The novel coronavirus (COVID-19) pandemic has put a spotlight on systemic health capacity and coverage issues in the U.S.¹  As case counts continue to climb, the ability to test and treat all patients, including the uninsured, will continue to be a challenge. Similarly, there are questions about the out-of-pocket costs patients who are uninsured or under-insured may face. One possible mechanism for additional assistance, both in covering certain costs and in providing additional care and disaster planning is the National Disaster Medical System (NDMS). The NDMS is a network of intermittent federal employees made up of health and planning professionals trained to deploy in the event of a natural or manmade disaster, including mass casualty or loss of healthcare infrastructure, and during large public scale events. It also includes a program that can be used to reimburse health care providers for care provided to patients in a disaster. This explainer describes the NDMS, explores how it has been used in the past, and assesses how it is already being used or has been proposed to be used to fill gaps in the current response to the COVID-19 pandemic.

What is the National Disaster Medical System?

The NDMS is a coordinated network of 4,600 authorized intermittent federal employees organized into teams and trained to deploy in the event of a natural or manmade disaster, including mass casualty or loss of healthcare infrastructure, a disease outbreak, and during large public scale events.^2 ,3  NDMS teams offer “medical and emergency management services and subject matter expertise” at the request of federal departments, state, local, and tribal or territorial authorities.⁴  The NDMS is administered by the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response in partnership with the Department of Defense and Office of Veterans Affairs.

NDMS was first established in the 1980s to respond to military casualties but has since shifted to include a civilian focus.^5 ,6  NDMS operated administratively until it was authorized under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, which was created in response to the anthrax attacks to bolster national public health infrastructure.⁷  Its authority has been subsequently extended several times and it has shifted from being administered at HHS to within FEMA at the Department of Homeland Security, following 9/11, and then most recently, back to HHS after wide criticism of mismanagement of the Hurricane Katrina response.^8 ,9 ,10  It is currently authorized through the Public Health Services Act.¹¹  The HHS Secretary has broad authority to deploy NDMS without specific statutory triggers or thresholds needing to be met.¹² 

NDMS personnel work in teams made up of physicians, nurses, dentists, logistical and safety specialists, and other health and support professionals¹³  and provide medical services, including public health support, medical transportation, veterinary services, and fatality management support, filling in the gaps of existing infrastructure.^14 ,15 ,16  For instance, NDMS teams may assist in health care settings, support medical shelters, provide prophylaxis during an outbreak, stand on-call during public events, or assist in wartime conflict. Teams can also deploy to assist in the “stabilization and transfer of all patients including ill/injured and nursing home patients.”¹⁷ 

Teams are typically activated for two weeks at a time and include:¹⁸ 

• Disaster Medical Assistance Teams (DMAT): Provide medical care and support during public health and medical emergencies in response to natural and manmade disasters, acts of terrorism, disease outbreaks, and special events. DMATs operate as self-sufficiently as possible with little resupply needed for the first 72 hours. DMATs include health care providers and non-clinical support staff and can deploy within eight hours of notification in 7, 14, or 35 person health and medical task force (HMTF) teams.
• Trauma and Critical Care Teams (TCCT): Provide trauma and critical care support during public health emergencies and special events, by providing a deployable advance unit, augmentation to existing medical facilities, patient transport preparation, or establishing stand-alone field hospitals. TCCTs include trauma and surgical professionals and deploy as 9, 10, 28, or 48-person units each with the capacity to conduct specific trauma related actions.
• Disaster Mortuary Operational Response Teams (DMORT): Provide services managing fatalities resulting from disasters, including victim identification support. Team structures include DMORT Fatality Management Assessment Teams and DMORT 12-Hour Morgue Operations Teams.
• Victim Information Center (VIC) Team: Supports local authorities during mass casualty events, including through the collection of ante-mortem data and liaising with victims’ families and other responsible parties in support of the DMORT.
• National Veterinary Response Team (NVRT): Provide veterinary care to service animals during disasters and large events. The NVRT is a single national team and includes veterinarians and animal health technicians.

Definitive Care Reimbursement Program

In addition to directly providing care to patients, the NDMS Definitive Care Reimbursement Program can reimburse eligible providers delivering definitive medical care to NDMS patients according to certain guidelines and provided funding is available.¹⁹  The NDMS definitive care reimbursement program is rarely activated and given statutory limitations on how the funds can be used, Congress has at times provided supplemental appropriations to bolster NDMS efforts, including for the 2005 Hurricane Katrina and 2010 Haiti earthquake responses (see below for details on the COVID-19 response).²⁰ 

Any Medicare and Medicaid participating provider giving care to an NDMS patient is eligible for reimbursement, including over 1,900 hospitals across the country that have signed an NDMS agreement and participate in the program.^21 ,22  Medicaid and Medicare providers that have not signed an agreement with the program can still receive reimbursement, albeit at a slightly lower rate. Facilities and practitioners are reimbursed at no less than the lesser of the billed amount or a rate closely tied to Medicare or Medicaid reimbursement levels (additional details provided in Table 1.).

How is the program funded?

NDMS administrative costs are funded through appropriations to the HHS Public Health and Social Services Emergency Fund under the Assistant Secretary for Preparedness and Response at HHS. In FY2020 the NDMS was funded at $57 million. The Trump Administration’s FY2021 Budget proposal, requested $88 million for the program, a $31 million (54%) increase over the FY2020 enacted amount. The increase in the FY2021 request is for the purposes of continuing a pediatric disaster pilot program ($20 million), maintaining 50 portable dialysis units ($5 million), supporting the emPOWER program ($1 million),²³  and training up to 6,7000 staff on field disaster medical operations, including highly infectious disease response ($5 million).²⁴ 

Deployment costs are not funded through the appropriations to the program and may be funded by the agency responsible for costs related to federal incident/event response. In other cases, HHS assumes the cost of deployment.²⁵  Additionally, NDMS administrative funding at the DOD and VA are not available.

When has it been used in the past?

NDMS has deployed teams to assist with more than 300 domestic and two international incidents since it was established with deployment of medical response teams in the wake of major disasters being the most common activation.^26 ,27 

As noted, NDMS teams are deployed to provide medical support in response to disasters and emergencies such as floods, hurricanes, tornados, terrorist attack, or the wake of a disease outbreak, as well as large-scale national events such as Presidential Inaugurations, political conventions, and papal visits.²⁸ 

How is the NDMS being used to address the COVID-19 Pandemic?

