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Volume 30, Supplement - Infectious Diseases and Carceral Health

SUPPLEMENT ISSUE
Policy

Medicaid Inmate Exclusion Policy and Infectious Diseases Care for Justice-Involved Populations

Alysse G. WurcelComments to Author , Katharine London1, Erika L. Crable, Nicholas Cocchi, Peter J. Koutoujian, and Tyler N.A. Winkelman
Author affiliations: Tufts University School of Medicine, Boston, Massachusetts, USA (A.G. Wurcel); Massachusetts Sheriffs’ Association, Boston (A.G. Wurcel, N. Cocchi, P.J. Koutoujian); University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA (K. London); University of California San Diego, La Jolla, California, USA (E.L. Crable); Hampden County Sheriff’s Office, Springfield, Massachusetts, USA (N. Cocchi); Middlesex County Sheriff’s Office, Woburn, Massachusetts, USA (P.J. Koutoujian); Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA (T.N.A. Winkelman)

Main Article

Table

Case examples of potential impact of overturning MIEP on infectious disease care for eligible persons*

Case Before waiver approval After waiver approval
25-y-old man with HCV and opioid use disorder, incarcerated for 50 d, plans for release in the next month • Short incarceration period and high medication cost are barriers to testing to confirm chronic HCV infection and to initiating HCV treatment.
• Gap in insurance coverage impedes transfer of OUD treatment to pharmacy after release.
• Interested in PrEP but no system to ensure follow-up by community clinician (community clinic requires active health insurance at time of appointment scheduling).		 • HCV medications and PrEP initiated as soon as diagnoses are confirmed.
• Minimum of 30-d supply of medications provided upon release.
• With active insurance, appointment can be scheduled with community health center for day after release.
55-y-old woman with HIV and bipolar disorder,
Incarcerated for 10 y and preparing for community re-entry in the next 2–3 months		 • HIV diagnosed while in prison; does not have ties to a clinician in the community.
• Bipolar disorder well managed in prison with medication; however, there are no systems to coordinate outpatient mental health care in the community.
• She would like to connect with a community health center that can manage HIV and bipolar disorder. She does not know where she will be living, and she does not know which community health center will be accessible by public transportation.		 • Linkage to care specialist connects with case worker to advocate for specific living situation near community health center.
• Telehealth appointments scheduled with HIV clinician and mental health clinician before release to ensure warm handoff.
• Phone number and appointment time for post-release appointment given to the patient.
• 30-d supply of HIV medication and lithium delivered to living situation.
• Phone number for care coordination contact at prison in case she has issues with medications or needs to transfer her care to a different community health center.
40-y-old trans woman receiving PrEP, incarcerated for 3 mo. Preparation for release began at intake. • Has been receiving oral PrEP in the community, but PrEP not continued during incarceration.
• Has not received STI testing or treatment in the community. The jail can do oral and urine STI testing; however, rectal testing is not available.
• Interested in long-acting PrEP, but it was not on the jail formulary.
• 1st hepatitis B vaccine given in jail but no plan for next vaccine		 • Resources allocated from waiver funding to support protocolization of long-acting injectable PrEP delivery to persons within 30 d of release.
• Infectious diseases nurse at the jails works with local clinicians and public health experts to coordinate testing for rectal gonorrhea and chlamydia.
• Hepatitis B vaccine series scheduled at local pharmacy after release.
• Records of vaccines and PrEP care transferred from jail to community health clinician.

*HCV, hepatitis C virus; MIEP, Medicaid Inmate Exclusion Policy; OUD, opioid use disorder; PrEP, preexposure prophylaxis; STI, sexually transmitted infection.

Main Article

1Current affiliation: Independent consultant.

Page created: March 14, 2024
Page updated: March 31, 2024
Page reviewed: March 31, 2024
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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