Post-Release Provider System
Ensure that provider systems are adequate to offer OUD services post-reentry
Why is this important?
Given that jails cover cities and counties, their post-release provider systems can often cover the same geographic area. But this isn’t true for prisons.
Because incarcerated people almost always return to the communities they came from, a prison’s post-release provider system must have broader geographic reach than a jail’s.
Jails’ access to community providers
In contrast to prisons, 34% of jail jurisdictions have an ADP of 50 or less, and for 54% of jails, the ADP is 100 or less. As a result, they likely have limited access to community providers for both MAT and case management.
Geography also plays a role in service access. For example, most small jails are located in rural areas, which may be service deserts. And while jails in large cities or counties likely have sufficient availability of community providers for case management, they may face difficulties in identifying sufficient MAT providers and accessing methadone.
Strategy
Prisons must identify the communities of origin for their population and develop provider systems in high-volume communities. In addition, these facilities must decide whether post-release case management providers should be local to the prison or located in the communities to which individuals will return.
As for pre-release services, telehealth should play a large role in providing access to post-release services, especially for rural prisons and jails, given the lack of community providers.
7.1 Services
Why is this important?
While only case management and MAT are required pre-release, post-release, individuals will still need access to a broad array of behavioral health, health, and health-related services that are delivered by diverse providers.
Strategy
Reentry provider systems should include CHCs, primary care practices, and community-based organizations addressing health-related social needs (e.g., housing, housing assistance), in addition to behavioral health providers. SMAs, MCOs, or their correctional partners may be able to:- Create affiliations between specific correctional facilities and CHCs, which have broad geographic reach,30 to provide health services and MAT, if possible.
- Designate CHCs as Medicaid Health Homes to coordinate primary and specialty care for individuals with chronic conditions. Medicaid Health Homes coordinate care for people with Medicaid who have chronic conditions. Medicaid Health Home providers are expected to operate under a whole-person philosophy — integrating and coordinating all primary, acute, behavioral health, and long-term services and supports.
- Determine whether specific correctional facilities are located near to CHCs, Transitions Clinic Networks, or other providers who offer reentry-focused models of care and prioritize these providers as potential reentry contractors.
- Identify potential reentry providers who can make peer specialists or community health workers with correctional lived experience available to support individuals during and after the care transition period.
- Implement community care hubs that coordinate health and behavioral health services with community social services and supports.
Example #1: New Hampshire
New Hampshire identified a list of intended community provider partners, including peer support services, and shared it with its MCOs that are currently expanding provider networks to incorporate additional community options for the reentry initiative. The state has also designated individuals reentering from correctional facilities as a priority population for core behavioral health providers. This priority population designation will continue for a year after reentry.
Read: New Hampshire Reentry Implementation Plan, pages 11–13
Example #2: District of Columbia
The District of Columbia is implementing a program to provide health care to unhoused individuals. Unity Health Care contracts with the District of Columbia’s jail to provide comprehensive health care for individuals who are incarcerated. As part of this program:
- Unity staff conduct an evaluation as part of the intake process
- Some of Unity’s primary care providers work within the jail full time, while others spend 2 days per week in the jails and 3 days in one of Unity’s 20 locations throughout the District
- For individuals who continue care with Unity post-release, EHRs are shared between the jail and health center
- Unity partners with other housing and service providers to provide a broad array of post-release services
Learn more: Stopping the Revolving Door: How Health Centers Can Serve Justice-Involved Populations, page 4
Example #3: Washington
Washington is establishing Community Care Hubs under the auspices of Accountable Communities of Health (ACH). These hubs will coordinate health, behavioral health, and social services supports for individuals post-reentry.
Browse: ACH Community Care Hubs
Example #4: Michigan
The Michigan Prisoner Reentry Initiative, a statewide coordinated care program, employs community health workers to help individuals access health care and social services in the community.
Example #5: New York
New York implemented a criminal justice pilot program under the state’s Health Home state plan option. The Department of Health and the Division of Criminal Justice Services share data to identify eligible individuals and coordinate a warm handoff at discharge to connect returning community members to Health Home care managers.
Example #6: California
La Clinica, a Transitions Clinic in California, provides a medical home for formerly incarcerated community members with chronic health conditions, mental health disorders, and/or SUDs. Community health workers begin engagement while potential clients are incarcerated, offering virtual case management services in the county jail. Individuals are also assessed for other needs, like food insecurity, housing, employment, and skills development.
Read: Stopping the Revolving Door: How Health Centers Can Serve Justice-Involved Populations, page 3
Example #7: Franklin County, Massachusetts
The Franklin County Sheriff’s Office collaborates closely with a group of community providers who develop relationships with jail residents during incarceration and continue to provide support post-release. This provider system includes a CHC, a behavioral health provider, an office-based addiction treatment program, and a peer advocacy agency.
Check out: Improving Continuity of Care for Justice-Involved Individuals: Lessons from the Field, slides 27–28
7.2 MAT with Buprenorphine and Naltrexone
Why is this important?
While buprenorphine is the most frequently prescribed MOUD, there is still insufficient provider supply to meet the need, and adding the justice-involved population to the existing population requiring treatment will widen the access gap. In addition, like methadone, buprenorphine is significantly less available in rural areas than in more densely populated communities.
