCHS has long emphasized the blurred lines between carceral facilities and behavioral health systems. Too often, correctional institutions are tasked with responsibilities that extend beyond their core mission of safety and security. Under Medicaid, reentry planning, including warm handoffs to community services, is a central feature of care coordination. Whether through an 1115 waiver or under services provided by Federally Qualified Health Centers (FQHCs), Medicaid can support care coordination that mitigates these risks.

These three stories circle back to a central issue: the vital role Medicaid plays in shaping who ends up in jail, why they are there, and how they reenter the community. Last week, COCHS released a Dear Colleague letter analyzing the House Energy & Commerce Committee’s proposed Medicaid cutbacks. Notably, the proposals left intact access to Medicaid services in jails and prisons—a significant point for both Montana and New Mexico, which have approved 1115 waivers for pre-release services.

If anything, the stories this week underscore just how urgent it is to integrate Medicaid with correctional and behavioral health systems. Medicaid cutbacks won’t dissolve that urgency, they may only deepen the consequences of ignoring it.

Montana

Montana’s frayed behavioral health care system, still recovering from the effects of past budget cuts, will get a shot in the arm after state lawmakers approved sweeping changes to upgrade and expand facilities, increase community services, and revise commitment procedures. Lawmakers backed the bulk of Republican Gov. Greg Gianforte’s multimillion-dollar vision to bolster and expand the system, which has experienced waitlists for care and has been working in recent years to reverse the loss of community-based mental health service. Legislators heard about the backlog of people waiting in jails across the state and the prolonged delays — some stretching more than a year — that sometimes led to cases being dismissed because of concerns that the delays had violated the defendants’ constitutional right to a speedy trial.

Iowa

This town’s hospital is a holdout on behalf of people going through mental health crises. The facility’s leaders have pledged not to shutter their inpatient psychiatric unit, as dozens of other U.S. hospitals have. Keeping that promise could soon get tougher if Congress slashes Medicaid funding. The joint federal-state health program covers an unusually large share of mental health patients, and hospital industry leaders say spending cuts could accelerate a decades-long wave of psychiatric unit closures. At least eight other Iowa hospitals have stopped offering inpatient mental health care since 2007, forcing people in crisis to seek help in distant facilities. Sheriff’s deputies often are assigned to transport patients to available facilities when treatment is court-ordered. “It’s not uncommon for us to drive five or six hours,” said Clay County Sheriff Chris Raveling, whose northwestern Iowa county includes Spencer, a city of 11,000 people.

New Mexico

Rebecca Jaramillo stepped out of the Santa Fe jail and into the cold one night in January 2021. Ms. Jaramillo, 33, made it only about a mile from the jail that night before she was hit by a sheriff’s deputy driving a police pickup truck at 57 miles per hour. Her body was thrown more than 100 feet, and she was pronounced dead at the scene. Five people have been fatally struck shortly after being released over the past decade, four of them since March 2020. Across the country, local jails have faced criticism for releasing people late at night, into dangerous neighborhoods or without transportation options.

Follow Ups

Editor's Comment: This week’s Follow Ups begin with news that Wellpath has officially emerged from Chapter 11 bankruptcy. Two additional articles underscore the continuing controversy surrounding the company. In Alameda County, California, advocates are calling for Wellpath’s removal as the healthcare provider at Santa Rita Jail, citing concerns about how the bankruptcy has affected individuals harmed by its care. Meanwhile, in Loudoun County, Virginia, the Board of Supervisors is recommending renewal of Wellpath’s contract. The article notes that the county originally contracted with Wellpath when it operated as Correct Care Solutions (CCS), which had contributed to the sheriff’s election. As COCHS has previously reported, CCS founder Jerry Boyle pled guilty to bribery charges involving former Norfolk Sheriff Bob McCabe.

Turning to Rikers Island, a federal judge has finally placed the troubled New York City jail complex under receivership—ending a long period of delays despite Mayor Eric Adams’ efforts to retain local control. The ruling by Judge Laura Taylor Swain follows years of litigation and growing scrutiny over conditions at Rikers.

And the broader New York State prison system continues to draw attention. A New York Times story details ongoing abuse within state-run facilities, including mention of the recent wildcat strike. Separately, ABC News reports that another correctional officer has reached a plea deal in connection with the beating death of Robert Brooks.

