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veterans enrolled in the VA health care system. However, few other health programs, systems, or insurers provide a similar benefit. Having treatment available and transportation to that treatment upon release from incarceration is a common-sense way to help prevent overdose deaths among people leaving incarceration.235 Case management to connect people to treatment and transportation upon release should be an allowable cost for program services reimbursement. 4 The exceptions are that Medicaid dollars are available for an inmate experiencing an inpatient stay of 24 hours or more at a health care facility. See https://www.medicaid.gov/sites/default/files/Federal-PolicyGuidance/Downloads/sho16007.pdf « « « « « « 56 NATIONAL DRUG CONTROL STRATEGY Principle 4: Build the Treatment Workforce and Infrastructure Government estimates suggest the nation’s behavioral health, including the SUD, workforce will continue to experience staffing shortages,236 and we need to address future workforce needs for several behavioral health occupations.237 Racial disparities in health care utilization may be partially explained by the lack of providers of similar race and ethnicity as the populations being served.238 Hiring diverse practitioners who reflect the people and cultures they serve is an important workforce issue.239 Research has shown that PWUD may avoid health systems, particularly people who inject drugs,240 because they are often treated poorly. Fear of discrimination and stigmatization discourages people with SUD from seeking care and compromises the care they receive when they do seek it. Training all health professionals about SUD as a medical condition could improve the health care experience for PWUD, and integrating health services into organizations frequented by PWUD could increase use of health services by this population.241,242 As depicted in the HHS map243 below (Exhibit 1), the majority of counties in the United States are experiencing shortages of mental health professionals. The second HHS map244 below (Exhibit 2) highlights areas with low or no access to buprenorphine treatment for OUD at doctors’ offices. EXHIBIT 1 EXHIBIT 2 SUD treatment providers in criminal justice settings are also severely lacking. According to the Bureaus of Justice Statistics, in 2019 the US federal and state prison population was 1,430,800245 and local jails reported about 734,500 inmates at midyear 2019.246 According to the National Center on Addiction and Substance Abuse, this is a population in which an estimated 65-percent has an active SUD, most of whom go untreated.247 A. Expand Certified Community Behavioral Health Clinics (CCBHCs) and SUD services in Federally Qualified Health Centers (FQHCs). (Agencies Involved: HHS/ASPE, HRSA, SAMHSA) Multiple points of entry to treatment in communities are required to increase access to treatment services. States should explore establishing additional Certified Community Behavioral Health Clinics in places with greatest need to ensure local 24-hour access to SUD treatment services or linkage to services. Federal agencies should work with stakeholders to raise awareness and help improve uptake of these services, including access for law enforcement drop off and referral. Also, Federally Qualified Health Centers (FQHCs), a core provider of health services to underserved populations, should « « « « « « NATIONAL DRUG CONTROL STRATEGY 57 work to provide the full spectrum of SUD services. Federal agencies should work with stakeholders to raise awareness and help improve uptake of these services. B. Continue low-interest Federal loans for treatment program initiation in Rural Areas. (Agencies Involved: Treasury; USDA) Hospitals and treatment programs wishing to start or expand SUD treatment services programs in rural areas may need low-interest loans for brick and mortar expansion and program start-up funding. USDA Rural Development can provide support for infrastructure, equipment, and start-up costs for treatment services in rural areas through a variety of programs. Rural Development provides guaranteed loans through lenders to public bodies, non-profit organizations, federally recognized American Indian Tribes, and for-profit businesses in communities with populations of 50,000 or less through the Rural Development Community Facilities and Business and Industry Guaranteed Loan programs covered under the OneRD Guarantee Program. Direct loans and grants are available for government, non-profit, and tribal entities for projects in communities with populations of 20,000 or less through the Rural Development Community Facilities programs. Other support for treatment services includes funding for equipment and startup costs for treatment and workforce development through the Distance Learning and Telemedicine Program in communities of 20,000 or less. Additionally, utilities can obtain zero interest loans from the Rural Economic Development Loan and Grant program to relend to local businesses to support projects that create and retain employment in rural areas with a population of 50,000 or less. Funding for hospitals and other types of care facilities are common uses of this program. Rural Development also administers the Delta Health Care Services Grant
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