A ‘Bold Step Forward’ in Inmate Health Care

Lilo H. Stainton | January 27, 2020 | Health Care, Social
Lawmakers to hear details today of eight bills that address significant upgrades in addiction treatment, re-entry services, Medicaid in NJ jails, prisons
Credit: NJTV News
Advocates say more needs to be done to address substance use disorders behind bars.

The solutions proposed may sound relatively simple, but supporters insist that the policy changes the state Legislature will debate today could significantly improve the health and welfare of former prison inmates released into New Jersey communities.

Among the requirements contained in eight recently introduced bills, which are scheduled for a hearing in the Senate health committee’s first meeting of the new legislative session, are access to the most effective addiction treatments at all jails and prisons in the state; case managers to help inmates coordinate complex disease care in advance of their release; enrolling prisoners in Medicaid and providing them a benefits card and state-issued identification before they return to the community.

One advocate called them a “bold step forward” that, if eventually enacted, would make the Garden State a national leader in these areas.

Most of the measures would codify recommendations outlined in an October report released by an expert panel on prisoner re-entry that lawmakers had appointed nearly a year earlier. The report included 100 suggestions to help smooth prisoners’ transition from incarceration to the community, including ensuring their access to certain benefits, like real drug treatment, while behind bars.

The new legislation would also require all corrections facilities to provide screening for hepatitis B and C, two highly contagious infections; create peer programs to train inmates who could counsel prisoners bound for release on Medicaid benefits and the enrollment process; and expand the use of re-entry programs at county jails. Another bill would require prisoners to be released during business hours, when they could obtain support services, and be provided with two weeks’ worth of medicine when they go.

“These are issues that have been discussed for many years now,” said former Gov. Jim McGreevey, chairman of the New Jersey Reentry Corporation and co-chair of the panel that produced the report. “It’s about (closing) the gap between the prison door and those next steps,” he said.

McGreevey says measures would ‘save lives’

While some of the changes are “long overdue,” McGreevey called the proposals “tremendous” and said many of the policies would “absolutely save lives.” He said he was very grateful to lawmakers, including the Democratic leadership, for taking the panel’s recommendations seriously.

The primary sponsors, health committee chairman Sen. Joe Vitale (D-Middlesex) and Sen. Joe Cryan (D-Union), were not available late last week to discuss the bills.

New Jersey has taken numerous steps in recent years to expand access to treatment for individuals with substance use disorders who are not imprisoned, including training scores of providers to offer medically assisted treatment, or MAT, considered the gold standard in opioid care, and expanding Medicaid coverage for these services. It has also sought to connect nonviolent offenders facing low-level drug charges with treatment, instead of just incarceration, and announced last fall an $8 million investment in expanding access to MAT in county jails.

But McGreevey and other allies insist more needs to be done to address substance use disorders behind bars, given the statistics involved. An estimated three-quarters of all prisoners report an addiction, according to the re-entry report, and 40% are also struggling with a separate mental health issue. And when an addicted inmate is released without a treatment safety net, that individual is 129% more likely to die of a heroin overdose than the public at large, it notes.

In New Jersey, the state Department of Corrections oversees roughly 19,000 inmates in a dozen facilities; some 9,000 prisoners are released or paroled from this system each year. More than 86,000 individuals cycle through the 21 county jail systems annually, according to the re-entry commission, and at least 3,200 are held in federal custody. The racial disparities in the prison population in the state are the worst in the United States, the panel found, with black adults at least 12 times more likely to be incarcerated, and Latinos six times more likely, than white adults.

According to DOC, more than 2,500 inmates have benefited from MAT programs in prison since the state launched the initiative in 2018. As of last week, the program included at least 950 within state prisons, including roughly 40 individuals continuing this care at associated halfway house facilities. Inmates also have access to nearly a dozen other treatment programs, according to a department representative, including models that also address parenting skills or family relationships, and multiple 12-step programs, which are based on anonymity.