The Families First Coronavirus Response Act, signed into law by President Trump on March 18, 2020, is the second major piece of legislation responding to the COVID-19 pandemic.³²  The Bill includes $1 billion for the Public Health and Social Services Emergency Fund leveraging the National Disaster Medical System’s Definitive Care Reimbursement Program to deliver certain services.³³ 

The allocation in the Families First Act is specifically for the purposes of paying provider reimbursement claims for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19 and testing related visits for the uninsured. At this time the allocation does not appear to cover costs related to treatment for those with COVID-19, though the administration did reportedly consider this as a policy option at an earlier point.³⁴  Democratic presidential candidate Joe Biden has proposed expanding the authority and funding for the program to cover COVID-19 treatment costs for people who are uninsured as well as cost-sharing for people who are insured. The allocation for this limited purpose somewhat differs from traditional use of NDMS funding which can more broadly cover a range of health services related to the public health event.³⁵ 

In addition to providing reimbursement for certain COVID-19 related services, NDMS is positioned to assist with medical and strategic responses as requested, and has already been deployed to carry out several activities:

• NDMS teams have been reportedly deployed to strategic locations across the country, including to the states of Washington and Georgia, to provide support in caring for those who may have been exposed to SARS-CoV2.^36 ,37 
• NDMS Disaster Mortuary Operational Response Teams (DMORTs) have also been deployed, including to support New York City Medical Examiner’s Office and provide portable facilities.³⁸ 
• In addition, a Disaster Medical Assistance Team (DMAT), along with other federal emergency workers, was deployed to support American citizens on the Diamond Princess cruise ship in Japan and at the U.S. Embassy to provide medical care, medication, and behavioral health support on February 12, 2020.³⁹ 
• Along with others, NDMS personnel staffed a National HHS Incident Management Team (IMT) to assist in the COVID-19 related repatriation efforts from Wuhan and Diamond Princess.⁴⁰ 
• Moving forward, NDMS could continue to deploy teams to COVIS-19 “hot spots,” bolstering regional health system capacity particularly taxed by the pandemic. For instance, NDMS could provide assistance to hard hit nursing homes to assist with care and transportation, as was done during Hurricane Katrina.⁴¹  Further, stipulations around any additional funding for provider reimbursement could be loosened to allow for coverage of treatment as well as diagnostics.

1. Person-Kaiser Health System Tracker. Kamal, R., Kurani, N., McDermott, D., and Cox, C. How prepared is the US to respond to COVID-19 relative to other countries? 2020. https://www.healthsystemtracker.org/chart-collection/how-prepared-is-the-us-to-respond-to-covid-19-relative-to-other-countries/ ↩︎
2. Congressional Research Service. Deployable Federal Assets Supporting Domestic Disaster Response Operations: Summary and Considerations for Congress. 2015. Available at: https://crsreports.congress.gov/product/pdf/R/R43560/9 ↩︎
3. Department of Health and Human Services. Public Health and Social Services Emergency Fund FY2021 Justification of Estimates for Appropriations Committee, 2020. https://www.hhs.gov/sites/default/files/fy-2021-phssef-cj.pdf ↩︎
4. Department of Health and Human Services. Public Health and Social Services Emergency Fund FY2021 Justification of Estimates for Appropriations Committee, 2020. https://www.hhs.gov/sites/default/files/fy-2021-phssef-cj.pdf ↩︎
5. Francso, C, et al. “The National Disaster Medical System: Past, Present, and Suggestions for the Future.” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Volume 5, Number 4, 2007. ↩︎
6. While agency budget justifications state the NDMS was formed in 1987, Congressional Research Service reports and other non-agency documents report the start year as 1984. ↩︎
7. Congressional Research Service. Public Health Security and Bioterrorism Preparedness and Response Act (P.L. 107-188): Provisions and Changes to Preexisting Law. 2002. https://www.everycrsreport.com/reports/RL31263.html ↩︎
8. U.S. House of Representatives. Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina. 109th Congress; 2nd Session. 2006. https://www.nrc.gov/docs/ML1209/ML12093A081.pdf ↩︎
9. U.S. House of Representatives Committee On Government Reform —Minority Staff Special Investigations Division. The Decline of The National Disaster Medical System. 2005 https://www.hsdl.org/?view&did=463751 ↩︎
10. Phillips, Z. Government Executive. “The emergency medical system returns home, hopefully to better health.” February 21, 2007. https://www.govexec.com/management/2007/02/geographic-cure/23771/ ↩︎
11. Congressional Research Service. Deployable Federal Assets Supporting Domestic Disaster Response Operations: Summary and Considerations for Congress. 2015. Available at: https://crsreports.congress.gov/product/pdf/R/R43560/9 ↩︎
12. Congressional Research Service. Deployable Federal Assets Supporting Domestic Disaster Response Operations: Summary and Considerations for Congress. 2015. Available at: https://crsreports.congress.gov/product/pdf/R/R43560/9 ↩︎
13. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: The Best of Care in the Worst of Times. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx ↩︎
14. Department of Health and Human Services. Public Health and Social Services Emergency Fund FY2021 Justification of Estimates for Appropriations Committee, 2020. https://www.hhs.gov/sites/default/files/fy-2021-phssef-cj.pdf ↩︎
15. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: The Best of Care in the Worst of Times. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx ↩︎
16. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: The Best of Care in the Worst of Times. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx ↩︎
17. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: The Best of Care in the Worst of Times. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx ↩︎
18. Department of Health and Human Services. Public Health and Social Services Emergency Fund FY2021 Justification of Estimates for Appropriations Committee, 2020. https://www.hhs.gov/sites/default/files/fy-2021-phssef-cj.pdf ↩︎
19. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: NDMS Definitive Care Reimbursement Program. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/definitive-care/Pages/default.aspx ↩︎
20. Congressional Research Service. Deployable Federal Assets Supporting Domestic Disaster Response Operations: Summary and Considerations for Congress. 2015. Available at: https://crsreports.congress.gov/product/pdf/R/R43560/9 ↩︎
21. U.S. Dept. of Health and Human Services. Press Release: HHS activates program to reimburse hospitals caring for patients evacuated following Hurricane Irma. September 17, 2017. Available at: https://www.hhs.gov/about/news/2017/09/17/hhs-activates-program-reimburse-hospitals-caring-patients-evacuated-hurricane-irma.html ↩︎
22. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: NDMS Definitive Care Reimbursement Program. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/definitive-care/Pages/default.aspx ↩︎
23. The emPOWER program “provides datasets and tools to public health agencies to identify individuals who rely on electricity-dependent medical equipment and devices.” Department of Health and Human Services. Public Health and Social Services Emergency Fund FY2021 Justification of Estimates for Appropriations Committee, 2020. https://www.hhs.gov/sites/default/files/fy-2021-phssef-cj.pdf ↩︎
24. U.S. Dept. of Health and Human Services. FY2021 Budget in Brief. https://www.hhs.gov/sites/default/files/fy-2021-budget-in-brief.pdf ↩︎
25. Congressional Research Service. Deployable Federal Assets Supporting Domestic Disaster Response Operations: Summary and Considerations for Congress. 2015. Available at: https://crsreports.congress.gov/product/pdf/R/R43560/9 ↩︎
26. Department of Health and Human Services. Public Health and Social Services Emergency Fund FY2021 Justification of Estimates for Appropriations Committee, 2020. https://www.hhs.gov/sites/default/files/fy-2021-phssef-cj.pdf ↩︎
27. Congressional Research Service. Deployable Federal Assets Supporting Domestic Disaster Response Operations: Summary and Considerations for Congress. 2015. Available at: https://crsreports.congress.gov/product/pdf/R/R43560/9 ↩︎
28. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: The Best of Care in the Worst of Times. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx ↩︎
29. Congressional Research Service. Deployable Federal Assets Supporting Domestic Disaster Response Operations: Summary and Considerations for Congress. 2015. Available at: https://crsreports.congress.gov/product/pdf/R/R43560/9 ↩︎
30. Department of Health and Human Services. Public Health and Social Services Emergency Fund FY2021 Justification of Estimates for Appropriations Committee, 2020. https://www.hhs.gov/sites/default/files/fy-2021-phssef-cj.pdf ↩︎
31. Department of Health and Human Services. Public Health and Social Services Emergency Fund FY2021 Justification of Estimates for Appropriations Committee, 2020. https://www.hhs.gov/sites/default/files/fy-2021-phssef-cj.pdf ↩︎
32. Moss, et al. The Families First Coronavirus Response Act: Summary of Key Provisions. 2020. https://modern.kff.org/global-health-policy/issue-brief/the-families-first-coronavirus-response-act-summary-of-key-provisions/ ↩︎
33. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: The Best of Care in the Worst of Times. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx ↩︎
34. Armour, S. Wall Street Journal. “U.S. Weighs Paying Hospitals for Treating Uninsured Coronavirus Patients.” March 3, 2020. Available at: https://www.wsj.com/articles/trump-administration-considering-paying-hospitals-for-treating-uninsured-coronavirus-patients-11583258943 ↩︎
35. U.S. Dept. of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency. National Disaster Medical System: The Best of Care in the Worst of Times. Accessed, April 19, 2020. https://www.phe.gov/Preparedness/responders/ndms/Pages/default.aspx ↩︎
36. U.S. Senate Committee on Homeland Security & Governmental Affairs. Hearing: The Federal Interagency Response to the Coronavirus and Preparing for Future Global Pandemics. March 5, 2020. https://www.hsgac.senate.gov/the-federal-interagency-response-to-the-coronavirus-and-preparing-for-future-global-pandemics ↩︎
37. CAM Erie. “We want to sincerely thank everyone in the healthcare industry for all of their dedication and determination during the COVID-19 pandemic. We also want to specifically thank our Board Chairman, Trevor Pearson, who is down in Georgia working for the NDMS team. #ThankYou.“ March 30, 2020. Tweet. https://twitter.com/CAMEriePA/status/1244656974668730376?s=20 ↩︎
38. HHS Office of the Assistant Secretary for Preparedness and Response (ASPR). “Responders from the NDMS’s Disaster Mortuary Assistance Teams are serving on the front lines of health by supporting the #NYC Medical Examiner’s Office and providing portable facilities to aid in the response. The heroic efforts of the men and women of NDMS DMORT demonstrate their commitment to treating each victim of #COVID19 with the dignity and respect they deserve until they can be returned to the families and loved ones.” LinkedIn Post. April 2020. https://www.linkedin.com/posts/hhs-aspr_nyc-covid19-activity-6654163801765629952-TInl ↩︎
39. Kadlec, R., M.D., Assistant Secretary for Preparedness and Response Witness Testimony. Senate Committee on Homeland Security & Governmental Affairs. Hearing: The Federal Interagency Response to the Coronavirus and Preparing for Future Global Pandemics. March 5, 2020.  https://www.hsgac.senate.gov/imo/media/doc/Testimony-Kadlec-2020-03-05-REVISED.pdf ↩︎
40. Kadlec, R., M.D., Assistant Secretary for Preparedness and Response Witness Testimony. Senate Committee on Homeland Security & Governmental Affairs. Hearing: The Federal Interagency Response to the Coronavirus and Preparing for Future Global Pandemics. March 5, 2020.  https://www.hsgac.senate.gov/imo/media/doc/Testimony-Kadlec-2020-03-05-REVISED.pdf ↩︎
41. Lurie, N., DeSalvao, K., and Finne, K. “Ten Years After Hurricane Katrina: Progress And Challenges Remain For US Emergency Preparedness.” Health Affairs Blog. August 27, 2015. https://www.healthaffairs.org/do/10.1377/hblog20150827.050201/full/ ↩︎

