In Camden, feds announce that states can soon use Medicaid to pay for addiction treatment in jail

The nation’s drug czar visited a Camden jail on Tuesday to highlight the potential benefits of a White House effort to allow states to apply to use Medicaid funding to pay for the treatment of substance use and mental illness in jails and prisons. It’s a plan that could help expand treatment in a population disproportionately affected by addiction and mental health issues.

During a visit to the Camden County Correctional Facility, Rahul Gupta, director of the Office of National Drug Control Policy, offered new detail on President Joe Biden’s move to allow states to apply for waivers to a federal rule that has long barred them from providing medical care to incarcerated people with Medicaid, the publicly funded health program for low-income individuals.

Biden announced the initiative during his State of the Union address earlier this month.

Gupta told reporters that states that apply to expand Medicaid funding in their jails and prisons must use the money to cover substance use and mental health treatments. Beyond that, the federal government wants to allow states flexibility in how they propose to use the funds, he said, noting that details are still being worked out and new guidelines will be released this spring.

Currently, Medicaid cannot be used to cover the costs of medical treatment in jail or prison, unless that person is receiving care as an inpatient in a hospital or clinic outside the jail. That leaves states and counties responsible for funding medical treatment for some incarcerated people who might otherwise qualify for Medicaid.

» READ MORE: What is medication-assisted opioid addiction treatment?

Advocates and policymakers have long called for better funding for health care in prisons, especially for substance use disorder. According to the National Institute on Drug Abuse, an estimated 65% of people in prison in the United States have a substance use disorder, and an additional 20% were serving time for crimes committed under the influence of drugs or alcohol.

Earlier this year, the federal government approved a waiver that allows California to use Medicaid to cover a number of health-care initiatives for incarcerated people eligible for the program, up to 90 days before their release, in an effort to ease their transition back into the community. Gupta said that California’s efforts could serve as a model for other states as they apply to expand Medicaid in prisons.

In Camden on Tuesday, Gupta applauded the county’s addiction treatment programs in its county jail. Since 2019, the jail has offered all three federally approved medication options to treat opioid addiction: methadone and buprenorphine, both opioid-based medications, and naltrexone, which blocks opioids from latching on to receptors in the brain.

The county jail also screens every newly incarcerated person for substance use disorder and, if they ask for treatment, aims to get them on medication within 24 to 48 hours.

“This is a role model for the country, and it’s the kind of approach we need to be taking,” Gupta said.

All but one of New Jersey’s counties now offer similar programs in their jails, but Camden’s was the first to offer all three opioid addiction medications. Before it expanded its treatment offerings, the only option for most people in jail with opioid addiction was to detox cold turkey.

That consigned them to intense withdrawal pain in jail. In the past, warden Karen Taylor said, some incarcerated people in Camden would attempt suicide just so they would be taken to a hospital and given medication to get them through withdrawal.

Withdrawing in jail also put them at higher risk for overdose when released: After a period of abstinence, people with addiction lose their tolerance for opioids, putting many uniquely at risk of overdose after release from jail.

If they return to using drugs, they may overestimate how much they can handle. And since the powerful opioid fentanyl has replaced most of the area’s heroin supply, the risk of overdose is even higher.

» READ MORE: As New Jersey seeks harsher punishments for fentanyl possession and dealing, advocates say the new laws risk harming people with addiction

State officials also are hoping that the new Medicaid guidelines will lower their own spending on health care in jails. Since 2019, Camden County has spent more than $1.2 million on addiction treatment medications for more than 3,500 inmates, paid for mostly through state grants, Taylor said.

One treatment, a monthly shot of long-acting buprenorphine called Sublocade, costs the jail $1,800 per shot. Medicaid coverage could help alleviate those costs, Taylor said. State officials say they hope those savings could help them fund more addiction services for incarcerated people during and after their release.

“We’ve been able to fund these programs in 20 out of 21 counties,” said Sarah Adelman, the commissioner of the state Department of Human Services. “But when we receive additional funding from the federal government, that could potentially cut our state investment by half or thereabouts. It allows us to use those saved dollars to go farther and to do more.”

For people currently incarcerated in Camden County, having access to addiction medications has helped to alleviate long-standing concerns about detoxing in jail.

Rachel Parker, who has been in the county jail for about a month after a drug court violation, was prescribed buprenorphine before entering jail and was able to continue her treatment inside.

In the past, she had gone through withdrawal in jail. Just thinking about the prospect was brutal, she said: “Your body feels like it’s physically dying — preparing for death.”

Staying on the medication, she said, will also help her to reenter the community without returning to drug use: “You have time here to get adjusted and get stable.”