The Governor’s Office of Crime Prevention and Policy and the Maryland Judiciary once again highlight the need for state and local collaboration to improve health care delivery and outcomes for returning citizens. While these recommendations are nothing new, General Assembly and Administration support for these vulnerable populations has waned significantly over the last decade.

State agencies routinely call for more state action in assisting locals with the care of incarcerated individuals, and this year is no exception. The Governor’s Office of Crime Prevention and Policy (GOCPP) and the Maryland Judiciary once again are taking the lead in highlighting deficiencies and recommendations for better service delivery to vulnerable populations with substance use and mental health challenges. These insights demand more state involvement and come at a time when local detention centers currently shoulder the burden of an increasing number of missed state obligations.

GOCPP recently contracted the services of Health Management Associates (HMA) to conduct an analysis of behavioral health treatment capacity in local detention centers, highlighting barriers that demand state support. Concurrently, in May, the Maryland Judiciary, in partnership with GOCPP and the Maryland Department of Health’s Behavioral Health Administration, hosted the fourth statewide summit on behavioral health for justice-involved individuals, with an extensive audience of local and state officials, including General Assembly members as well as state cabinet and executive level attendees. Early feedback on that gathering suggests the need for targeted policies, collaboration, and funding support from state and local entities in order to move toward a more equitable, effective, and clinically appropriate system of care for justice-involved individuals. A final report is forthcoming.

The recommendations generally say that both the state and local agencies need to play a role particularly within the local detention centers. But counties currently are playing both roles by picking up state costs for state detainees in local facilities, paying state bills for substance used disorder treatment, and providing supplemental psychiatric care when state patients are left in local facilities for months at a time. The GOCPP assessment showed that even while many local facilities are making concerted efforts to deliver care and support for successful transitions back into the community many gaps in service are still apparent. This is evidence that the commitment locally is only one piece of the equation. The need for services has increased substantially and these gaps will only widen as the state continues to avoid playing their statutorily required role without the General Assembly holding them accountable.

Picking up the tab for state costs in local detention centers is beginning to take a significant toll but is not the only challenge. The GOCPP report makes clear that even though local facilities demonstrate a strong and shared commitment to meeting the behavioral health needs of their populations, workforce shortages, insufficient and aging infrastructure, and delays in accessing higher levels of care at the state, significantly undermine their efforts.

MACo supported legislation in the most recent General Assembly session to encourage more state responsibility, with Delegate Peña-Melnyk and Senator Charles Sydnor taking the lead as long-time advocates of services for vulnerable populations. County representatives sat alongside sponsors, two state agencies – and with the consent of a third state agency – requesting the General Assembly move legislation forward to bind the state, more clearly to their obligation of funding medication assisted treatment for locally incarcerated individuals. The General Assembly took no action on the bill despite the extensive collaboration and consensus, citing fiscal challenges and a lack of time during the 90-day session. This effort at the time did not include the Maryland Judiciary, but findings from the 2025 summit could encourage their role, which would bring the total to four state agencies supporting a greater state commitment. With stakeholder groups and independent reports coming together during the 2025 legislative interim, an opportunity to move those initiatives forward and implement some of the findings from the interim discussions could culminate in legislation during the 2026 session.