Eastern Ohio Correction Center: MAT & Aftercare
A Dedicated MAT and Aftercare Model Closing the Treatment Gap Inside a Community‑Based Facility
Eastern Ohio Correction Center used its first opioid settlement award to create a dedicated medication-assisted treatment and aftercare specialist position and to pay for injectable MAT medications for residents across nine Appalachian Ohio counties, closing a long-standing gap between the substance use treatment its clients need and the medical funding its state corrections budget does not cover.
The Challenge They Were Addressing
Roughly 95 percent of the 340 residents EOCC serves each year arrive with a substance use disorder, and most have an opioid use history. EOCC is a community-based correctional facility, an alternative to prison where felony clients step up from probation violations or step down from longer sentences, typically for a four-month stay. Ohio Department of Rehabilitation and Correction dollars cover cognitive behavioral treatment, education, and life skills programming at a per-diversion rate. They do not cover medical services, and they do not cover medication.
That left a clear structural gap. Clinical staff could run substance use groups and cognitive behavioral programming, but the facility had no reliable way to pay for the medication half of medication-assisted treatment, and no dedicated staff position to coordinate it. Because EOCC is designated as a detention facility, residents are not Medicaid-eligible during their stay, so there was no third-party payer to pick up the cost. For years the program pieced together support by asking local drug and alcohol boards for partial funding and working with the Ohio Department of Behavioral Health on reimbursement for medications the facility had already paid for out of its operating budget.
The opioid settlement opportunity through the Ohio Attorney General's office changed that. The AG initially offered settlement dollars only to jails, then opened the program to Ohio's 19 community-based correctional facilities. EOCC applied for close to the maximum allowed, $199,721, and received its full award. For the first time, the facility had a dedicated funding stream to pay for injectable MAT and to staff the coordination work that makes MAT a real clinical pathway rather than a referral on paper.
What They Built
EOCC used its settlement dollars to stand up two things at once: a dedicated MAT and aftercare specialist position, and a medication budget to pay two community MAT providers for the actual injections residents receive. Together they form a complete clinical pathway inside a facility where no such pathway existed before.
The MAT and aftercare specialist is a certified peer support specialist under Ohio's credentialing board. She sits at the front of the clinical pathway and at the back. At the front, she meets every new resident, walks them through what medication-assisted treatment is, explains the three injectable options EOCC supports (Vivitrol, Sublocade, and Brixadi), and helps each resident make an informed choice. At the back, she organizes the resident's appointments with the two contracted MAT providers, tracks the injection schedule, and stays in virtual contact for roughly two months after release to sustain continuity through the transition home.
Because residents come from nine different counties, the aftercare hand-off is explicit. Before release, the specialist identifies a local MAT provider in the resident's home county, confirms a first appointment, and enrolls the resident in Ohio Medicaid so coverage starts the day they walk out. Medicaid enrollment at release is close to universal, around 99 percent, which means the resident leaves with a Medicaid card, a provider, and a confirmed appointment rather than a referral list. The new provider picks up the prescription, and the injection schedule continues without a gap.
EOCC uses injectables only. Oral formulations such as Suboxone were ruled out because the DEA storage requirements cannot be met in the facility's current configuration. Methadone is also not part of the model because no methadone clinic is within a drivable distance of either site, and daily transport for a four-month population is not operationally feasible. The injectable-only approach simplifies logistics, supports a one-injection-per-month cadence, and lets the contracted MAT providers deliver the service on-site or at a nearby clinic.
Key Program Components
Who You Need at the Table
What made a willing partner essential vs. optional?
Required partners are the ones without whom no medication reaches a resident. The Ohio Attorney General's Office writes the rules for settlement eligibility and approves the award. The Ohio Department of Rehabilitation and Correction defines the programming scope inside which EOCC operates. The two contracted MAT providers physically deliver the injections and run the lab work. The facility governing board authorizes the new position and the financial architecture. Remove any one of these and the program stops.
Helpful partners extend reach and smooth the transition back into the community. Sheriff's departments, drug courts, probation offices, and local drug and alcohol boards shape who arrives at EOCC and what supports follow them home. Ohio Medicaid and the Department of Behavioral Health carry residents from release into ongoing care. These partners were not prerequisites for launch, but they determine whether a resident's recovery survives the first ninety days after leaving the facility.
