Dyer is a road patrol deputy-turned social worker who campaigned on a reform vision that includes trying to steer people away from the justice system rather than draw them into it. Her win in November is a culmination of prior wins by a coalition of reformers in the county that also brought progressives into the prosecutor’s office and courts. 

Dyer has worked with these reformers to lay out plans to reduce unnecessary police encounters and arrests by limiting officers from making stops for certain low-level violations. She has pledged to address the stark racial disparities in traffic enforcement by ending quotas for traffic stops, and says arrests are the wrong tools for dealing with substance abuse and the opioid crisis: Her approach rejects the war on drugs and aims to steer people towards support rather than criminal punishment.

“Looking at the disparities involving drug arrests, there was a general understanding that we don’t want officers wasting their time,” Dyer told Bolts in an interview. “There is a frustration when officers are nickel and diming or getting involved in low-level things, and a frustration with pretext stops in general was resounding countywide.”

Dyer’s platform appealed broadly to voters in the liberal college town of Ann Arbor, as well as the surrounding rural areas where even many voters with more conservative values are fed up with the kind of policing that cycles people through the legal system without addressing their needs. 

But to effectively carry out her plans, Dyer will also need allies in the justice system. She has at least one in Eli Savit, who was just reelected as Washtenaw’s Prosecuting Attorney after running unopposed. Savit first won office in 2020 at the height of the racial justice movement that swept through the country following the police killing of George Floyd. The movement helped give rise to a brand of progressive prosecutors including Savit, who embraced a less punitive approach that broke away from his tough-on-crime predecessor. His office took aim at the issue of racial profiling by announcing he would drop the charges in situations where officers use minor traffic violations as an excuse to search for drugs or other contraband. A slew of other policies offered leniency towards juveniles arrested on minor offenses, and declined charges for consensual sex work and certain low-level drug crimes — but those reforms can only make an impact after an arrest has already been made. 

Now with Dyer as the county’s top cop and Savit as its lead prosecutor, they hope to move these reforms forward by working collaboratively on policies that were previously siloed in different parts of the justice system. 

“What you see in Washtenaw is a lot of different partners in conjunction with the community are largely working towards the same goals and from the same playbook,” Savit said. “It reflects our community values. Ultimately, what people in Washtenaw want is for us to work together to get people on the right track, rather than cycling them through the justice system over and over again in an ineffective fashion.”

In November of 2020, Savit’s win was hailed as a success for the progressive prosecutor movement that for at least a decade has sought to reform local DA offices across the country. His policies gave reformers in Washtenaw an inroad for curbing the harm wrought on by excessive criminal punishment by deflecting some low-level arrests. 

Savit regards his policy on pretextual stops — where minor traffic violations are used as an excuse to search cars for contraband — as a success. His office initially declined several of those cases, Savit told Bolts. But soon, police agencies across the county largely stopped sending those kinds of cases to his office. The approach later gained support in Ann Arbor, the county’s largest city, where the city council unanimously voted last year to limit police from stopping drivers for minor violations like cracked windshields or broken taillights that do not pose any risk to traffic safety. 

Now with Dyer in office as well, organizers hope to stop even more of those arrests from happening in the first place. 

“Our racial disparities in low level traffic stops are through the roof at the sheriff’s office,” Dyer told Bolts. “Regardless if the prosecutor decides to charge a case, the harm is still caused at the forefront. Avoiding those stops when possible, when it’s not a safety-related issue, is really important. There are so many instances where somebody has been pulled over, pulled out their car and searched. The police find nothing. They let them go, but the harm stays with that person.”

Like Dyer, Savit also embraced a legal strategy for addressing drugs that is focused on harm reduction and rehabilitation rather than punishment. His office decriminalized the possession and distribution of controlled medications like methadone and buprenorphine that are used to treat opioid addiction and curb fentanyl use. Like with the traffic stop arrests, very few of those cases now come across Savit’s desk. The remaining arrests for illegal possession of methadone or buprenorphine mostly come from people incarcerated in nearby prisons, and Savit’s office typically drops those cases, he said. Even though prosecutors rarely need to decline charges now, it is critical to have a public policy in place so the fear of criminal penalties will not deter people from accessing life saving medications, he said. 

