New Federal Funding Could Improve Opioid Use Disorder Treatment in Correction Facilities

Late last year, the streaming platform Hulu aired the critically-acclaimed 8-part drama miniseries “Dopesick.” The show is based on a non-fiction book about America’s opioid addiction crisis, Oxycodone, and the pharmaceutical company that has promulgated its devastating impact on unsuspecting patients and their physicians.

“Dopesick” tracks the lives of those impacted by the drug. In doing so, the program drew national attention to the dangers of Oxycodone abuse. It also showed the undeniable connection between Opioid Use Disorder (OUD) and criminal conduct. For some, the program brought light to this shocking epidemic. For others, the information was another reminder of the prevalence of opioid addiction and its inseparable connection with the criminal justice system.

According to a report published in the Health and Justice Journal, 2016 survey evidence revealed that 1 in 4 people with an OUD had contact with some part of the criminal justice system in the preceding year. The data also showed that those with criminal justice system involvement had significantly higher rates of OUD than those without criminal justice involvement.

Lifetime rates of OUD increase as people penetrate further into the justice system. Further, the greater the severity of opioid use, the higher the likelihood of criminal justice involvement. Therefore, not surprisingly, Opioid Use Disorders are believed to be highly prevalent in incarcerated populations. U.S. Department of Justice data shows that approximately half of federal and state prisoners meet the criteria for substance abuse disorder. However, according to a report by the National Academy of Sciences, only 5% of people with OUD in jail and prison settings receive medication treatment. Moreover, criminal justice institutions have been reluctant to use methadone, buprenorphine, and naltrexone to treat OUD. Consequently, those with OUD usually discontinue treatment while incarcerated and resume use soon after they are released.

Medicaid Funding and OUD

A disproportionate number of these incarcerated individuals have low incomes, meaning they qualify for Medicaid coverage. However, under federal law, the Medicaid program cannot pay for health services, including OUD treatment, during incarceration. Currently, there is proposed legislation in Congress that seeks to address this issue by creating a new funding source for correctional health care, which could include OUD treatment.

According to a recent report, the Medicaid Reentry Act of 2021, the Due Process Continuity of Care Act, and the Humane Correctional Health Act would authorize Medicaid to:

Cover services for patients 30 days before release from incarceration,
Cover individuals detained pretrial, and
Be made available for all eligible individuals for the duration of their incarceration

CMS Program Coverage

In addition, several states are petitioning the Centers for Medicare and Medicaid Services (CMS) to cover at least some parts of correctional health care through the agency’s Section 1115 demonstration waiver program. The waiver program permits states to implement pilot programs with Medicaid dollars.

It's believed that Medicaid funds for OUD treatment would improve treatment and provide greater access to essential care services. However, Medicaid has never paid for correctional health care services. Therefore, implementation would require establishing a regulatory structure and other operational features to allow the facilities to be reimbursed for treatment and care services.

CMS has strict quality and data reporting requirements. Further facilities regulated by the program are subject to audit and review. At present, correctional facilities don't have uniform health care quality measures, and creating the necessary infrastructure and adapting to these standards may prove to be challenging. However, the fact remains that opioid addiction is a continuing and growing problem within the criminal justice system. Without wide-scale systematic change, this population will increase, and correctional facilities will be left without the resources needed to address treatment needs.

If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation, contact us or call (509) 991-7058.

Additional Resources

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