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By Elizabeth Thompson

The long-awaited final budget from the North Carolina General Assembly is finally out, and it includes several provisions that would directly impact the health of North Carolina’s prison system and justice-involved population.

While the budget did not include Medicaid expansion, which would help people reentering the community to get the medication and treatment they need, it did allocate money for medication-assisted treatment (MAT) for the justice-involved populations as well as reentry programming. It also allocated funds to improve prison safety.

No Medicaid expansion

Many people leaving incarceration have chronic physical and mental health conditions that require treatment, but those same people are often uninsured or uninsurable as they reenter society.

Some small counties and sheriffs — even in conservative-leaning parts of the state — have advocated for Medicaid expansion because their local jails are struggling to pay the medical costs of people detained in their facilities, many of whom struggled with behavioral and mental health conditions.

One staunch advocate for Medicaid expansion, Alamance County Sheriff Terry Johnson, has pointed out that often, people with mental health problems are sent to jail instead of receiving treatment. The budget allocated $500,000 in non-recurring funds to the Alamance County Sheriff’s Office Stepping Up Initiative, which will develop a diversion center for people with mental illness arrested for nonviolent offenses in order to reduce recidivism.

Programs such as North Carolina Formerly Incarcerated Transition Program (NC FIT) connect some people with health care upon reentry, but they don’t have the resources to help every person coming out of jail or prison, NC Health News has reported previously.

Advocates for the health of formerly incarcerated people, such as Dr. Evan Ashkin, founder of NC FIT, have argued for Medicaid to be expanded to people reentering society for at least their first 12 months post-incarceration.

“People do get out, they get their diagnosis in the hospital of heart failure or prostate cancer or any disease, and they need to see a specialist, and again NC FIT cannot do that,” Ashkin said in an interview with NC Health News. “So people are going without specialty care. Which is going to result in bad outcomes and again, drive up emergency room utilization and other avoidable costs.”

Medication-assisted treatment for justice-involved population

Opioid funds won from Attorney General Josh Stein’s settlement with major opioid manufacturers went into a Opioid Abatement Reserve fund created in the budget bill. Some of those funds will go to expanding treatment for people with opioid use disorder in the state’s criminal justice system.

The budget compromise allocates money to MAT programs, which use one of three drugs approved by the U.S. Food and Drug Administration: methadone, buprenorphine and naltrexone to help treat Opioid Use Disorder, for the state’s jails and prisons.

The budget also allocates $2 million in recurring funds to go to addiction treatment in jails, through grants to sheriffs’ offices that expand, maintain or establish MAT programs. Of those funds:

  • $750,000 goes to establishing MAT programs
  • $750,000 goes to expanding existing MAT programs
  • $500,000 for the maintenance of existing MAT programs 

NC Health News has previously reported on MAT in jails and the inconsistent use of the treatment across different counties. In some jails, people on MAT for opioid use disorder are forced into withdrawal instead of continuing their treatment, which can lead people to relapse or overdose upon release. Other jails, such as the Buncombe County Detention Center, have helped detainees with opioid use disorder get on MAT.

The budget gives $8 million in non-recurring funds from the federal Substance Abuse Prevention and Treatment Block Grant to the MAT Community Supervision pilot program. This would serve people recently released from prison using medication approved by the Food and Drug Administration to treat alcohol and opioid use disorder.

Many people reentering the community from incarceration need evidence-based reentry programming, such as MAT, as NC Health News previously reported. After leaving prison or jail, people were 40 times more likely to die of an opioid overdose within two weeks after their release, according to a study conducted by the University of North Carolina at Chapel Hill.

Reentry programming

Even though 98 percent of people incarcerated in North Carolina will be eventually released, many people reenter society feeling unsupported. Reentry programs can help alleviate that need. The COVID-19 pandemic made reentry even harder, NC Health News reported.

Reentry programs connect people reentering the community with food, job and health resources, among other things, to help them start their life again post-incarceration.

The compromise budget includes $400,000 in one-time funds for local reentry councils. It also allocates a one-time release of $250,000 to the Robeson County Reentry Program.

After the North Carolina General Assembly passed the Raise the Age legislation to change the age at which young people are automatically charged as adults, the budget allocated $2.5 million in one-time funds for youth reentering the community from state Youth Development Centers.

For incarcerated people who were released due to the settlement in NC NAACP v. Cooper, when the North Carolina prison system reduced the prison population due to the COVID-19 pandemic, the budget provides $1 million in non-recurring funds for community supervision programs. Those dollars would go to pay for, among other things, short term housing, recidivism and reduction services.

Prison facility improvements

North Carolina’s prison system will also be receiving some facility updates in the budget.

The spending plan specifies a one-time allocation of $2.75 million for safety improvements across the prison system. That includes increased access to automated external defibrillators, replacing firearms and metal bed springs, and other “critical safety upgrades” to facilities.

Central Prison will also receive about $4.8 million in net appropriations in funding for medical and custody positions to operate a long-term care facility for chronically ill people incarcerated there. NC Health News previously reported that the facility had no staff or funds for the 46-bed center due to the state budget standoff.

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Elizabeth Thompson

Elizabeth Thompson is our Report for America corps member who covers gender health and prison health topics. Thompson is a UNC Chapel Hill graduate...

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