“Why on earth would we want to be discouraging somebody from using a medicine that we know is an alternative to using a dangerous drug that could kill them? We want less overdose deaths, not more. ” Savit told Bolts.

But a policy of non-enforcement is only effective if the entire criminal legal system is aligned across prosecutors and police, which isn’t the case for most places in the state. As Michigan has scaled up harm reduction initiatives in recent years—funded in part by payouts from pharmaceutical companies acquired through opioid settlements—the enforcement around controlled methadone and buprenorphine has been a patchwork across the state and even within Washtenaw County. 

Dyer’s position—that criminal enforcement and arrests are the wrong way to address addiction issues—is rooted in her background as a social worker and therapist. She has advocated for unarmed community responders and public health outreach workers to deal with opioids, rather than police. And she plans to end internal quotas that encourage officers to make stops, search people for drugs, and cite or arrest them for minor drug violations.

Having a sheriff who’s onboard with harm reduction tactics helps establish a uniform approach to managing the opioid crisis, said Jonathan Laye, program director for Supportive Connections, a social service group aimed at steering people away from the justice system.

“The county is definitely starting to go in the right direction when it comes to prioritizing treatment or engagement rather than locking people up over petty stuff. The question is really getting people in the right places who understand the difference between a symptom and a crime,” Laye said.

Even when police don’t make arrests for drug paraphernalia, those items are sometimes still used by officers as probable cause to justify a search, said Cindy Bodewes, president of the Washtenaw Regional Organizing Coalition, a grassroots group pushing for reforms in the county. She hopes Dyer will bridge the “disconnect between the prosecutor’s strategy and arrest strategy,” Bodewes said.

“That’s why it is so important to have a law enforcement policy in place in order to have harm reduction in a community where they don’t have to be looking over their shoulder, afraid of the police taking action, regardless of whether they can be charged or not,” Dyer said.

Even when prosecutors signal that they will not pursue certain cases, changing the culture and behavior of police departments can be more difficult. Police leaders don’t always know what is happening on the ground, and are sometimes unaware that officers need to be brought up to speed on policy changes, Bodewes said. That is why it is important for grassroots organizations and community members to have a way to “report directly to the sheriff,” she said.

Dyer says her experience as a rank-and-file deputy showed her the extent to which officers are often slow to adapt to new policing strategies, especially when changes are not written into department policy and backed with additional training. 

She is forming community advisory committees on issues like traffic stops, jail visitation and mental health to bolster transparency and accountability by allowing the public to help shape department policy. Savit formed similar committees after first winning office to develop his reforms, which also helped prosecutors develop a restorative justice process that diverts people from criminal punishments. Dyer aims to create another group of diverse community voices to make policy recommendations directly to her office. It’s another step, she says, to ensure that her advisors are not just an echo chamber of police brass: critics will have access to the inner workings of the department.hold their elected officials accountable. 

“Having a community that is educated around what we’re doing, our operations, our policies, can be a really powerful ally to make sure that what I think is happening at the top is what’s actually happening at the bottom,” Dyer said.

Dyer’s and Savits’ victories last month were an exception to what was largely a nationwide turn away from reform politics. 

In Chicago, retiring State’s Attorney Kim Foxx, who championed reforms like the abolition of cash bail statewide and the development of the nation’s first restorative justice community court, will be replaced by tough-on-crime Democrat Eileen O’Neill Burke, who has promised to roll back some of Foxx’s policies. In Los Angeles and Alameda Counties, progressive prosecutors George Gascon and Pamela Price were unseated amid complaints that their lenience was to blame for crime, which has largely declined since the pandemic, and social issues like opioids and homelessness. On the national stage, the Democratic party’s national platform abandoned issues like police violence and mass incarceration that were at the core of past campaigns. 

For many observers, this election signaled a waning in the strength of the criminal justice reform movement that came into full force just four years ago. 

But criminal justice reform has managed to remain on the agenda in Michigan. In October, the state enacted an overhaul of the juvenile justice system to eliminate most of the fines and fees that saddled young people with debt and penalized them for being unable to pay. Widespread dissatisfaction with the juvenile justice system helped stoke an appetite for continued change in Washtenaw, according to some of Dyer’s supporters. She wasn’t the only progressive candidate running for sheriff in Washtenaw. She narrowly won the primary against Derrick Jackson, the current director of community engagement at the sheriff’s office who works closely with grassroots reform groups and has a track record of boosting diversion efforts. In many communities, Dyer’s message resonated more deeply in many Washtenaw communities because her vision for reform was more bold, said Carolyn Madden, co-chair of Friends of Restorative Justice. 