Budget Breakdown
What is the minimum viable budget to replicate this?
The EOCC experience points to a floor of roughly $200,000 per year for a facility serving several hundred residents with high SUD prevalence. About one-third of that covers a dedicated MAT and aftercare specialist with credentialed peer support experience. The remaining two-thirds covers injectable medications and lab work for the residents who choose MAT, at approximately $1,700 per person per month. A smaller facility could run leaner, but the two pieces cannot be separated: the position without the medication budget produces education without access, and the medication budget without the position produces access without informed choice.
What Worked and Why
Specific decisions or design features that drove success
Creating a dedicated position, rather than layering MAT responsibilities onto existing clinical or case-management staff, is the design choice that carries the program. Residents enter EOCC with a fixed window to begin a medication pathway, enroll in Medicaid, identify a home-county provider, and confirm a first appointment. A part-time responsibility does not meet that window. A full-time specialist does, and the role exists only because the settlement award funded it.
Hiring a candidate with both peer support credentials and MAT-specific expertise gave the position reach it would not otherwise have. A certified peer can have conversations about medication, recovery, and informed choice that a purely clinical staffer cannot. Residents who were skeptical of MAT at intake have chosen it after structured education from someone who understood both the clinical and the lived experience.
Standardizing on injectables only, rather than mixing injectables with oral formulations, simplified the operational stack. No DEA-compliant storage buildout was needed. No daily dosing logistics for methadone. The specialist coordinates one injection per month per resident with one of two contracted providers. The clinical complexity stays with the providers; the facility handles education, enrollment, and scheduling.
Keeping the settlement award in a separate account from ODRC per-diversion funds protected the program from competing financial pressures and kept quarterly reporting to the Attorney General simple. The financial architecture mirrors the program architecture: settlement dollars pay for what no other stream will pay for, and nothing else.
Building the pre-release warm hand-off into the specialist's role, not the discharge paperwork, changed what release day looked like. Approximately 99 percent of residents leave EOCC enrolled in Ohio Medicaid with a confirmed first appointment at a MAT provider in their home county. The injection schedule continues without interruption, which is the point of using injectables in the first place.
Early outcomes and data
Roughly 340 residents per year across the men's and women's facilities are eligible to receive MAT education and enrollment support.
Approximately 95 percent of EOCC residents present with a substance use disorder at intake.
Approximately 99 percent of residents are enrolled in Ohio Medicaid before release, with a confirmed first appointment at a home-county MAT provider.
Two memoranda of understanding in place with On Demand and Southeast as contracted MAT providers delivering Vivitrol, Sublocade, and Brixadi.
Virtual aftercare check-ins continue for approximately two months post-release through the MAT and aftercare specialist.
Higher-than-expected resident uptake of MAT following structured education; program leadership anticipates the medication budget may be fully committed before the end of Year 1.
Quarterly financial reporting to the Ohio Attorney General's Office on track to support renewal for two additional years.
Lessons Learned
Ask for more than you think you need. The Year 1 award covers one specialist and a medication budget sized to conservative uptake assumptions. Real uptake, following structured informed-choice education, is running higher than projected, and program leadership expects the medication line to be fully committed before the grant year ends. Future requests will be sized to actual demand, not to an initial estimate.
Write the job description before hiring. The single most important decision in launching this program was what the MAT and aftercare specialist position was defined to do. A thoughtful, outcome-anchored job description attracts the right candidate and makes the first year of work legible. A vague description produces a position that drifts toward general case management.
Recognize that clinical experience alone is not enough. A strong clinician without MAT-specific knowledge cannot do this job well. The combination that works is MAT-specific experience plus a credential (such as certified peer support specialist) that supports conversations about medication choice from both clinical and lived-experience angles.
Keep the settlement account separate and report on a steady cadence. Holding the $199,721 in a standalone account, distinct from the facility's ODRC operating funds, simplified quarterly reporting to the Attorney General and kept the program on a clear path to renewal for two additional years. Financial clarity protects programmatic continuity.
Plan for the post-release window deliberately. The strongest in-facility MAT program fails if the first 30 days after release are unmanaged. Two months of virtual aftercare check-ins by the same person who educated and enrolled the resident is the minimum; more is better. The warm hand-off is not a line item to cut when budgets tighten.