After the 14-member Reentry Services Commission issued its report in October, lawmakers in both houses crafted legislation designed to put some — but not all — of its recommendations into law. The commission also called for standardized screening for substance use disorder at all facilities, requiring some addiction doctors to be available for 24 hours daily to serve those released from jail after business hours, and creating a peer hotline for re-entry services; these are among the elements not addressed in the proposed bills.

Proposed bills before Senate health committee  

These are the measures, all of which were reintroduced in recent weeks for the new legislative session:

S-369 — Would enable inmates to pre-enroll in Medicaid, obtain card at release

The bill, which predates the re-entry panel report, was first introduced in January 2019. It would require prisoners in state and county jails to have access to peer-led training programs on Medicaid at least two months before their release date. It also would require officials to help prisoners with the enrollment process no more than five days after this training. While federal law prohibits Medicaid coverage for inmates, it does not ban them from enrolling in the program before they leave jail. Inmates would still need to meet the existing income requirements to be eligible.

S-370 — Would establish rehabilitation and re-entry programs at county jails

Introduced in December, the bill would require wardens or other county jail leaders to work with state and county welfare officials on a program to determine if inmates are eligible for federal benefits — like Medicaid, food stamps and housing vouchers — before they are released. It would also identify those who needed addiction treatment. Officials would then seek to identify social service agencies and programs to meet these needs and connect the inmate with these benefits. Inmates with complex health care needs would also be assigned a caseworker to help them navigate this system and follow up after they return to the community. The measure also would require inmates to be equipped upon release with a state-issued ID card and two weeks’ worth of medication, and only to be let out during business hours.

S-371 — Would require DOC and the Department of Human Services to pre-enroll inmates in Medicaid

This measure, also dating to December, would require the state to establish a peer-mentoring Medicaid program and identify and train volunteer inmates who could teach those heading home about the program, its benefits and give guidance on how to fill out forms. These classes would be available to inmates at least three months before their release and they would be given a Medicaid card when they departed. Corrections officials would also need to coordinate with county welfare agencies on this process and assign case managers for inmates with complex health needs, who would help with the re-entry transition. Working by video link, these case managers would establish a transition plan, schedule an initial visit with a primary care physician, coordinate other services like housing and transportation, and follow up within five days of release.

S-347 — Would require counties to establish re-entry services committee

The proposal, also introduced in December, would require counties to establish nine-member re-entry committees to identify services important to former prisoners returning; establish a county-level database to enable providers, corrections officials and others to share health data; and make recommendations for change.

S-375 — Would authorize use of county funds

The bill would enable counties to tap into “inmate welfare funds” — generated through commissary sales, interest on certain inmate accounts, and charity — to pay for re-entry services. Also introduced in December.

S-527 — Would require state and county facilities to offer hepatitis B and C testing

Unlike the other measures, this bill — first introduced in November — passed the Assembly in early December with near unanimous support. The measure, sponsored by Vitale and Sen. Brian Stack (D-Union), would require both the state DOC and county corrections system to offer testing for both hepatitis B and C at the start of confinement. It would not require inmates to take the test and does not address treatment.

S-528 — Would require state and county facilities to provide MAT

Introduced in November, the legislation would require the state DOC and counties to evaluate all inmates for addictions and offer treatment, including MAT. It also would require officials to provide access to services to help inmates manage withdrawal symptoms, access other behavioral care, and receive treatment for substance use disorders from a licensed provider. It calls for state and county leaders to collaborate on a plan to ensure there are sufficient licensed providers and to identify community providers who can continue to treat former inmates after their release.

S-877 — Would require state and counties to develop peer counseling/navigator programs

This bill would require corrections officials to create strategic plans to ensure inmates have access to peer counseling and navigators, at least six months before their release date, to help coordinate community-based services. Although new bill text was not available last week, the measure is expected to echo legislation Sen. Linda Greenstein (D-Mercer) proposed in December.