“It was a matter of being a bit more progressive, a bit more out there, a bit more bold. And that is what we need in our criminal justice system right now—some boldness—and Alyshia seems to want to make some real change,” Madden said. 

Madden’s organization has already worked with Savit to help develop his office’s restorative justice process to repair the harm caused by a crime without “heaping on punishment,” Madden said. The program puts charges on hold for 18 months while the perpetrator of a crime works with the victim and community-based mediators to repair the harms they caused and address the underlying issues that led to their actions. Prosecutors drop the case if there are no new violations at the end of the period—though offenses that pose a serious risk to public safety or involve domestic or sexual abuse are not eligible for restorative justice. She hopes Dyer’s expertise in social work will help expand restorative justice practices in Washtenaw and improve opportunities for rehabilitation both in the community and in the jail.

“When police work very closely with the community, they know the people and they can go about addressing issues with different kinds of programs. Even if you’re not going to arrest them, particularly young people, you have to help them. You have to give them other things, especially if it’s a result of young people being confused or impoverished,” Madden said.

The county is already piloting a program to that effect: the Law Enforcement Assisted Diversion and Deflection (LEADD) initiative, which was spearheaded in part by Jackson’s community engagement team within the sheriff’s office. Unlike typical diversion programs, where the court drops charges once a person meets certain conditions like completing drug treatment, LEADD allows county officers to connect someone to a case manager to get the support they need in lieu of making an arrest in the first place.

“The goal is to provide an alternative to arrest or citations for individuals who have unmet basic needs that stem from things like mental illness, substance abuse, and severe poverty and homelessness. It can increase the number of people getting the services they need and decrease the number of people in contact with the criminal justice apparatus,” said Hailey Richards, the program coordinator for LEADD.

Many of Dyer’s supporters hope she will continue to build upon the LEADD program, which is currently being tested in Ypsilanti Township, and expand it across the rest of the county. The pre-arrest diversion model “is a less harmful way police can offer someone assistance, and it can really help change people’s lives,” Dyer said. But there remains a need for community-based alternatives for responding to many issues that armed law enforcement officers are not best suited to deal with. Dyer says she also plans to support these by using a portion of the county’s budget dedicated to mental health and public safety initiatives.

“We as a country have dumped everything on law enforcement. But officers are not doctors, are not social workers, they’re not therapists, and we keep expecting them to be. I talk to officers who say they don’t like to go on low-level calls or calls involving mental health when they’re not trained to understand how to handle it,” Dyer said.

 “We have a unique opportunity to really start building safety net responder programs that avoid the legal system.”

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The study comes at a time when many states are ramping up punishment in response to crime, while leaving public services largely underfunded. One of the study’s authors, Catherine Maclean, a professor of public policy at George Mason University, tells Bolts that policymakers should keep in mind the critical value of a strong social safety net for stabilizing communities. 

To study these relationships, Maclean and her coauthors examined crime rates in Tennessee before and after that state disenrolled some 200,000 people from Medicaid, with little warning, in 2005. That was and still remains one of the most sweeping state-level Medicaid drop-offs in U.S. history.

By 2007, the study finds, the crime rate in the median Tennessee county had increased by almost 17 percent, with large increases observed in both violent and non-violent crime; the study attributes this to the disenrollment through a series of causal analyses. “Losing Medicaid induced changes in economic standing, housing stability, healthcare use, and health, all of which are documented to be determinants of crime,” the authors write.

It stands to reason, Maclean said, that crimes inspired by desperation or behavioral health crises—or both—became more common in Tennessee post-2005, as poverty increased and people became more likely to delay needed health care. This was especially devastating for people who might have benefitted from mental health care or treatment for substance abuse disorder, the study found.

These patterns now risk repeating themselves at a large scale. Just last year, every state in the U.S. experienced a major contraction in Medicaid coverage, as the federal government ended an emergency pandemic policy that had kept millions enrolled in the program. States are still feeling the effects of that decision, as Bolts recently detailed. 

