High rates of overdose deaths in the U.S. have brought attention to the need to increase access to opioid use disorder (OUD) services, including for those exiting incarceration. Individuals recently released from jail or prison are at extremely high risk of dying from an overdose, yet few people who are incarcerated actually receive treatment.
Despite its central role in covering health care services for low-income people in the U.S., historically, Medicaid has been barred from covering services for Medicaid beneficiaries who are in prisons and jails except for inpatient hospital stays. Federal Medicaid policy is evolving, and state Medicaid programs may, through waivers of federal law, cover some services in prisons and jails in the period immediately prior to an individual’s release.
As more states apply for Medicaid waivers in order to provide care for returning citizens, the opportunity for improved access to quality, evidence-based treatment for OUD in prisons and jails is possible. Understanding what those treatments are and defining their intended outcomes will help states and citizens reach maximum success for individuals and for public safety.
HARP has created a set of three reports offering recommended approaches for OUD services, metrics, and payment models. Recommendation development was guided by three principles for effective OUD service provision in jails and prisons: (1) continuity of care, (2) timeliness of treatment, and (3) person-centered care. Briefly, existing standards from national groups for correctional and community OUD care were identified and compared and supplemented with position papers that provided recommendations for policymakers and providers for implementing services in jails and prisons. The authors also reviewed Medicaid policy and operational considerations that influence the provision of OUD services in jails and prisons and reviewed draft recommendations with an advisory council.
These reports are primarily intended for state Medicaid administrators and correctional health officials and administrators.
A brief slide presentation can be found here which summarizes findings from all three reports.
Recommendations for Medicaid Coverage of Opioid Use Disorder Services in Jails and Prisons: Recommends services and standards Medicaid could support for incarcerated individuals with OUD, separated into five key service areas that promote continuity of care (screening, assessment, medications for opioid use disorder (MOUD) initiation and continuation, counseling and intensive outpatient care, and reentry services). While these recommendations focus on the entirety of a person’s incarceration, they can also inform services provided immediately before release and throughout transitional reentry periods.
Authors: Daniel Teixeira da Silva MD, MSHP, John O’Brien, MA, and Vikki Wachino, MPP
Recommendations for Medicaid Performance Measures for Opioid Use Disorder in Jails and Prisons: Outlines 15 metrics to monitor and evaluate progress by states, managed care organizations, and correctional and other providers to meet the intended objectives and ultimately improve care and results for Medicaid beneficiaries with OUD, both in jails and prisons and re-entering the community.
Authors: Ashley DeGarmo, MA, Greg Williams, MA, and Vikki Wachino, MPP
Recommendations for Medicaid Payment Models for Opioid Use Disorder Services in Jails and Prisons: Proposes four different payment systems for states to consider as models for financing Medicaid-funded OUD services for individuals who are incarcerated. The recommended options aim to improve access to quality OUD treatment services within correctional facilities and can be applied to both jails and prisons.
Authors: John O’Brien, MA and Vikki Wachino, MPP