Providers must use innovative, person-centered practices to engage and retain individuals who are released from correctional facilities — consistent with the needs of others receiving MOUD.
Strategy
With the exception of Vermont, most counties and states have far fewer DEA-registered providers than the number required to meet existing need. SMAs, SSAs, and Medicaid Health Plans will need to consider developing plans and approaches to increase access to both buprenorphine and methadone.
As recommended for pre-release MAT, post-release MAT must maximize telehealth use to increase engagement and retention in treatment. In fact, research has shown that starting buprenorphine through telehealth is associated with an increased likelihood of staying in treatment longer compared to starting in a non-telehealth setting.31
Policymakers can:
- Establish relationships with agencies offering telehealth buprenorphine bridge programs, so that post-release MAT is rapidly available as a connection to long-term treatment if there are time or geographic gaps in access
- Encourage MCOs to designate providers who offer telehealth for MOUD as preferred providers to facilitate increased access to treatment
- Increase retention in treatment by identifying MAT providers using mobile digital technology to support individuals during treatment and after providing access to crisis alerts, e-therapy for recovery skill development, clinical support, and connection to peer specialists
Example #1: Washington, New York, New Jersey, and Pennsylvania
Modelled after hospital bridge clinics, organizations in many states are offering rapid linkages to buprenorphine telehealth providers or directly providing rapid initiation of buprenorphine. Examples of these organizations include Telebup in Washington and the MATTERS Network, which covers New York, New Jersey and Pennsylvania.
Explore:
Example #2: Pennsylvania and Illinois
The University of Pittsburgh Medical Center Telemedicine Bridge Clinic and Penn Medicine’s Care Connect in Pennsylvania and MAR in Illinois:
- Facilitate rapid engagement of individuals with OUD
- Initiate MOUD
- Make referrals to appropriate health and recovery programs
All three programs provide telephonic prescriptions and buprenorphine induction.
Learn more:
Example #3: Niagara and Dutchess Counties, New York
Jails in these counties have partnered with the MATTERS Network, whose referral network connects community providers and correctional facilities to treat individuals via telemedicine. Individuals can select the location and time for follow-up MOUD care that work best for them.
Access: Medication for Opioid Use Disorder (MOUD): Correctional Health Implementation Toolkit, page 38
Example #4: Middlesex, Massachusetts
The Middlesex Jail and House of Correction operates an in-facility MAT program and coordinates post-release treatment transitions with the Lowell Community Health Center.
Example #5: New York
New York implemented a criminal justice pilot program under the state’s Health Home state plan option. The Department of Health and the Division of Criminal Justice Services share data to identify eligible individuals and coordinate a warm handoff at discharge to connect returning community members to Health Home care managers.
Example #6: California
La Clinica, a Transitions Clinic in California, provides a medical home for formerly incarcerated community members with chronic health conditions, mental health disorders, and/or SUDs. Community health workers begin engagement while potential clients are incarcerated, offering virtual case management services in the county jail. Individuals are also assessed for other needs, like food insecurity, housing, employment, and skills development.
Read: Stopping the Revolving Door: How Health Centers Can Serve Justice-Involved Populations, page 3
Example #7: Franklin County, Massachusetts
The Franklin County Sheriff’s Office collaborates closely with a group of community providers who develop relationships with jail residents during incarceration and continue to provide support post-release. This provider system includes a CHC, a behavioral health provider, an office-based addiction treatment program, and a peer advocacy agency.
Check out: Improving Continuity of Care for Justice-Involved Individuals: Lessons from the Field, slides 27–28
7.3 MAT with Methadone
Why is this important?
The same regulatory restrictions that create barriers to pre-release methadone provision also apply to post-release access. These barriers include regulatory restrictions on who can deliver methadone and the presence of fentanyl in the drug supply. In this context, it’s crucial that methadone be available to individuals who are incarcerated as soon as possible.
Strategy
States may consider employing similar strategies for creating access to treatment post-release as for MAT with methadone pre-release, in terms of both:
- The delivery models used, like medication units
- The adoption of the 2024 regulatory flexibilities, especially take-home dosing
Notably, directly observed therapy with methadone has been shown to be safe and effective in increasing retention in treatment and take-home dosing privileges while reducing barriers related to daily in-clinic dosing. Directly observed therapy can combine video-observed dosing and an electronically controlled pill dispenser for administering and monitoring methadone.32
SMAs and SSAs can encourage MCOs to identify OTPs that offer telehealth for MOUD and greater use of take-home dosing, which could drive increased patient acceptance and lower treatment burden.
Example #1: Illinois
MAR NOW, a telehealth buprenorphine provider, offers same- or next-day appointments for methadone treatment at 14 OTPs throughout Illinois.
Learn more: Medication Assisted Recovery (MAR) Expansion
Learn more: Medication Assisted Recovery (MAR) Expansion
References
29 Separation by bars and miles: Visitation in state prisons. Prison Policy Initiative.
30 Across the country, 1,400 FQHCs operate 15,000 clinic sites.
31 Telehealth supports retention in treatment for opioid use disorder.
32 Journal of Substance Use & Addiction Treatment, 143, 108896.