Wellpath

Wellpath reported on on May 12, 2025 that it has emerged from Chapter 11 bankruptcy and completed its financial restructuring. The company sought to reduce about $550 million in debt. As part of the reorganization, Wellpath transitioned ownership to a group of its current and former lenders, referred to as the Ad Hoc Lender Group.

Social justice advocates with Interfaith Coalition for Justice in our Jails (ICJJ) are calling on the county to replace Wellpath, the provider of medical services at Santa Rita Jail in Dublin. Advocates with ICJJ wrote, “Every report card on Wellpath’s care at Santa Rita has come back with devastatingly low marks. Wellpath has been the medical care provider in Santa Rita jail since 2016. The company is owned by a global investment firm and provides healthcare in 34 of California’s 56 county jails. Over 1,500 lawsuits have been filed nationwide against Wellpath, and the company’s recent bankruptcy filing will prevent affected families from receiving justice.”

The Board of Supervisors' finance committee is recommending the renewal of a contract with Wellpath to provide medical and psychiatry services at the county jail but are looking toward changes in the future. Supervisors had raised concerns about the contract including the company’s 2024 bankruptcy restructuring filing and lawsuits filed by inmates. The company’s campaign contributions to Sheriff Mike Chapman, nearly $24,000 since 2016, also have drawn attention. While recommending approval of a two-year, $7.7 million contract extension with the firm, the motion by committee Chair Juli E. Briskman (D-Algonkian) also called for the county staff to begin work on a request for proposals to seek bids from other companies for a new contract expected to take effect in 2027. The current contract with Wellpath, previously CIBMED and Correct Care Solutions, was awarded in 2017 for $4.7 million with four two-year renewal options.

Rikers Islands

Judge Laura Taylor Swain, the federal judge overseeing New York City’s jails took Rikers Island out of the city’s control, ordering that an outside official be appointed to make major decisions regarding the troubled and violent jail complex. In a 77-page ruling Judge Swained specified that the official would report directly to her and would not be a city employee, turning aside Mayor Eric Adams’s efforts to maintain control of the lockups. The official, called a remediation manager, would work with the New York City correction commissioner, but be “empowered to take all actions necessary” to turn around the city’s jails. The order comes nearly a decade after the city’s jails, which include the Rikers Island complex, fell under federal oversight in the settlement of a class-action lawsuit.

New York

Family members and friends of men who died in New York State prisons in recent years denounced a system in turmoil and longstanding tolerance of brutality by guards at a joint legislative committee hearing. Earlier this year, thousands of prison guards walked off their assigned posts in a series of unsanctioned strikes that they said were in protest of hazardous working conditions. Last month, in the midst of the strikes, 10 corrections officers were charged in connection with the beating death of the 22-year-old man, Messiah Nantwi, with two accused of murder. That death followed the December killing of the inmate at Marcy, 43-year-old Robert L. Brooks. Ten officers were charged in that case as well, with six facing murder charges.

A New York corrections officer admitted in court he cleaned up blood from the fatal beating of an inmate that was captured on bodycam videos in an attempt to conceal evidence. Nicholas Gentile pleaded guilty to a misdemeanor charge of attempted tampering with physical evidence in the Dec. 9 beating of Robert Brooks at the Marcy Correctional Facility. Publicly released video of the assault, which shows officers beating Brooks while his hands were cuffed behind his back, sparked condemnation and calls for reforms. Under questioning from the judge and a prosecutor, Gentile acknowledged he knew about the assault by fellow guards, cleaned up Brooks’ blood and failed to document it.

Hepatitis

This white paper urges policymakers and public health leaders to implement stronger hepatitis B testing and prevention strategies in correctional facilities across the U.S.. An estimated 2.4 million people in the U.S. are living with chronic hepatitis B. Prevalence among incarcerated individuals ranges from 0.9% to 11.4%, significantly higher than the national average of 0.3%. Moreover, up to 42.6% of incarcerated people may have had a past infection, according to national estimates.