Addressing health care needs of people moving into and out of the criminal justice system and staff who work them is an important component of coronavirus response efforts and protecting and promoting public health within the communities in which correctional facilities are located. This brief provides data on spread of coronavirus within correctional facilities, discusses the health risks for the justice-involved population and the staff who work with them, identifies the role Medicaid can play in response efforts for justice-involved individuals, and highlights other steps correctional systems can take to mitigate risk of coronavirus for the justice-involved population and promote public health. It finds:

Data show confirmed coronavirus cases and deaths within federal and state correctional facilities and immigration detention centers. As of April 14, 2020, there were 694 confirmed coronavirus cases in the nation’s federal prisons, including 446 incarcerated individuals and 248 staff, as well as 14 reported deaths among inmates.¹  Comprehensive data are not available for state and local correctional systems. However, in New York City – one of the epicenters of the COVID-19 crisis – the Board of Correction reported two deaths and 961 confirmed cases of coronavirus among detained individuals (334 cases) and staff (627 cases) as of April 14, 2020.²  In Illinois, the Cook County Sherriff’s office reported three deaths and 323 confirmed cases among detained individuals, including 21 that were hospitalized as of April 14, 2020.³  Immigration and Customs Enforcement (ICE) reported 89 confirmed cases of coronavirus in detention centers operated or contracted by ICE, including local jails and prisons; 21 staff in ICE detention facilities; and 80 staff that are not assigned to detention facilities as of April 14, 2020.⁴ 

The millions of people who interact with the correctional system are at high risk for contracting coronavirus and experiencing serious illness if they become infected. About 2.2 million individuals are incarcerated in prison or jail each year, and millions more interact with the correctional system annually.⁵  In particular, there is rapid churn among the jail population that leads to significant movement into and out of jails. Between July 2016 and June 2017, an estimated 10.6 million people were admitted to local jails and, on average, jails experienced a weekly turnover rate of 54%.⁶  In addition, staff, health care workers, vendors, and visitors regularly move into and out of facilities. Coronavirus may spread easily among individuals who interact with correctional system given the close quarters and shared spaces within correctional facilities and extend into the broader community in which facilities are located. People in jails and prisons are at increased risk for experiencing serious illness from coronavirus due to high rates of underlying health problems. Justice-involved individuals also face a variety of social challenges that are associated with poorer health and increased barriers to accessing health care.