A number of states are contemplating further Medicaid cuts, including Kentucky, Utah, and New York. Elsewhere, in Mississippi and South Dakota, voters have tried to force elected leaders to expand Medicaid via direct democracy, but with mixed success. And on the national stage, Donald Trump is running for president again, calling for dramatic slashing of public funds for health coverage. 

Bolts spoke with Maclean about what the Tennessee study can tell us about the link between health insurance and public safety today; about what has and hasn’t changed since 2005; and about current proposed cuts to government-provided health insurance. 

“You might save some dollars in terms of Medicaid, but that may lead to some other problems with other objectives, like promoting public safety,” she warned.

There’s plenty of existing research on how people become less likely to commit crimes after gaining health coverage. Your study notes there’s been much less research into what happens when people lose coverage. Why did you find that important to examine? 

Over time, generally, Medicaid policy has led to expansion in coverage. But we’re now starting to see increasingly more talk and action about policy that could curtail it. 

Some of these losses may come as more of a surprise. (Editor’s note: People who lose Medicaid coverage due to a change in rules, or a lapse in documentation, may not find out in a timely manner or with advance warning.) If you’re gaining Medicaid, it may be that you’ve taken steps—you’ve applied for Medicaid and you’ve shown documentation, so it’s not much of a surprise. If you just suddenly lose Medicaid, that can be very destructive in and of itself, and also for the inability to plan for what you’re going to do next.

Your study found that crime increased generally in Tennessee among those who’d lost health coverage, and that the increase in nonviolent crime was particularly clear. What does that tell us?

I think our findings pointed toward a financial resources story. That is, we found stronger, more stable effects for non-violent crime, which tend to be property crimes. The property crimes we looked at are burglary, theft, motor vehicle theft, and arson. The violent crimes we looked at were murder, manslaughter, rape, sexual assault, robbery, and assault. When we broke these crimes out, we see that our findings for non-violent crime were really driven by theft. 

That, to me, suggested that some of these crimes we see might be financially motivated, which might be due to the loss of resources that one experiences when Medicaid is removed, or it could be increased need to finance medical bills. 

What new information can we glean about health care and crime from looking at what happened 20 years ago in Tennessee?

The broader theme is thinking about the value of Medicaid. You can think about it as the value of the social safety net, providing support for people who don’t have much. It doesn’t just impact those people. It impacts society. 

Even if we take a very restrictive view and we say that it’s each person’s responsibility to make a go of it themselves—finding jobs, getting insurance, staying out of quote-unquote trouble—there are implications for other people. So when you think about whether or not to provide a benefit to a particular segment of the population, I think we need to see the bigger picture: we’re all connected, we all live here together, and there are implications of policies targeting a particular group for the broader society. 

We’re just focusing on crime here, but we can think about improvements in economic standing, the impact of [Medicaid] contraction on evictions. We need to look beyond just the individual, and more at society, when we’re considering the benefits of providing these social programs. 

That would be my largest piece of advice: Don’t view any particular policy in isolation, because it’s very likely, given how complicated our world is, that that policy is going to spill over into other domains.

Today, many politicians who tend to oppose expanding social services, including government-covered health benefits, also tend to support “tough on crime” policies. Why do health access and public safety so often appear in conflict?

It does seem to me that there’s a strong correlation between policymakers and politicians being tough on crime while also taking a conservative view of the role of government in the provision of health insurance. People can certainly have different views about that role of government, but I sometimes suspect there is less [of] an understanding of the potential linkages between the two.

When you give people access to Medicaid, they generally have better financial outcomes. 

You see increases in poverty when you curtail Medicaid, as was done in Tennessee. The idea is that health insurance, in addition to providing access to care, also protects people against the risk and cost of unexpected health care expenditures. You see increases in evictions as well. You can think of a whole range of outcomes that could be improved with the provision of health insurance. It seems like there are other means through which we could reduce reliance on the criminal justice system.

Just to say, alright, let’s hire some new police officers or let’s buy some new infrastructure for the police to use—it’s there, it can be seen, you can show your constituents what you’ve done. There’s something about being able to show your constituents that you did something.

Your study is timely, given the recent Medicaid contraction and the fact that several states right now are contemplating further serious cuts. New York’s governor, for instance, proposed slashing Medicaid by $1.2 billion at the same time she’s making a public show of her desire to fight crime, including by putting National Guard soldiers in Subway stations. How does your study inform these debates?