Homelessness

Shelter-resistant homeless residents are the most entrenched in dangerous encampments, use the most emergency services and are among those most likely to die of an overdose. In response, frustrated local cities are increasingly seeking ways to compel homeless people to accept a shelter bed, or are clearing more encampments. Many adopted the more forceful approaches following a U.S. Supreme Court decision allowing local governments to close camps regardless of whether shelter beds are available. In San Jose, officials are now considering a controversial proposal by Mayor Matt Mahan to cite and arrest homeless residents who turn down multiple shelter offers. Along with county officials, experts and service providers are skeptical that threatening homeless people with criminal penalties will persuade them to move off the street. Labeling homeless people as shelter-resistant also ignores the reality that shelters aren’t always well-managed or maintained.

Opioid Epidemic

In 2019, Maryland enacted a comprehensive law mandating that all jails provide all three forms of MOUD during incarceration and reentry support. This study examines the perspectives of twenty-four people recently released from Maryland jails during the period January 2023–March 2024. Most participants noted an improvement in opioid addiction care in jail when compared with their previous jail stays. They praised jail-based MOUD and believed that receiving MOUD in custody helped reduce the risk for return to use, recidivism, and overdose death. However, participants described challenges in receiving timely care that led them to experience withdrawal in jail and ongoing stigma from jail staff.

Rio Arriba County Sheriff, Billy Merrifield, died due to the “toxic effects of fentanyl and ethanol.” The state’s medical team determined Rio Arriba’s former top cop had a blood alcohol concentration of 0.071% — below the legal limit of 0.08% to operate a motor vehicle in New Mexico. His blood also contained 23 nanograms per millimeter of fentanyl, a drug estimated to be 50 to 100 times more powerful than morphine. Appointed sheriff in 2022, Merrifield’s fatal overdose follows a string of controversies that have plagued the Rio Arriba County Sheriff’s Office in recent years. According to previous Journal reporting, former Rio Arriba sheriff James Lujan received a three-year prison sentence in 2021 after a jury convicted him of two felonies for helping a friend avoid arrest

Pregnancy

Ohio requires county jails to report in-custody deaths, but there are no reporting standards for miscarriages or stillbirths in jails. MetroHealth Medical Center provides healthcare services inside the Cuyahoga County Jail. From January 2022 through December 2024, the jail housed at least 305 women with known pregnancies. Of those, 16 women gave birth while incarcerated. In those same three years, just one failed pregnancy was reported Advocates and medical doctors call the lack of reporting for failed pregnancies a blind spot for women’s healthcare behind bars. Medical care provided inside the county jail has come under scrutiny in the past year amid claims of delayed treatment and mounting deaths.

End of Life

As the country's incarcerated population ages rapidly, thousands die behind bars each year. For some researchers, medical providers, and families of terminally ill people in custody. Incarcerated people typically have little say over the care they receive at the end of their lives. That's despite a broad consensus among standards boards, policymakers, and health care providers that terminally ill people in custody should receive treatment that minimizes suffering and allows them to be actively involved in care planning. State policies on end-of-life care vary widely, and they generally give much leeway to correctional officers, according to a 2021 study led by Georgia State University.

Heat, Water, Risk

Throughout the summer of 2024, six people in prison at Missouri’s Algoa Correctional Center experienced temperatures and humidity levels that violated their constitutional rights, a new lawsuit alleges. Inmates described conditions at Algoa Correctional Center, a nearly 100-year-old building without air conditioning, as a “coffin with a heat lamp.” Even through the nights, when temperatures drop, inmates would “pray to survive to the next day.” Heat indexes, which account for temperature and humidity levels, reached 120 degrees outside the minimum-security Jefferson City facility during 2024, the lawsuit states. It was the hottest recorded year in the United States, and climate scientists aren’t predicting the high temperatures will decline any time soon.

Most of America’s prisons and jails have drinking water quality issues, David Pellow, a professor of environmental studies at the University of California, Santa Barbara. In California correctional staff avoid drinking the tap water at work. Meanwhile, across the state, incarcerated people have been forced to drink water containing arsenic, pneumonia-causing bacteria, and nitrates from agricultural run-off, resulting in serious medical problems and, in at least one case, death. Those cases were discovered or confirmed by testing prisons’ drinking water for contaminants.

Minnesota's Stillwater correctional facility is set to close by 2029, as part of a budget agreement struck by the Legislature. After the announcement, Stillwater prison was put on lockdown as a precaution. Over the years inmates and staff have criticized the conditions inside the site. In 2023, Stillwater went into lockdown after inmates protested water quality issues within the prison. More than 100 men refused to return to their cells, decrying the extreme heat conditions — as the prison has no air conditioning — and limited access to ice and showers.