Medicaid coverage can enhance coronavirus response efforts for the justice-involved population. Medicaid facilitates access to care for eligible individuals moving into and out of justice system, particularly in states that have adopted the ACA Medicaid expansion to low-income adults. However, under current rules, Medicaid reimbursement for incarcerated individuals is limited to inpatient care provided in facilities subject to certain requirements. Medicaid coverage among incarcerated individuals will be increasingly important if hospital care needs grow among incarcerated individuals due to the COVID-19 crisis. States can also seek waivers to expand the role Medicaid can play in providing reimbursement for incarcerated individuals to enhance their coronavirus response.

Correctional systems can take a range of other steps to mitigate risks of coronavirus among justice-involved individuals to protect and promote public health. For example, correctional facilities can reduce admissions, increase the number of people released from jails and prisons, and reduce unnecessary contacts within facilities. A number of local jail systems and some state departments of corrections have released or are planning to release nonviolent, low-level offenders.⁷  All 50 states have implemented some form of restriction on visitation to correctional facilities, with 15 states suspending all visitation and 37 states suspending all visitation except for legal visits.⁸  Outside of facilities, courts can grant extensions on deadlines and suspend in-person proceedings and law enforcement agencies can limit arrests and/or expand citations in lieu of arrest policies. For individuals under community supervision, agencies can suspend all in-person reporting and check-ins, lengthen reporting periods, or allow people to connect remotely. Supervision agencies could also recommend early termination of supervision and/or suspend incarceration for noncompliance with supervision terms. Similar to correctional agencies, ICE has authority to curtail civil immigration enforcement and release individuals from custody to minimize public health risks of coronavirus. ICE has reported some changes to enforcement and detention facility operations in response to the COVID-19 crisis, but, to date, has taken limited steps to release individuals from detention facilities.

Introduction

Addressing health care needs of people moving into and out of the criminal justice system and staff who work with justice-involved individuals is an important component of coronavirus response efforts. Millions of people interact with the correctional system, including individuals moving into and out of jails, prisons, and immigration detention centers, as well as staff, health care workers, vendors, and visitors. Given the close quarters and shared spaces within correctional facilities, coronavirus and other infectious diseases may spread easily among individuals who interact with correctional system and extend into the broader communities in which facilities are located, including through transmission through workers and visitors. Further, justice-involved individuals are at increased risk for experiencing complications from coronavirus due to high rates of underlying health conditions. This brief provides an overview of health risks for the justice-involved population, discusses the role Medicaid can play in response efforts for justice-involved individuals, and identifies other steps states and localities can take to mitigate risk and spread of coronavirus among this population to protect and promote public health.

Data on Coronavirus Cases and Deaths

Data show confirmed coronavirus cases within federal and state correctional facilities and immigration detention centers. As of April 14, 2020, there were 694 confirmed coronavirus cases in the nation’s federal prisons, including 446 incarcerated individuals and 248 staff as well as 14 reported deaths among federal inmates.⁹  Comprehensive data is not available for state and local correctional systems. However, in New York City – one of the epicenters of the COVID-19 crisis – the Board of Correction reported two deaths and 961 confirmed cases of coronavirus among detained individuals (334 cases) and staff (627 cases) as of April 14, 2020.¹⁰  In Illinois, the Cook County Sherriff’s office reported three deaths and 323 confirmed cases of coronavirus among detained individuals, including 21 hospitalized individuals as of April 14, 2020.¹¹  ICE reported 89 confirmed cases of coronavirus in detention centers operated or contracted by ICE, including local jails and prisons; 21 staff in ICE detention centers; and 80 staff that are not assigned to detention facilities as of April 14, 2020.¹² 

The Justice-Involved Population

The criminal justice system is comprised of a range of different types of correctional facilities. Correctional facilities include prisons, which typically house longer-term felons or inmates serving a sentence of more than one year, and jails, which house individuals awaiting trial or sentencing and those convicted of misdemeanors and serving shorter terms that are typically less than one year. In addition, juvenile justice facilities house youth who have been convicted of offenses or who have not responded to intermediate sanctions. There also are several forms of community-based corrections, including probation, parole, and halfway houses. The federal government and states oversee prisons, while local cities or counties typically govern jails. There are over 3,200 jails nationwide housing individuals awaiting trial or serving a short sentence for a misdemeanor.¹³ 

About 2.2 million individuals are incarcerated in prison or jail each year, but millions more interact with the correctional system annually.¹⁴  Approximately 1.5 million individuals were incarcerated in prisons as of the end of 2016.¹⁵  Over the course of the year, about 600,000 individuals are admitted to prison and a similar number are released.¹⁶  As of midyear 2017, approximately 745,000 individuals were held in jails.¹⁷  About six in ten (65%) jail inmates were not convicted and awaiting court action; the remaining nearly four in ten (35%) were sentenced or convicted offenders awaiting sentencing.¹⁸  Given the shorter terms of jail inmates compared to prisoners, there is rapid churn among the jail population. Between July 2016 and June 2017, an estimated 10.6 million people were admitted to local jails and, on average, jails experienced a weekly turnover rate of 54%.¹⁹  The jail population is largely concentrated in large jails (that have an average daily population of 1,000 or more inmates), which house more than four in ten (43%) jail inmates but only account for 5% of all jail jurisdictions.²⁰  In addition to individuals incarcerated in prisons and jails, there were an estimated 423,000 correctional officers nationwide as of May 2019.²¹  An additional 4.5 million adults were under community supervision as of the end of 2016, and there were roughly 5 million entries to and exits from community supervision over the course of 2016.²²  About 80% of adults under community supervision are on probation, while the remainder are on parole.²³ 

ICE manages and oversees the nation’s civil immigration detention system, detaining individuals who are awaiting the outcome of their immigration cases or pending removal. People in ICE custody are housed in a variety of facilities, including ICE-owned and operated facilities; local, county, or state facilities; and contractor-owned and operated facilities.²⁴  Individuals held in ICE facilities include asylum seekers transferred from ports of entry, as well as community residents taken into custody by ICE in their homes, neighborhoods, or after an interaction with the criminal legal system. ICE uses dedicated facilities to house families with children who are going through immigration proceedings. ICE operates or contracts to operate over 200 detention facilities across the U.S. and, in fiscal year FY 2019, reported over 510,000 book-ins to those facilities, a 29% increase from the year prior.²⁵  The average length of stay for individuals in detention was over a month (34.3 days). Customs and Border Patrol (CBP) detains individuals on a short-term basis to allow for initial processing but will then transfer individuals to other agencies like ICE.²⁶ 

