State correctional officials and clinical leaders on Jan. 17 described the Department of Corrections’ (DOC) three-year contract with Wellpath, the private vendor that provides health services inside Vermont’s correctional facilities, and reviewed recent changes to how the department treats opioid use disorder in custody.

The DOC contract with Wellpath began in July 2023 and is paid as a per-member-per-month rate based on a set population; the department said costs escalate over the three-year term to reflect health-care inflation. Aviva Tabah, executive director of health and wellness for DOC, said the payment model “is based on a per member per month calculation, which reflects all of the expenses of the healthcare services that we provide people who are in custody.”

The contract includes a 10% administrative fee and performance-based incentives that can add up to 3% of the contract value if Wellpath meets agreed metrics; DOC officials also described liquidated-damage provisions the state can invoke if performance standards are not met. Committee members raised transparency and continuity concerns after recent national press reporting that parts of Wellpath’s corporate structure had filed for bankruptcy. DOC staff said corporate leadership has assured the state that Vermont operations and vendor payments will continue; the department said it is monitoring the situation and that Vermont vendors would be paid in full.

Why it matters: Corrections health care affects the safety of people in custody and of communities to which they return. Officials said aligning in-custody treatment with community standards reduces post-release overdose risk and recidivism.

What DOC and Wellpath described

- Scope and scale: DOC officials said the system serves an average daily population of roughly 1,300 people and roughly 1,800 unique individuals each month. Wellpath provides routine clinic care, infirmary-level care, mental health, dental and specialty care through on-site and off-site services.
- Utilization metrics cited by DOC/Wellpath: monthly initial health screenings (hundreds per month), more than 3,000 sick-call requests per month, roughly 100 specialty visits per month and tens of thousands of prescriptions dispensed systemwide (figures cited by presenters). Patient-satisfaction surveys conducted in 2023 and again in the fall showed improvement, DOC staff said; the most recent results were not included in the materials provided to the committee but will be shared with legislators.
- Contract protections: DOC staff said the contract requires regular reporting, quarterly quality reviews and weekly contract-management meetings. Wellpath may be required to pay cost overruns up to a threshold, beyond which the parties negotiate; the state can withhold liquidated damages for failures to meet contract obligations.

MOUD policy and clinical changes

The committee heard that Vermont’s in-custody medication program, required by state law adopted after earlier committee work, was established to match community levels of care rather than offer a lower standard in correctional settings. Speakers described recent updates to assessment and induction protocols for medication for opioid use disorder (MOUD, sometimes called medication-assisted treatment or MAT in earlier legislation).

Clinical leadership described a move to more rapid, higher-dose buprenorphine induction protocols for people who arrive in withdrawal, reflecting federal and specialty guidance. A Wellpath clinical leader told the committee that "we need to give buprenorphine" to people in withdrawal rather than waiting for lengthy assessments when clinically indicated. DOC and Wellpath officials said provider confidence, training, night-shift workflows and privacy around medication lines remain barriers they are working to address.

Officials also discussed methadone: DOC currently does not operate as an opioid treatment program (OTP) and therefore does not provide on-site methadone maintenance; the agencies coordinate with community OTPs for individuals who need methadone. Presenters cautioned that providing liquid methadone in a facility requires additional controls because of diversion risks.

Bankruptcy, vendor continuity and transparency

Committee members pressed DOC and Wellpath about national reports that parts of Wellpath’s corporate structure had sought bankruptcy protection. DOC officials said the Vermont contract and its operating component have continued to run and that Vermont vendors will receive full payment; they said they are tracking vendor concerns and communications but have not withheld payments or invoked contract penalties to date.

Quotations

"The cost is based on a per member per month calculation, which reflects all of the expenses of the healthcare services that we provide people who are in custody," said Aviva Tabah, executive director of health and wellness for DOC.

"We need to give buprenorphine," a Wellpath clinical leader said in describing induction practices for patients presenting in withdrawal.

Context and next steps

DOC officials said they will return to the committee for deeper briefings on MOUD and implementation steps. They also urged legislators to consider IT and Medicaid enrollment changes being implemented next year (a Medicaid 1115 waiver described by staff) that the department said will improve pre-release care coordination for sentenced people who will be eligible for Medicaid up to 90 days before release. Staff said technical and IT work is required to implement that change.

Limitations and open items

Committee materials and testimony left some figures—such as exact monthly counts for certain services and the most recent patient-survey data—marked as to-be-shared. DOC staff said they will provide the committee with performance metrics and the latest patient-satisfaction results on request.