Major changes in how Maine’s prisons and jails pay for addiction treatment and other health care services are on the horizon.
The U.S. Centers for Medicare and Medicaid recently approved Maine’s request to allow correctional facilities to bill MaineCare, the state’s Medicaid program, for certain medical and behavioral health services provided in correctional facilities up to 60 days prior to release.
Federal law prohibits the use of Medicaid to pay for health care services for incarcerated people, meaning that correctional facilities foot the bill for all medical costs. But that will soon change.
Under Section 1115 of the Social Security Act, states can seek approval from the federal Department of Health and Human Services to waive certain Medicaid requirements and restrictions. A bipartisan law passed during the first Trump administration gave states the ability to seek waivers specific to re-entry services in carceral facilities.
Gov. Janet Mills in July 2023 signed a law directing the Maine Department of Health and Human Services to apply for an 1115 re-entry waiver and after a long application process, it was approved on Sept. 25. Maine now joins 21 states and the District of Columbia with such waivers.
“This is one of the largest changes in the criminal-legal system in 30 years,” said Dr. Courtney Pladsen, the MaineCare medical director.
The new waiver will allow correctional facilities to bill MaineCare for certain services provided to individuals incarcerated in jails and prisons up to 60 days prior to their release and individuals in youth correctional facilities up to 90 days prior to release.
“This will make it easier when someone leaves to have access to medications and easier for them to see a doctor because those connections to services will start prior to release,” said Vikki Wachino, the executive director of the Health and Reentry Project, a national group focused on improving health and safety through re-entry policy. “We know that when people have access to health care and access to mental health care, they are less likely to experience the criminal justice system or to be reincarcerated. So I think that’s really the potential here, is these changes can make people healthier and make it less likely that they cycle through prisons and jails.”
On Thursday, the Health and Reentry Project launched a technical assistance center to help states with the implementation process.
Among the services eligible for coverage under the waiver are medications to treat opioid use disorder, such as buprenorphine and naloxone. The officials who run Maine’s jails have said that their budgets are increasingly strained by the cost of providing health care to the people in their custody, particularly given the high prevalence of substance use and mental health issues.
Officials have said that while they see the value in providing medication-assisted treatment to prisoners, which Maine jails and prisons have been required to do since a 2019 ruling, they face a year-after-year struggle to find funding, often turning to temporary sources such as opioid settlement funds.
“This is good news,” Somerset County administrator Tim Curtis said of the waiver approval. “This is beneficial to the county taxpayer but most of all it’s beneficial to the inmate that needs certain services and coverage.”
Curtis, as a member of the County Corrections Professional Standards Council, worked with each county to estimate the cost of providing substance use and mental health care in jails. The results were published in the council’s January report which showed, for the first time, that jails spent over $12.6 million on addiction and mental health treatment last year.
The waiver also opens up funding for some services that many jails do not currently provide, including case management, HIV and Hepatitis C treatment and family planning services. It also gives correctional facilities the ability to bill MaineCare for a 30-day supply of an individual’s prescription medications, to be provided to them at the time of release.
“We’ll be able to provide really much more comprehensive services within all the jails in the state of Maine in the pre-release period,” said Dr. Alane O’Connor, who works with the Maine Sheriffs Association and oversees the Franklin and Somerset jails’ extended-release buprenorphine programs.
“I think it’s still going to be a lengthy process in terms of getting everything up and running,” O’Connor said.
Putting the application together took a year and a half, Pladsen, the MaineCare medical director said, and involved gathering input from all 15 of Maine’s county-run jails, the Maine Sheriffs Association and the Department of Corrections, which oversees prisons.
“I heard very clearly from the sheriffs that what happens and works in Aroostook County is not going to work and what happens in Cumberland County,” she said. “And so rather than having one uniformed initiative and one uniformed implementation plan, we are going to work with each county individually.”
The state now has 120 days to put together an implementation plan to submit to the federal government. Pladsen said the implementation process will be a huge lift for jails.
As just one example: Most jails do not have electronic health record systems, so part of the challenge will be getting jails set up with the technology and systems they need to both provide the services and to bill for them.
Pladsen said the state expects correctional facilities to be able to start billing MaineCare on July 1, 2028, though the timeline for each of the jails to get their own systems up and running will likely vary.
This story appears as part of a collaboration to strengthen investigative journalism in Maine between the BDN and The Maine Monitor. Read more about the partnership: bangordailynews.com/the-maine-monitor