Health Risks for Justice-Involved Population

Coronavirus and other infectious diseases may spread easily among individuals who interact with correctional system given the close quarters and shared spaces within correctional facilities. Incarcerated individuals live in close contact with other individuals, including shared cells and shared living spaces, such as laundry and eating areas. Moreover, transmission can occur between facilities and the community in which they are located given that many individuals, such as staff and visitors, move into and out of facilities on a daily basis and the very high turnover rate in jails. Deficiencies in medical and hygiene practices within correctional facilities and immigration centers may also exacerbate risks of transmission. For example, previous research has found previous outbreaks of infectious diseases in ICE detention centers, reflecting conditions in the facilities.²⁷  Research also shows that, although correctional facilities and immigration detention centers are required to provide health care services, many individuals detained in these facilities go without needed care, receive inadequate or delayed care, or experience living conditions that present health risks, such as mold and unusable toilets.²⁸ 

People in jails and prisons are at risk for experiencing complications from coronavirus due to high rates of underlying health conditions. Chronic disease is prevalent among the population with higher rates of tuberculosis, asthma, diabetes, hypertension, HIV, hepatitis, stroke, and sexually transmitted disease compared to the general population.²⁹  They also have significant behavioral health needs. Over half of prison and jail inmates have a mental health disorder, with local jail inmates experiencing the highest rate (64%).³⁰  Moreover, the majority of inmates with a mental health disorder also have a substance or alcohol use disorder.³¹ 

Individuals moving into and out of the criminal justice system also face a variety of social challenges that are associated with poorer health and increased barriers to accessing health care. Poverty, unemployment, lower education levels, housing instability, and homelessness are all more prevalent issues among criminal justice-involved population than the general population.³²  This population also generally has higher rates of learning disabilities and lower rates of literacy.³³  Moreover, there are stark variations in incarceration rates by race and ethnicity. For example, the state imprisonment rate among Black adults is nearly six times the rate for White adults and Blacks and Hispanics represent disproportionately higher shares of the sentenced prison population compared to their share of the total adult population.³⁴  Data suggest that communities of color are at higher risk for health and economic challenges associated with COVID-19 and early data suggest that groups of color are experiencing disproportionately high rates of infection and death.³⁵ 

Role of Medicaid

Access to Medicaid for justice-involved individuals varies across states depending on whether they have adopted the Medicaid expansion to low-income adults. In the 37 states that have adopted the Medicaid expansion, nearly all adults with incomes up to 138% FPL ($17,609 for an individual as of 2020) are eligible for Medicaid. Eligibility for adults remains very limited in the remaining 14 states, where parent eligibility levels are often limited to less than half the poverty level and adults without dependent children generally are not eligible regardless of their income.

Amid the COVID-19 crisis, Medicaid coverage will be important for covering costs of inpatient hospital care provided to incarcerated individuals and for facilitating access care for individuals upon release. Current rules allow individuals to be enrolled in Medicaid while incarcerated, but Medicaid reimbursement for incarcerated individuals is limited to inpatient care provided at facilities that meet certain requirements. States can facilitate access to Medicaid coverage for people moving into and out of incarceration by suspending rather than terminating Medicaid coverage for enrollees who become incarcerated, which over 40 states reported doing as of January 2019.³⁶  Suspending eligibility expedites access to federal Medicaid funds if an individual receives inpatient care while incarcerated, which will be of increasing importance if inpatient care needs grow due to coronavirus. Suspending Medicaid coverage also allows individuals to have their coverage active immediately upon release, facilitating access to health care services in the community. In addition, some states take steps to enroll uninsured individuals into Medicaid and connect individuals to care in the community prior to release, which is particularly important for maintaining treatment and continuity of care for people with substance use disorder.³⁷ 

Some states are seeking waiver authority to expand the scope of services provided to incarcerated individuals that can qualify for Medicaid reimbursement as part of coronavirus response efforts. Section 1115 waivers allow states to test new approaches in Medicaid that differ from federal rules if they promote the objectives of the Medicaid program. Illinois has submitted a Section 1115 waiver to allow the state to claim federal Medicaid matching funds for the testing, diagnosis, and treatment of COVID-19 or other services provided in jails and prisons, and California has submitted a waiver proposal to allow for Medicaid coverage of testing and treatment.³⁸  In addition, South Carolina has submitted a Section 1115 waiver request to allow for federal matching funds for inpatient care provided to incarcerated individuals by a correctional facility.³⁹  Because South Carolina has not adopted the ACA Medicaid expansion to low-income adults, few adults in facilities will likely qualify for Medicaid-covered services. CMS has not previously waived the inmate exclusion, and the proposed waivers would not address issues related to whether services provided in correctional facilities meet other Medicaid standards, for example, related to quality, transparency, and infrastructure. States can also obtain Section 1135 waivers to waive certain Medicaid requirements during a national emergency, which has been declared due to COVID-19. States could pursue Section 1135 waivers to allow for greater flexibility over requirements that facilities must meet to receive Medicaid reimbursement for inpatient care, for example, to allow reimbursement for emergency facilities that primarily serve justice-involved individuals or to house justice-involved individuals within a single unit within a health care facility. This could help ensure care for people involved in the justice system while minimizing burdens on local hospitals serving the broader community and reduce correctional staff needs by eliminating requirements for one-to-one staff management requirements that are otherwise required for individuals in an inpatient setting.⁴⁰ 

Other Actions to Mitigate Risk

Correctional systems can take a range of other steps to mitigate risks of coronavirus among justice-involved individuals to protect and promote public health. For example, correctional facilities can reduce admissions, increase the number of people released from jails and prisons, and reduce unnecessary contacts within facilities, as described below. While these steps can help mitigate risks within facilities, individuals may face an array of challenges upon re-entry into the community, which may leave them at high risk for health, social, and economic challenges due to the COVID-19 pandemic.⁴¹ 

• Some state and local correctional systems have implemented policies to reduce the number of people entering into facilities. For example, several governors have issued executive orders to limit admissions into jails and prisons. In Alabama, the governor issued a proclamation to provide police officers discretion to issue a summons of complaint in lieu of arrest for minor crimes; California’s governor issued an order to temporarily halt the intake and/or transfer of inmates and youth in the state’s prisons and youth correctional facilities; and the governor in Illinois issued an order to suspend all admissions from county jails. Other examples include Jails in King County, Washington, which are no longer accepting people brought in for misdemeanors that do not pose a serious public safety concern, and Maine releasing over 12,000 bench warrants for outstanding fines.⁴² 
• The federal government and some state and local correctional systems have also taken some steps to release detained individuals.⁴³  In early April, Attorney General William Barr instructed the Bureau of Prisons (BOP) to maximize the use of home confinement for federal prisoners while prioritizing the hardest hit facilities and public safety.^44 ,45  Following the Attorney General’s memo, the BOP has placed 566 inmates on home confinement.⁴⁶  In addition, several governors have taken action to increase the number of people eligible for release from prison or jail. For example, governors in New Jersey, Ohio, Oregon, and Pennsylvania have directed correctional systems to take steps focused on releasing individuals who are particularly vulnerable to COVID-19. Other local jail systems and some state departments of corrections also have taken steps to release detained individuals, with most efforts targeted on release of nonviolent, low-level offenders (Box 1).⁴⁷ 

• All 50 states have implemented some form of restriction on visitation to correctional facilities, with 15 states suspending all visitation and 37 states suspending all visitation except for legal visits.⁵⁶ 

Outside of facilities, courts can grant extensions on deadlines and suspend in-person proceedings and law enforcement agencies can limit arrests and/or expand citation in lieu of arrest policies. For individuals under community supervision, agencies can suspend all in-person reporting and check-ins, lengthen reporting periods, and or allow people to connect remotely. Supervision agencies could also recommend early termination of supervision and/or suspend incarceration for noncompliance with supervision terms.