An after-action review report by the Marlboro County Sheriff's Office details a number of concerns regarding the detention center. ABC 15 obtained 73 pages of work orders and an action report on the jail dating back five years ago and a copy of the after-action review through Freedom of Information. Several families with inmates being held at the detention center have reached out to us regarding their concerns, saying there are problems with mold and flooding inside the facility.

Data & Statistics

Published data include both national- and state-level data. The surveys cover all 50 states, the federal system, and the District of Columbia. They began in 1980 and are conducted annually. For more data see Probation Dashboard and Parole Dashboard.

State Roundup

California

Gov. Gavin Newsom called for the closure of another prison in his new budget proposal, which would be the fifth facility closed under his watch, though he didn’t specify which institution now has a target on its back. The closure, which Newsom proposed take place by October 2026, would happen despite the implementation of Proposition 36, a new California law that is predicted to briefly increase the number of people in the prison system. At the inmate population’s peak in 2006, California locked up 165,000 people in state prisons. Today, after a decade of sentencing changes, federal court intervention and a surge of releases tied to COVID-19, California’s prisons house about 91,000 people.

For years, the Los Angeles County jail has been known as the United States’ largest mental health institution. But a peer-to-peer program called Forensic Inpatient (FIP) Stepdown is making progress. Incarcerated people trained as mental health assistants are helping hundreds of others with severe mental illness who are held at the same facility. The California state prison system – long under federal court orders to improve mental health care – is taking notice. Many familiar with the county program see it as a national model.

A Ninth Circuit panel appeared skeptical of arguments made by the state of California in a decadeslong case about the mental health care in prisons. The two appeals, both filed by the state, dig into the weeds of the sprawling Coleman v. Newsom case. The first focuses on a lower court order prohibiting California officials from conducting tours of prison facilities. The second appeal stemmed from a lower court finding that California has a constitutional obligation to provide access to proper mental health care to tens of thousands of inmates. To achieve that, it must implement U.S. District Judge Kimberly Mueller's order and also take on self-monitoring responsibilities, currently performed by a special master.

Louisiana

The rectangular hole in the cell wall was just big enough for a person to squeeze through. Right next to it, a metal toilet and sink had been ripped from the wall. Above the hole, someone had scrawled a picture of a face with a tongue sticking out and taunting messages for Sheriff’s Office officials, saying it was all too “easy. LOL.” Ten inmates, who may have had help from jail workers, broke out of a New Orleans jail early Friday, escaping through that hole in a cell wall.

Texas

Currently, about 80% of inmates in the Harris County Jail report symptoms of a mental health disorder, and one-third are prescribed psychotropic medications. A $7.8 million emergency budget increase from Harris County Commissioners Court, $3 million of which is going to the new Mental Health and Diversions Bureau, has allowed the DA’s office has begun hiring more than 15 additional prosecutors, healthcare workers, and social workers to help address the crisis. The bureau is also staffing a full-time position at the Joint Processing Center to help identify individuals in crisis at intake and divert them into treatment. Since January, more than 340 people have been diverted from incarceration into mental health treatment programs.

The Hays County Commissioners Court held a discussion related to consideration of the expansion of a Mental Health Diversion Center along with a 60 bed expansion of the existing jail facility footprint and to proceed with negotiating an agreement with HOK, utilizing their existing architectural and engineering contract. Three commissioners expressed concern with the item — particularly the location of the center, the timing and the firm choice — and Hays County Judge Ruben Becerra tabled the item until it could be altered to satisfy those apprehensions.

Vermont

Vermong lawmakers created the corrections investigations unit, a group tasked with internal investigations and housed outside the primary DOC office. Staffed in February last year, the unit focuses on incidents including deaths, escapes, contraband movement, threats to staff and people in custody and allegations related to the federal Prison Rape Elimination Act. To date in 2025, the unit has dealt primarily with the latter: 56% of 88 cases investigated have involved sexual harassment or abuse, according to Aaron Reichert, the unit’s director. Roughly 5% of the unit’s cases have revealed a substantiated allegation, he told lawmakers in the House Corrections and Institutions Committee.

In Observation Of Memorial Day
COCHS Weekly Update Will Not Be Published Next Week