Those involved in the criminal justice system have high rates of opioid use and are disproportionately low income, which means the majority of them are eligible for Medicaid coverage. But federal law prohibits Medicaid from paying for health servicesincluding treatment for opioid use disorder (OUD), while an individual is incarcerated or confined to jail or prison, a prohibition often referred to as “inmate exclusion”.
The same time, few prisons and prisons provide medication for UDOs—methadone, buprenorphine and naltrexone—which are the standard of care for the condition, regardless of the treatment setting. But people in prison need access to these drugs more than ever. Substance-related deaths during incarceration increased in recent years, and incarcerated people are at increased risk of death from overdose in the weeks immediately following release. Importantly, studies have shown that people treated with methadone while incarcerated more frequent continuation of treatment after releaseand patients who received buprenorphine had less involvement with the criminal justice system after incarceration.
Lawmakers push for Medicaid funding for correctional health care
Jail and prison administrators often cite insufficient funding for OUD drugs and the staff needed to dispense them as reasons why their facilities do not offer treatment. Current legislation being proposed to Congress aims to change that by creating a new stream of funding for correctional health care, which could include OUD treatment. More specifically, the Medicaid Reinstatement Act of 2021the Continuity of Care Actand the Human Correctional Health Act would, for the first time, allow Medicaid to cover services for patients 30 days before release from incarceration, for those detained before trial, and for all eligible people for the duration of their incarceration, respectively. Additionally, several states have asked the Centers for Medicare and Medicaid Services (CMS) to cover at least some elements of correctional health care through the agency’s program. Section 1115 Demonstration Waiver Program, which allows states to implement pilot programs with Medicaid dollars. But as of March 2022, CMS had yet to act on any of the petitions.
A stream of Medicaid funding for treatment of OUD in jails and prisons would reduce some major barriers to initiating lifesaving care. However, because Medicaid has never paid for any aspect of correctional health care, there are no regulatory or implementation guidelines on quality care standards, performance measures, and payment models in jurisdictions. correctional facilities that could help support reimbursement efforts.
Meet Medicaid standards
CMS evaluates the performance of Medicaid programs on basic measures of health care quality for the care provided to beneficiariesas well as the contribution of registrant satisfaction surveys, to improve the delivery of health care under the Medicaid program. Prisons and prisons currently lack consistent measures of health care quality, so many facilities would need to adapt to meet the expectations for quality, service delivery, and data reporting that the Medicaid program will set. probably before covering the services. When setting these expectations, the Medicaid program must consider the varying degrees of staffing capacity and infrastructure needed to implement drug dosing in correctional facilities.
Implementing Medicaid Reimbursement for Correctional Health Care
Medical providers believe that Medicaid reimbursement for correctional health care has the potential to improve care coordination and overall health care after release. To successfully implement Medicaid reimbursement, policymakers must realize that correctional health care is different from care provided in the community, and therefore regulations must take into account the unique circumstances of providing treatment in these settings. . In anticipation of this challenge, the Health and reintegration project hosted a multi-stakeholder meeting in March 2022 to discuss possible policy changes regarding the exclusion of inmates from Medicaid, their potential to improve public health and safety, and how to successfully implement these changes . Participants described the value of increased access to OUD care, among other services, in jails and prisons, and stressed the importance of developing stronger health care approaches for people who are currently or have been incarcerated. As a result, jails and prisons will need guidance on how to implement quality standards and payment models to meet Medicaid standards and ensure that reimbursement can be quickly operationalized.
Alexandra Ducan works on The Pew Charitable Trusts Drug Prevention and Treatment Initiative.