Similarly, ICE has authority to curtail civil immigration enforcement and release individuals from custody to minimize public health risks of coronavirus. ICE reported that, as of March 18, 2020, it would focus enforcement activities on public-safety risks and individuals subject to mandatory detention based on criminal grounds.⁵⁷  ICE also reiterated that, under existing policy, it will not carry out enforcement operations at or near health care facilities except in the most extraordinary of circumstances and that individuals should not avoid seeking medical care because they fear civil immigration enforcement. However, following the March 18^th announcement, Administration officials indicated that they will continue enforcement actions and that those actions would not be limited to individuals convicted of a crime or who pose a threat to public safety.⁵⁸  Also, although ICE has an existing policy of not carrying out enforcement actions at or near health care facilities, some individuals still may forego accessing health care services, including testing for coronavirus, due to fear. Prior to the coronavirus outbreak, research documented elevated fears of accessing health care and other services due to the current immigration policy environment.⁵⁹  ICE reports that it is screening individuals in detention for coronavirus and is housing individuals at risk for spreading coronavirus separately from the general population. ICE also has suspended social visitation in all detention facilities.⁶⁰  However, to date, it has taken limited steps to release individuals from detention facilities. A federal judge recently ordered ICE to release ten detained immigrants due to risks of contracting coronavirus and medical experts and civil rights groups have called for broader release actions.⁶¹  As of early April, media accounts report that ICE has identified 600 individuals held in detention for possible release because they are deemed as vulnerable to coronavirus and that 160 have already been released for these reasons. As of April 11, 2020, ICE reported holding 32,309 individuals held in detention.⁶² 

