Mass JCOIN II Clinical Research Hub

ABSTRACT Our Justice Community Opioid Innovation Network Phase I Hub (MassJCOIN I) assessed the implementation, substance use outcomes, and costs of pilot programs initiated in 2019 to provide all FDA- approved forms of medication to treat opioid use disorder (MOUD) in seven Massachusetts (MA) county jails. We found that only half of individuals who received MOUD in jail continued in the community after release. Jails must strengthen transitional treatment during reentry to improve post-release MOUD continuity of care. The federal Medicaid Inmate Exclusion Policy (MIEP), which removes Medicaid eligibility during incarceration, is an obstacle to transitional treatment during community reentry. However, MA has received federal approval for a MIEP waiver to restart MassHealth (i.e., Medicaid) coverage 90 days before release to the community starting July 1, 2025 in 4 pilot jails (Franklin, Hampden, Middlesex, Suffolk) that deliver MOUD and participated in MassJCOIN I. This policy change has the potential to improve transitional treatment for individuals at high risk for post-release opioid overdose, although effective models of transitional care are needed to optimize the impact of this policy innovation. Grounded in the Exploration, Preparation, Implementation and Sustainment (EPIS) framework, our Aim 1 study will capitalize on existing MassJCOIN I partnerships to study the implementation of the MIEP waiver to understand its impact on service delivery, outcomes and costs of care for persons with OUD in the four pilot jails. Innovative cross-agency linked data from the MA Public Health Data (PHD) warehouse will allow us to examine service utilization during the last 90 days of jail detention as well as the utilization and outcomes (e.g., MOUD initiation, engagement and retention, and OOD) after jail release. Costing methodology developed in MassJCOIN I will estimate the potential downstream cost-offsets with the MIEP waiver. For Aim 2, we will adapt an evidence-based manualized cognitive behavioral therapy (CBT) intervention to a reach-in, telehealth format for community providers to deliver to jailed, MIEP-waivered individuals on MOUD within 90 days before release and during community transition. For Aim 3, we will test the adapted Reach-in CBT intervention in cluster-randomized, stepped wedge clinical trial in which the Reach-in CBT will be sequentially rolled-out in the four pilot jails for residents on MOUD whose MassHealth has been restarted and whose reentry plan includes a participating community provider. We hypothesize that Reach-In CBT will enhance MOUD initiation, engagement and retention, and reduce opioid overdose, reincarceration, and mortality over the 12 months post-release. This project is significant and innovative because it will determine and disseminate best practices in MIEP waiver implementation, as well as adapt and test a model of reach-in counseling to enhance MOUD continuity at reentry. Findings will inform paradigm-shifting implementation efforts and services in MIEP waiver states.