Funding

This section provides potential funding opportunities and modalities to cover the costs of MOUD (also referred to as MAT) for pregnant patients in jail – things like where to find funding to run a program, what will impact costs, and resources to support estimating and acquiring funding. While MOMCARE is geared toward serving pregnant patients with OUD, many of these funding considerations apply to non-pregnant patients in custody as well. 

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Key Points

HOW

  • Determine what model of MOUD delivery best suits your jail’s needs.
    • Engage in conversations with your contracted healthcare provider to assess whether MOUD can be included in your contract.
    • Contact your local health department (or other community MOUD providers) if an alternative option is needed.
  • Estimate the cost of MOUD for pregnant patients. Include items like medication costs, staff time (assessment, dosing, transport), and behavioral health services.
  • Determine what funding mechanisms your jail is eligible for. Some include:


WHY

  • Jails need funding to provide and sustain sufficient evidence-based MOUD care to pregnant patients.
  • Jails should offer both methadone and buprenorphine, but some may be more readily available in the community.


KEEP IN MIND

  • Consultation with a perinatal care provider may be an additional cost if your healthcare provider does not have pregnancy expertise
  • Since pregnant patients need more frequent dose adjustments, it may mean more off-site transports or visits to medical within the facility
  • Breastmilk expression and storage are important (g. equipment, coordination, etc.)
  • Most pregnant individuals without private insurance are eligible for Medicaid in every state, and it should include MOUD coverage. MOUD services after release can be paid through Medicaid. Reentry staff should ensure the pregnant patient is signed up for Medicaid upon release so they can access MOUD and prenatal care at little to no cost.

Deeper Dive

HOW

Action Items 

  1. Consult with your contracted health provider (if applicable) to discuss MOUD being in the request for proposals (RFP) and having at least buprenorphine on the formulary. See sample contractual language used for incorporating MOUD services into medical provider RFPs.
  2. Contact your local health department for possible funding and collaboration opportunities for MOUD. Find out if your state has received opioid abatement funds from pharmaceutical company settlements to be used towards overdose reduction programs.
  3. Determine what MOUD delivery model is best for your facility. The model will directly impact There are pros and cons to each.
  4. Assess what medications are available in the surrounding community (accessible to your facility and the public). Evidence-based MOUD involves making multiple forms of medication available and promotes shared decision-making between the patient and provider.
  5. Find out whether your state has been awarded opioid response grants, and if so, what they are. This can help fund MOUD treatment and training for staff in corrections settings.


Estimating costs 

Each jail must first determine what MOUD delivery model is feasible and appropriate for their setting. Administrators should consider the following when determining the delivery model: staffing capacity to get daily MOUD doses to patients, staffing expertise in OUD and pregnancy care, health care delivery models and contracts, and community infrastructure. The type of medications your jail makes available will impact cost, as each formulation and delivery method vary. We recommend making both methadone and buprenorphine available. Methadone is often the least expensive. Extended-release injectables like naltrexone and Sublocade are often the most expensive, but these are not recommended in pregnancy. 

Please see the Implementation – MOUD delivery –  Delivery models for information describing the different modalities of delivering MOUD to people in jail custody. 


Tools to help you estimate what the costs will be for your jail to have MOUD: 


Identifying funding opportunities 

Jails fund MOUD in many different ways ranging from local, state, and federal grants and support. We first suggest finding out whether your state has applied and been approved for a Medicaid Reentry Section 1115 Demonstration Waiver to cover health care costs, including MOUD, for services provided in custody between 30-90 days pre-release. Then, you should look at whether your state has been awarded opioid response grants and what they are. Jails may be able to get discounted rates on MOUD through state block grants, Federally Qualified Health Centers (FQHCs), or subsidized medication programs. Use the table below to learn more details on possible funding options.

Name of Funding (with link)

Description

Medicaid Section 1115 Waivers

BJA webinar: Navigating the New Medicaid Section 1115 Demonstration Opportunity

Medicaid will not pay for ongoing health services for people in custody, but states can apply for a Section 1115 Waiver that will allow Medicaid to pay for health care costs, potentially including MOUD, for people in jail 30-90 days pre-release. The waiver is dually beneficial since it offsets some costs from the jail and ensures the patient has coverage at reentry.

If your state has applied and been approved for a waiver, then you can enroll patients in Medicaid while they are in jail, and it will cover health care costs for them! This website can tell you if your state has an approved 1115 Waiver that covers incarcerated people. 

SAMHSA State Targeted Response to the Opioid Crisis Grants (STR)

Intended to close the treatment gap between those who seek treatment and those who receive it. At least 80% of the award must fund treatment services and may be used for services in corrections settings and for reentry.1

SAMHSA State Opioid Response Grants (SOR)

$1 billion grant program with 15% set aside for the states with the highest rates of drug overdose deaths. Grants can be used for services including treatment and training for staff in corrections settings and for reentry. 1

Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP)

The COSSAP grant program is awarded to state, local, and tribal entities to support responses to the opioid epidemic to reduce overdose deaths, promote public safety, and support access to treatment and recovery services in the criminal justice system, including in correctional facilities. 1

DOJ, BJA Residential Substance Abuse Treatment (RSAT)

The RSAT for State Prisoners Program assists states, local, and tribal governments in the development and implementation of substance abuse treatment programs in state, local, and tribal correctional and detention facilities. Funds are also available to create and maintain community reintegration services for individuals after they are released from incarceration. 1

SAMHSA Block Grants

SAMHSA funds states and territories through the following grants:

Block grants are used to supplement Medicaid, Medicare, and private insurance to provide access to prevention, treatment, recovery supports, and other services. Grant funds are awarded to the state behavioral health authority, substance abuse authority, and/or mental health authority, depending on how the state agencies are arranged.1

340B Drug Discount Program

Allows certain entities that serve large uninsured patients to obtain drugs from pharmaceutical supplies at the same discounted rates that Medicaid pays (i.e. 25-50% less).2

Federally Qualified Health Centers (FQHCs)

FQHCs are located in inner cities and rural areas and serve uninsured and low-income individuals. Many offer Buprenorphine based on discounted fees. 2

1 Expanding Access to Medications for Opioid Use Disorder in Corrections and Community Settings: A Roadmap for States to Reduce Opioid Use Disorder for People in the Justice System. (Washington, D.C.: National Governors Association and American Correctional Association, January 2021).

2 Jail-based Medication-Assisted Treatment: Promising Practices, Guidelines, and Resources for the Field. (National Sheriff’s Association and National Commission on Correctional Health Care, October 2018)


WHY

A successful and comprehensive MOUD program for pregnant individuals is dependent on being able to pay for the medications, staffing, and training required to run it. Addressing funding will help you plan for your program’s capacity, scope, and sustainability. 

Resources