1. Federal Bureau of Prisons, “COVID-19.” Retrieved from https://www.bop.gov/coronavirus/ (accessed April 15, 2020). ↩︎
2. New York City Board of Correction. “Board of Correction Daily COVID-19 Update (April 14, 2020)”. (April 11, 2020). Retrieved from https://www1.nyc.gov/site/boc/covid-19.page (accessed April 15, 2020). ↩︎
3. Cook County Sheriff’s Office. “Update on COVID-19 Cases at Cook County Jail.” (April 14, 2020). Retrieved from https://www.cookcountysheriff.org/covid-19-cases-at-ccdoc/ (accessed April 15, 2020). ↩︎
4. U.S. Immigration and Customs Enforcement. “ICE Guidance on COVID-19.” Last updated April 14, 2020. Retrieved from https://www.ice.gov/coronavirus (accessed April 15, 2020). ↩︎
5. Danielle Kaeble and Mary Cowhig. Correctional Populations in the United States, 2016, (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, April 2018), https://www.bjs.gov/content/pub/pdf/cpus16.pdf ↩︎
6. Ibid. ↩︎
7. Prison Policy Initiative. “Responses to the COVID-19 Pandemic”. Last updated March 31, 2020. Retrieved from https://www.prisonpolicy.org/virus/virusresponse.html (accessed March 31, 2020). ↩︎
8. The Marshall Project. “Coronavirus Tracker: How Justice Systems are Responding in Each State. Updated March 25, 2020. Retrieved from https://www.themarshallproject.org/2020/03/17/tracking-prisons-response-to-coronavirus (accessed March 31, 2020). ↩︎
9. Federal Bureau of Prisons, “COVID-19.” Retrieved from https://www.bop.gov/coronavirus/ (accessed April 15, 2020). ↩︎
10. New York City Board of Correction. “Board of Correction Daily COVID-19 Update (April 14, 2020)”. (April 11, 2020). Retrieved from https://www1.nyc.gov/site/boc/covid-19.page (accessed April 15, 2020). ↩︎
11. Cook County Sheriff’s Office. “Update on COVID-19 Cases at Cook County Jail.” (April 14, 2020). Retrieved from https://www.cookcountysheriff.org/covid-19-cases-at-ccdoc/ (accessed April 15, 2020). ↩︎
12. U.S. Immigration and Customs Enforcement. “ICE Guidance on COVID-19.” Last updated April 14, 2020. Retrieved from https://www.ice.gov/coronavirus (accessed April 15, 2020). ↩︎
13. James Stephan and Georgette Walsh, Census of Jail Facilities, 2006 (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, December 2011), http://bjs.gov/content/pub/pdf/cjf06.pdf; and National Association of Counties, County Intelligence Connections (CIC) database, 2012. Some states operate unified prison and jail systems; in these states, the state Department of Corrections oversees both the prisons and jails in the state. See Barbara Krauth, A Review of the Jail Function within State Unified Corrections Systems (Longmont, CO: LIS, Inc., US Department of Justice, National Institute of Corrections Information Center, September 1997), http://nicic.gov/library/014024 ↩︎
14. Danielle Kaeble and Mary Cowhig. Correctional Populations in the United States, 2016, (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, April 2018), https://www.bjs.gov/content/pub/pdf/cpus16.pdf ↩︎
15. Ibid. ↩︎
16. Jennifer Bronson and E. Ann Carson, Prisoners in 2017, (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, April 2019), https://www.bjs.gov/content/pub/pdf/p17.pdf ↩︎
17. Zhen Zeng, Jail Inmates in 2017 (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, April 2019), https://www.bjs.gov/content/pub/pdf/ji17.pdf ↩︎
18. Ibid. ↩︎
19. Ibid. ↩︎
20. Ibid. ↩︎
21. U.S. Bureau of Labor Statistics, “Occupational Employment and Wages, May 2019, 33-3012 Correctional Officers and Jailers.” Last updated April 3, 2019, (Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics). Retrieved from https://www.bls.gov/oes/current/oes333012.htm#nat (accessed April 14, 2020). Note: Correctional Officers and Jailers are defined by the Bureau of Labor Statistics as employees who “[g]uard inmates in penal or rehabilitative institutions in accordance with established regulations and procedures. May guard prisoners in transit between jail, courtroom, prison, or other point. Includes deputy sheriffs and police who spend the majority of their time guarding prisoners in correctional institutions.” ↩︎
22. Danielle Kaeble, Probation and Parole in the United States, 2016, (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, April 2019), https://www.bjs.gov/content/pub/pdf/ppus16.pdf ↩︎
23. Ibid. ↩︎
24. U.S. Immigration and Customs Enforcement. “Detention Management.” Retrieved from https://www.ice.gov/detention-management (accessed March 31,2020). Note: A list of facility types used by ICE is also available at: Office of the Inspector General, ICE Does Not Fully Use Contracting Tools to Hold Detention Facility Contractors Accountable for Failing to Meet Performance Standards, (Washington, DC: Department of Homeland Security), January 29, 2020, https://www.oig.dhs.gov/sites/default/files/assets/2019-02/OIG-19-18-Jan19.pdf ↩︎
25. U.S. Immigration and Customs Enforcement. U.S. Immigration and Customs Enforcement Fiscal Year 2019 Enforcement and Removal Operation Report. Retrieved from https://www.ice.gov/sites/default/files/documents/Document/2019/eroReportFY2019.pdf (accessed April 10, 2020). ↩︎
26. Ibid. ↩︎
27. Jessica Leung et al., Notes from the field: Mumps in detention facilities that house detained migrants – United States, September 2018-August 2019. Morbidity and Mortality Weekly Report. 2019; 68(34):749-750. DOI: http://dx.doi.org/10.15585/mmwr.mm6834a4external icon and Bridget Kuehn. Mumps in migrant detention centers. JAMA. 2019;322(14):1344. DOI: 10.1001/jama.2019.15663 ↩︎
28. Wilper AP, Woolhandler S, Boyd JW, Lasser, KE, McCormick D, Bor DH, et al. The health and health care of US prisoners: results of a nationwide survey.  American Journal of Public Health. 2009; 99(4):666-72; Laura M. Maruschak and Marcus Berzofsky, Medical Problems of State and Federal Prisoners and Jail Inmates, 2011-12, (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, February 2015), https://www.bjs.gov/content/pub/pdf/mpsfpji1112.pdf; John V. Kelly (Acting Inspector General), Concerns about ICE Detainee Treatment and Care at Detention Faciltie, (Washington, DC: Department of Homeland Security, Office of Inspector General, December 11, 2017), https://www.oig.dhs.gov/sites/default/files/assets/2017-12/OIG-18-32-Dec17.pdf ↩︎
29. Laura Maruschak and Marcu Berzofsky, Medical Problems of State and Federal Prisoners and jail Inmates, 2011-12 (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, February 2015), https://www.bjs.gov/content/pub/pdf/mpsfpji1112.pdf ↩︎
30. Doris James and Lauren Glaze, Mental health problems of prison and jail inmates, (Washington, DC:US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, September 2006), http://www.bjs.gov/content/pub/pdf/mhppji.pdf ↩︎
31. Ibid. ↩︎
32. Kamala Mallik-Kane and Christy Visher, Health and prisoner reentry: how physical, mental, and substance abuse conditions shape the process of reintegration, (Washington, DC: Urban Institute, Justice Policy Center, February 2008), http://www.urban.org/UploadedPDF/411617_health_prisoner_reentry.pdf and Adam Looney and Nicholas Turner, Work and Opportunity Before and After Incarceration, (Washington, DC: The Brookings Institution, Economic Studies at Brookings), https://www.brookings.edu/wp-content/uploads/2018/03/es_20180314_looneyincarceration_final.pdf ↩︎
33. Caroline Wolf Harlow, Education and Correctional Populations, (Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, January 2003), http://www.bjs.gov/content/pub/pdf/ecp.pdf ↩︎
34. John Gramlich, The Gap Between the Number of Blacks and Whites in Prison is Shrinking, (Washington, DC: Pew Research Center), https://www.pewresearch.org/fact-tank/2019/04/30/shrinking-gap-between-number-of-blacks-and-whites-in-prison/ ↩︎
35. Samantha Artiga, Rachel Garfield, and Kendal Orgera, Communities of Color at Higher Risk for Health and Economic Challenges due to COVID-19, (Washington, DC, Kaiser Family Foundation, Kaiser Program on Medicaid and the Uninsured, April 2020), https://modern.kff.org/disparities-policy/issue-brief/communities-of-color-at-higher-risk-for-health-and-economic-challenges-due-to-covid-19/ ↩︎
36. Kaiser Family Foundation, States Reporting Corrections-Related Medicaid Enrollment Policies in Place for Prisons or Jails, SFY 2019, (Washington DC: Kaiser Program on Medicaid and the Uninsured, 2019), https://modern.kff.org/state-category/medicaid-chip/corrections-related-medicaid-policies/ ↩︎
