‘Longer we wait, the more people will die’

Opinion editor’s note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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Serving as the jail administrator in northern Minnesota’s Cass County has put Chris Thompson on the front lines of the nation’s opioid epidemic. The experience has had a profound impact on him.

Thompson, now a lieutenant, started with the Cass County Sheriff’s Office in 1997, moving to jail management in 2016. He’s seen firsthand how many people now under his responsibility struggle with substance abuse disorder, upwards of 65% at his facility, which was built to house 60 inmates and boards about 40 others elsewhere. One of the inmates affected: one of Thompson’s former schoolmates, who later succumbed to this disease.

Thompson’s also seen how wretched withdrawal can be, particularly for fentanyl users. He describes it as having the flu, COVID and food poisoning all at once, “and then multiply that by five or 10.”

Before his jail management role, Thompson said he had a typical “lock ’em up and throw away the key” attitude. Now, he’s an eloquent advocate for a sensible new proposal from Gov. Tim Walz’s administration to improve substance abuse treatment for inmates nearing release.

If thoughtfully implemented and utilized, the new program would “allow counties to offer increased health care, chemical and mental health treatment and re-entry services to those who need it, without exhausting local county funds,” Thompson told an editorial writer this week. “Releasing healthier people back into the community with resources and medications they need will lead to higher success rates, fewer overdose deaths, fewer emergency room visits for withdrawal and overdose and lower recidivism.”

For Minnesota legislators, whose approval is both needed and merited to launch this pilot program, Thompson noted that substance abuse affects families on both sides of the political aisle. “The longer we wait, the more people will die,” he told an editorial writer this week. “Put the betterment of our communities first and foremost. Do the right thing, for the right reason.”

It’s hard to top Thompson’s argument for the proposal, which is often referred to by an ungainly name: the “1115 Re-Entry Medicaid Waiver.” But the Star Tribune Editorial Board would like to add its strong support for this compassionate, innovative effort to combat the opioid epidemic in Minnesota.

The only addition we’d make is to point out that the program would also draw down substantial federal dollars to cover its costs. The new program would be under the umbrella of the nation’s Medicaid program, which provides free or low-cost medical coverage to the needy and is jointly funded by state and federal governments.

If implemented, the waiver proposal would allow Medicaid to pay for a set of services up to 90 days prior to an inmate’s release, “including access to medicines for opioid use disorder and care coordination ... giving that individual a strong foundation to transition into recovery ecosystem,” according to information provided by the Walz administration.

Currently, a lamentable and longstanding federal policy known as the “Medicaid Inmate Exclusion Policy” prevents this critical safety-net program from covering inmates’ care in public institutions. That shifts these costs to other levels of government, particularly to counties that may struggle in areas with smaller tax bases to provide substance abuse medications, which have a vital role in preventing relapse. A 2021 study by Minnesota Management and Budget found that less than half of all jails in Minnesota provide access to these medicines.

Fortunately, federal officials also have flexibility in administering the program, and do so by approving “waivers” to expand coverage and provide the resources to do so.

With overdose deaths hitting a grim new national record last year, the Biden administration is understandably encouraging states to apply for an 1115 waiver to improve treatment for inmates immediately prior to their release. It’s a smart public health strategy because so many people incarcerated struggle with this disease, and are at high risk of overdosing after a period of sobriety while behind bars. The generous financial assistance provided by the feds for this provides further incentive to act.

“Many of the capacity building and administrative dollars in this proposal come with a 90/10 federal match, making this a powerful lever to improve the infrastructure of Minnesota’s carceral institutions,” Jeremy Drucker, the state’s first director of the new Office of Addiction and Recovery, wrote in an April 16 letter to Minnesota Senate health care leadership.

Those federal dollars would keep a welcome lid on state costs for the program, which are projected to be $6.5 million for the first biennium (fiscal years 2024 and 2025) and then $12.6 million for the second biennium.

It’s unfortunate that Drucker’s letter had to be sent. Legislation to launch the program has made satisfactory progress in the state House but, as of Friday, was not included in the Senate’s Human Services omnibus bill, a key step for ultimate approval. That’s an oversight that Sen. John Hoffman, DFL-Champlin and chair of that chamber’s Human Services Committee, should remedy swiftly.

The waiver program has support from Minnesota counties and law enforcement around the state, with Hennepin County Sheriff Dawanna Witt a prominent advocate. Information provided by her office notes that Hennepin County has provided medically assisted treatment and medications for opioid use disorder for several years. Witt’s office also pointed to a national study showing that inmates with access to this treatment were significantly less likely to be re-incarcerated after five years.

Witt, in an interview, sounded the same call to compassion as Cass County’s Thompson. She urged legislators to approve the 1115 waiver program this year, saying this is a chance to “lead with humanity.” That’s a plea that should be heeded this session.