Measuring the Performance and Quality of Opioid Addiction Treatment in Correctional Facilities

Milbank State Leadership Network
Focus Area:
State Health Policy Leadership

Congress, the Centers for Medicare and Medicaid Services (CMS), and some state Medicaid authorities are proposing or are in the process of implementing new policies allowing Medicaid to cover opioid use disorder (OUD) treatment in state and local jails and prisons. These changes follow decades of prohibition on Medicaid coverage of most correctional health care services. In October, we described our report recommending OUD services and standards for Medicaid coverage in state prisons and local jails. The second report in this series proposes performance measures to ensure correctional facilities are providing high quality, evidence-based, and effective care throughout a person’s incarceration.  

The need for addiction care in jails and prison is well-documented. Since 2000, drug and alcohol intoxication deaths in jails and prisons have increased dramatically, and people recently released from jail or prison are at high risk of dying from a drug overdose. Providing medications for opioid use disorder (MOUD) — the gold standard of treatment — to people while incarcerated has been found to increase their engagement in treatment after reentry to the community, yet few facilities do so, partly due to a reported lack of adequate funding to pay for it. 

A first step to ensuring prisons and jails provide high quality OUD care is for CMS and state Medicaid authorities to consider necessary services and standards for correctional settings seeking to provide OUD care. After CMS and state Medicaid authorities have considered necessary services and standards for correctional settings seeking to provide OUD care, CMS should develop clear goals, measurable objectives, and metrics for treatment. These measures will help ensure states can effectively monitor and evaluate how well jails and prisons, health and behavioral health providers, and managed care partners meet objectives and ultimately improve care and health outcomes for individuals who are incarcerated and who will reenter the community.  

Required and Encouraged Performance Measures 

To best capture program performance and outcomes, we recommend that CMS require the reporting of certain measures and encourage the reporting of others for state Medicaid authorities to assess services provided to Medicaid beneficiaries in jails and prisons. Many of these measures are based on existing ones used in community OUD treatment, while others are specific to providing these services in correctional facilities. The measure selection process was guided by an eight-member advisory council that included individuals with lived expertise in substance use disorder and incarceration, Medicaid and managed care experts, clinicians, and persons with correctional facility operations expertise, and also informed by two expert reviewers. For additional detail on the measures, see Appendix C in the performance measures report. 

Recommended Medicaid OUD Measures at Admission to a State or Local Correctional Facility   

Measure  Required or Encouraged
Percentage of Medicaid beneficiaries screened for OUD using a standardized screening tool during the measurement period  Required  
Percentage of Medicaid beneficiaries who had a documented OUD diagnosis (e.g., on insurance claim or electronic health record) during the measurement period) Required  
Percentage of Medicaid beneficiaries with OUD who initiate MOUD, by type of MOUD (methadone, buprenorphine, or naltrexone) while in a jail or prison  Required  
Percentage of Medicaid beneficiaries continuing community initiated MOUD at admission  Required  

Recommended Medicaid OUD Measures During Incarceration   

MeasureRequired or Encouraged
Percentage of individuals who filled or were prescribed and dispensed an MOUD who received the MOUD for at least six months, overall, and by type of MOUD (methadone, buprenorphine, or naltrexone)    Required  
Percentage of Medicaid beneficiaries who change MOUD (by type) while in jail or prison  Encouraged   
Number and rate of overdose deaths for Medicaid beneficiaries during incarceration  Required  

Recommended Medicaid OUD Measures During Reentry  

MeasureRequired or Encouraged
Percentage of Medicaid beneficiaries with an OUD who were dispensed an MOUD (by type of medication: (methadone, buprenorphine, naltrexone) and naloxone on the day they re-entered the community  Required
Percentage of adult individuals [with an OUD] leaving incarceration with Medicaid coverage  Required

Recommended Medicaid OUD Measures Post-Reentry  

MeasureRequired or Encouraged
Follow-up after release from a jail or prison: percent of Medicaid beneficiaries released from jails or prisons that result in a follow-up visit or service for OUD within seven and 30 days post-reentry Required
Number and rate of overdose deaths for Medicaid beneficiaries one month and six months post-reentry  Required
Percentage of Medicaid beneficiaries who received an MOUD for at least 60 and 90 days and by type of MOUD (methadone, buprenorphine, or naltrexone)    Required
Percentage of Medicaid beneficiaries who return to jails and prisons post-reentry   Encouraged  
Percentage of Medicaid beneficiaries reporting positive recovery-related outcomes post-reentry  Encouraged  


MeasureRequired or Encouraged
Number and percent of jails and prisons that participate as Medicaid providers in the state’s Medicaid program during the 1115 demonstration period  Required

Challenges and Opportunities in Data Collection 

 It’s challenging for correctional facilities to collect data on health care services and outcomes, but also necessary for Medicaid agencies to analyze the quality of services provided and pay claims, and for jails and prisons to make data-driven program improvements. Most importantly, these settings frequently lack infrastructure like electronic health records to track performance, the technology to submit claims, and correctional staff with medical coding and claims submission experience.  

But just as Medicaid requires community treatment providers to report data, correctional settings offering OUD care will need to do the same — and should receive technical assistance and Medicaid funding to do so. Our performance measures report offers guidance that can be shared with state and local correctional partners about how best to gather information and report on measures. CMS and state Medicaid agencies should also consider input on collecting and reporting measures from federal and state policymakers, health care providers, community-based organizations, Medicaid managed care organizations, advocates, and people who have direct experience with incarceration and OUD.   

The third and final report in this series on OUD treatment in correctional settings, focusing on suggested reimbursement and payment models, will publish early next year.