37. Vikki Wachino and Samantha Artiga, How Connecting Justice-Involved Individuals to Medicaid Can help Address the Opioid Epidemic, (Washington DC: Kaiser Family Foundation, Kaiser Program on Medicaid and the Uninsured), https://modern.kff.org/medicaid/issue-brief/how-connecting-justice-involved-individuals-to-medicaid-can-help-address-the-opioid-epidemic/; and Jennifer Ryan et al., Connecting the Justice-Involved Population to Medicaid Coverage and Care: Findings from Three States, (Washington DC: Kaiser Family Foundation, Kaiser Program on Medicaid and the Uninsured), https://modern.kff.org/medicaid/issue-brief/connecting-the-justice-involved-population-to-medicaid-coverage-and-care-findings-from-three-states/ ↩︎
38. Illinois Department of Healthcare and Family Services, Illinois COVID-19 Section 1115(a) Demonstration Application. Submitted March 26, 2020. Retrieved from https://www.illinois.gov/hfs/SiteCollectionDocuments/03262020IllinoisCOVID19Section1115 DemonstrationProposalFinal.pdf (accessed April 10, 2020); and California Department of Health Care Services, Request for Section 1115 Demonstration Authority Related to the COVID-19 Public Health Emergency. Submitted April 3, 2020. Retrieved from https://www.dhcs.ca.gov/Documents/COVID-19/CMS-Ltr-and-CA-COVID-19-1115-Waiver-040320.pdf (accessed April 10, 2020). ↩︎
39. Joshua D. Baker, COVID-19 Section 1115(a) Demonstration Application Template, (South Carolina Department of Health and Human Services, March 27, 2020). Retrieved from https://msp.scdhhs.gov/covid19/sites/default/files/%282020-03-27%29%20SC%201115%20Inpatient%20COVID19.pdf (accessed April 10, 2020). ↩︎
40. Daniel Mistak, Addressing the Needs of Justice-Involved People During the COVID-19 Pandemic: An 1135 Waiver Approach, (Oakland, CA: Community Oriented Correctional health Services), https://cochs.org/files/medicaid/COVID-19-Justicie-Involved-1135-Waiver.pdf ↩︎
41. Benjamin A. Howell et al., Protecting Decarcerated Populations in the Era of COVID-19: Priorities for Emergency Discharge Planning, Health Affairs Blog (April 13, 2020), DOI: 10.1377/hblog20200406.581615 ↩︎
42. “Quickly, Safely Reducing the Jail Population so Staff can Ensure the Health of Everyone in Correctional Facilities”. King Count Executive Dow Constantine (March 24, 2020). Retrieved from https://www.kingcounty.gov/elected/executive/constantine/news/release/2020/March/24-jail-population.aspx (accessed April 10, 2020); and Chief Justices Susan Sparaco, Jed French, and Robert E. Mullen, Emergency Order Vacating Warrants for Unpaid Fines, Unpaid Restitution, Unpaid Court-appointed Counsel Fees, and Other Criminal Fees, Maine District Court, March 16, 2020. Retrieved from: https://www.courts.maine.gov/covid19/emergency-order-vacating-warrants-fines-fees.pdf (accessed March 31, 2020). ↩︎
43. Other examples of governors’ executive orders to expedite the early release of inmates in response to coronavirus include New Jersey, Ohio, Oregon, Pennsylvania, Texas, and the District of Columbia. ↩︎
44. Attorney General William Barr, “Increasing Use of Home Confiement at Institutions Most Affected by COVID-19”, Memorandum for Director of Bureau of Prisons (April 3, 2020). Retrieved from https://www.politico.com/f/?id=00000171-4255-d6b1-a3f1-c6d51b810000 ↩︎
45. Josh Gerstein, Barr to Speed Releases at Federal Prisons Hard Hit by Virus, Politico (April 3, 2020). Retrieved from https://www.politico.com/news/2020/04/03/barr-to-speed-releases-at-federal-prisons-hard-hit-by-virus-164175 (accessed April 5, 2020). ↩︎
46. Federal Bureau of Prisons. “Update on COVID-19 and Home Confinement”. Last updated April 5, 2020. Retrieved from https://www.bop.gov/resources/news/20200405_covid19_home_confinement.jsp (accessed April 6, 2020). ↩︎
47. Prison Policy Initiative. “Responses to the COVID-19 Pandemic”. Last updated March 31, 2020. Retrieved from https://www.prisonpolicy.org/virus/virusresponse.html (accessed March 31, 2020). ↩︎
48. California Department of Corrections and Rehabilitation, “CDCR Announces Plan to Further Protect Staff and Inmates from the Spread of COVID-19 in State Prisons”. News Release (March 31, 2020). Retrieved from https://www.cdcr.ca.gov/news/2020/03/31/cdcr-announces-plan-to-further-protect-staff-and-inmates-from-the-spread-of-covid-19-in-state-prisons/ (accessed April 10, 2020). ↩︎
49. Tracey Tully, 1,000 Inmates Will Be Released from N.J. Jails to Curb coronavirus Risk. The New York Times (March 23, 2020). Retrieved from https://www.nytimes.com/2020/03/23/nyregion/coronavirus-nj-inmates-release.html (accessed March 31, 2020). ↩︎
50. Prison Policy Initiative. “Responses to the COVID-19 Pandemic”. Last updated March 31, 2020. Retrieved from https://www.prisonpolicy.org/virus/virusresponse.html (accessed March 31, 2020). ↩︎
51. Lin Ta. “Iowa’s Prisons will Accelerate Release of Approved Inmates to Mitigate COVID-19”. (March 20, 2020). Retrieved from https://iowacapitaldispatch.com/2020/03/20/iowas-prisons-will-accelerate-release-of-approved-inmates-to-mitigate-covid-19/ (accessed April 1, 2020). ↩︎
52. Justin Carissimo. 1,700 Inmates Released from Los Angeles County in Response to Coronavirus Outbreak”. CBS News (March 24, 2020). Retrieved from https://www.cbsnews.com/news/inmates-released-los-angeles-county-coronavirus-response-2020-03-24/ (accessed April 1, 2020). ↩︎
53. New York City Board of Correction. New York City Board of Correction Calls for City to Begin Releasing People From Jail as Part of Public Health Response to COVID-19, (March 17, 2020). Retrieved from https://www1.nyc.gov/assets/boc/downloads/pdf/News/2020.03.17%20-%20Board%20of%20Correction%20Statement%20re%20Release.pdf (accessed April 1, 2020). ↩︎
54. New York City Office of the Mayor. “Transcript: Mayor de Blasio Holds Media Availability on COVID-19”. (March 24, 2020). Retrieved from https://www1.nyc.gov/office-of-the-mayor/news/188-20/transcript-mayor-de-blasio-holds-media-availability-covid-19 (accessed April 1, 2020). ↩︎
55. John Bowden. New York City has Released 900 Inmates in Response to Coronavirus Pandemic. The Hill (March 31, 2020). Retrieved from https://thehill.com/homenews/state-watch/490444-new-york-city-has-released-900-inmates-in-response-to-coronavirus (accessed April 1, 2020). ↩︎
56. The Marshall Project. “Coronavirus Tracker: How Justice Systems are Responding in Each State. Updated March 25, 2020. Retrieved from https://www.themarshallproject.org/2020/03/17/tracking-prisons-response-to-coronavirus (accessed March 31, 2020). ↩︎
57. U.S. Immigration and Customs Enforcement. “Updated ICE Statement on COVID-19”. (March 18, 2020). Retrieved from https://www.ice.gov/news/releases/updated-ice-statement-covid-19 (accessed March 31, 2020). ↩︎
58. Daniel Lippman and Anita Kumar, Immigration Chief on Thin Ice for Adopting Obama’s Stance During Crisis. Politico (March 27, 2020). Retrieved from https://www.politico.com/news/2020/03/26/white-house-immigration-chief-coronavirus-150497 (accessed April 10, 2020). ↩︎
59. Kaiser Family Foundation, Changes to “Public Charge” Inadmissibility Rule: Implications for Health and Health Coverage, (Washington, DC, Kaiser Family Foundation), https://modern.kff.org/disparities-policy/fact-sheet/public-charge-policies-for-immigrants-implications-for-health-coverage/ ↩︎
60. U.S. Immigration and Customs Enforcement. “ICE Guidance on COVID-19”. Last updated March 30, 2020. Retrieved from https://www.ice.gov/coronavirus (accessed March 31, 2020). ↩︎
61. Thakker et al. v. Doll. Memorandum and Order Filing. March 31, 2020. Retrieved from https://www.law360.com/articles/1259004/attachments/0 (accessed April 10, 2020); and the American Civil Liberties Union, “ACLU Demands that ICE Suspend Civil Enforcement, Release Detainees During COVID-19 Pandemic”. Press Release (April 3, 2020). Retrieved from https://www.aclu.org/press-releases/aclu-demands-ice-suspend-civil-enforcement-release-detainees-during-covid-19-pandemic (accessed April 10, 2020). ↩︎
62. U.S. Immigration and Customs Enforcement, “Detention Statistics”. Last updated April 8, 2020. Retrieved from https://www.ice.gov/detention-management (accessed April 15, 2020). ↩︎