In the two weeks after leaving incarceration, individuals are 40 times more likely to die from an opioid overdose than the general public. Yet, for years, there has been little attention paid to treating substance use disorders (SUD) in prisons and when individuals are reintroduced into society.
But this could improve as providers team up with local corrections departments to provide SUD treatment, and as state Medicaid changes expands access to more incarcerated or newly released individuals.
“Statistics vary, but most agree that roughly 85% of all people incarcerated have some kind of problematic substance use or problematic relationship with substances, and much of that drives their incarceration,” Meghann Perry, a recovery coach professional educator and person with lived experience of substance addiction and incarceration, told Behavioral Health Business. “Because of the war on drugs, we’ve criminalized substance use. Therefore, the vast majority of people who are incarcerated, it’s related in some way to substance use.”
SUD providers are looking to partner with correction facilities
Partnerships have become crucial in helping people transition out of correction facilities with SUD treatment.
For example, substance use disorder provider Groups Recover Together has partnered with several state correctional departments, including Indiana and Maine’s department of corrections (DOC), to provide transitional care and reentry services for individuals transitioning out of incarceration.
“It’s really important for a few reasons,” Cooper Zelnick, chief revenue officer at Groups Recover Together, told BHB. “One, that the population has a massive prevalence of substance use disorder, specifically opioid use disorder. Two, it’s a population that is much more likely to die of a fatal overdose upon release than the general population. And three, the goal of corrections is to rehabilitate people. And part of doing that is helping people build a life once they’re released.”
Founded in 2014, Groups Recover Together is a Boston-based opioid use disorder provider that operates on value-based care arrangements. The provider closed its $60 million Series C funding round in 2021.
When an individual is referred for treatment, Groups Recover Together links the individual to a care team, including a care navigator who works as a point of contact. Individuals are also assigned to a weekly group meeting at the same date and time.
“We’re working with the care managers and the care navigators in the facility to identify those who need services, get them screened, understand what they need, both from a substance use disorder treatment perspective, but also just from a broader, social determinants of health perspective,” Zelnick said. “Then we’re working to schedule them rapid access in-take appointments so that they can walk out of the doors of prisons and into the arms of a really high-quality treatment provider, which is the difference between life and death.”
Groups Recover Together isn’t the only SUD provider teaming up with state DOCs.
SUD provider Boulder Care has teamed up with the Oregon Department of Corrections to offer virtual care treatment and medication-assisted treatment (MAT) services to individuals involved with the justice system. Typically, Boulder engages individuals when they have been released from a correctional facility, but still have some time to complete at a work center or have been referred to their services by a probation officer.
“When individuals enter the work center, they’re then evaluated by the work center staff for substance use,” Jodi Bostwick, associate medical director at Boulder Care, told BHB. “If someone identifies as having an opioid use disorder, or they’re actively in withdrawal, then they are scheduled an appointment with one of our Boulder providers.”
Portland, Oregon-based Boulder Care is a digital SUD provider. It has raised over $50 million in venture capital funding.
If one of Boulder’s nurse practitioners or doctors prescribes a MAT to a patient, a DOC staff member will pick it up at a partner pharmacy and disperse it at the work center.
Both Boulder and Groups Recover Together continue to work with individuals even after they are no longer in the justice system.
Financial barriers to care
While partnership programs are one way to provide more access to SUD care, historically, financial barriers have made it difficult for individuals leaving incarceration to get care.
Generally, when a Medicaid beneficiary is incarcerated, they lose that coverage. This loss in coverage can lead to access issues when they are released.
“If [we] allowed incarcerated individuals … to retain their insurance, like their Medicaid or Medicare, or whatever insurance they have,” Perry said, “we’d be able to provide them much better medical care and behavioral health care while incarcerated, which would really support them doing much better when they transition back into the community and not have that gap.”
Losing that coverage is just one more safety net removed, Perry noted.
This could be changing in at least one state. In January, the U.S. Department of Health and Human Services (HHS) approved a first-of-its-kind1115 demonstration amendment in California that allows Medi-Cal to cover SUD treatment before a Medicaid beneficiary is released from jail, prison or a correctional facility.
“For incarcerated individuals struggling with substance use disorders, transitional care is critical and can be life-saving,” Zelnick said. “Historically, loss of Medicaid coverage upon incarceration has indeed been a key barrier for folks seeking substance use disorder treatment upon release. At Groups, we’ve long provided transitional care services for folks re-entering the community from criminal justice settings; California’s 1115 Waiver can and will make this work easier.”
Although this waiver hasn’t reached most states, providers like Groups Recover Together and Boulder have programs to help people get back on Medicaid. They also care for individuals during that gap in care.
“We’re not charging; we’re not billing for any of what we’re doing to help the member be successful, and [to] support the partnership and the relationship,” Joe Henry, director of partnerships at Groups Recover Together, told BHB. “Once their insurance goes active, if we’re able to backfill, we will, for whatever services. But regardless, if we’re doing all the right things prior to them starting treatment, it’s more likely that they’re going to stick with it.”
Grant money or impact investment dollars can also help programs provide care when there is a coverage gap.
“We’ve been very fortunate in that we have non-dilutive impact investment dollars from Acumen, and they specifically have given us money to provide that care while folks are incarcerated when there’s no Medicaid coverage,” Rose Bromka, chief operating officer at Boulder Care, told BHB. “One of the things that we do in partnership with the managed Medicaid plans in Oregon and the carceral system is to connect folks back to Medicaid once they get released.”
No one-size-fits-all solution
Paying for care isn’t the only barrier to entry for individuals with SUD. While incarceration takes away a person’s autonomy, a person must make decisions about their recovery, according to Perry.
“When we decide for people that they should get on medically assisted recovery, and they should get a therapist, and they should go to groups, and they should go to meetings,” Perry said, “it doesn’t give people the opportunity to find what is actually right for them.”
Many providers have tapped peer recovery support specialists to help patients navigate care and their social determinants of health.
“One of our greatest assets that we have is a peer recovery specialist. There are individuals who have lived experience and lived recovery.” Bostwick said.” They’re the best hands down motivational interviewers that I’ve ever met, but they can connect with patients on a level that I’m never going to be able to do, to be honest.”
Henry said MAT is central to recovery, but it’s only one part of the puzzle. It’s also essential to holistically support patients and help them navigate their social determinants of health (SDoH).
“All those other things that exist in their life that could derail their recovery are so real,” he said. “They’re things that we have to help them navigate. Maybe it’s just maybe it’s something that’s navigated in their weekly group, or maybe they need assistance, navigating that through our care navigation team.”
Helping patients navigate their SDoH and find a community is especially important after incarceration.
“Connection and belonging are one of the most fundamental elements of being human,” Perry said. “And it is because people coming out of incarceration and people with convictions are so alienated and marginalized that the climate is very steep to find a place where there’s belonging to find a place where they feel connected to people and a community. We often don’t do a good job. We have these silos–you go here for therapy, you go here for the methadone clinic, you go here for, you know, an intensive outpatient program, you go here for housing, and it’s all just [disconnected].”
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