A policymaker’s job is a very hard one and I’m certainly cognizant of that, but I do think that points to an overlooked linkage: I think that as people lose access to coverage, as is going on through the unwinding, this can be quite destabilizing for individuals, and we think that could contribute to crime.

Medicaid is the largest purchaser of behavioral health care services in the country, so it plays a really important role of connecting people to services. I’m not trying to say that every crime is related to behavioral health, to substance use, because I don’t think that’s true, but I think it could be a bit short-sighted for policymakers not to consider those linkages.

The way these two things jibe together—being concerned about crime but also curtailing expenditures on a very valuable program, particularly for people with behavioral health conditions—I’d encourage people to think about what that might mean. You might save some dollars in terms of Medicaid, but that may lead to some other problems with other objectives, like promoting public safety.

Jails and prisons are often terribly unhealthy and even deadly places to be. To build off your study a bit: It seems that these so-called houses of correction and rehabilitation not only fail the people they’re holding, but—to the extent that health care access is a predictor of criminality—actively harm public safety when they release people in worse health conditions than when they arrived.

I certainly can’t disagree with that. 

At various levels, be it people who are incarcerated, people who are not incarcerated, those goals—being “tough on crime” and taking a conservative view of the role of government in the provision of health care—can very often work against one another. The social determinants of health, or just health care access, can’t be forgotten if we’re going to try to improve outcomes. And I think a lot of these very punitive approaches have unintended negative consequences.

Overdose deaths have soared since 2005. What is your view of the importance of Medicaid to treat substance use disorder and ultimately to limit the number of people dying, and to limit the criminalization of drug use?

We are looking at a time period of the mid-2000s, which was the first wave of the opioid crisis. The second wave started in roughly 2010 and transitioned more toward heroin. We’re now in a third wave, at least, of the opioid crisis, where there’s been a substantial movement to synthetic opioids like fentanyl and analogs. 

So what might that mean? Fentanyl is just substantially more harmful and easier to overdose on than prescription opioids in the 2000s, and I think that’s why we see this huge spike in opioid overdoses. At the same time, for a variety of reasons, we’re seeing more medications that can be used to treat opioid use disorder, we’re seeing what I’d say is a reduction in stigma around receiving treatment for substance use disorder. Medicaid in many states has increasingly played a larger role in providing that treatment, so my take is that, comparing the 2005 experiment to what we’re seeing now, Medicaid plays a larger role today in fighting the opioid crisis. 

I do think understanding how cutting people off Medicaid is going to affect society—especially when we have these goals of enhancing public safety being talked about in so many localities across the country—I would just hope policymakers would consider that there are some things you can’t get back. You can of course reinstate Medicaid, but the negative implications of removing it will have already occurred.

This interview has been edited for length and clarity.

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“I’ve never been sober a day or two since I was 16,” Omps, who was 34, texted her sister on Oct. 5 of last year. “I do not want to be addicted. I fucking hate needing something to feel normal. I might as well actually get high if I’m going to be an addict.”

Though she resented the suboxone, people close to her said it was crucial to her recovery from substance use disorder. And so it was catastrophic that she could no longer obtain it, midway through 2023, after she was kicked off Medicaid. 

At the onset of COVID-19, the federal government suspended normal rules for Medicaid to keep people from losing coverage during the pandemic, allowing recipients, including Omps, to go three years without having to demonstrate eligibility. But that policy ended in March 2023, and Omps and millions of others across the country were swiftly dropped from government coverage—for instance because they forgot to file for renewal or made a mistake on their paperwork, or because they had moved to a new state or started earning too much money to qualify for Medicaid. In West Virginia, this change was compounded by the existing staffing and funding challenges in the state’s Medicaid office, and the legislature’s inaction to avert this cliff.

In 2022, Omps started working at the nonprofit West Virginia Family of Convicted People, where she organized events to protest and raise awareness about conditions inside West Virginia’s deadly jails. The job paid $22 an hour, which put her in a difficult spot: She was making too much money to stay on Medicaid, but the job didn’t provide health insurance and Omps couldn’t afford to pay out-of-pocket for her drug treatment.

“She had to go off of suboxone and that is what put her body under a lot of stress,” Omps’ sister, Victoria Omps, told Bolts recently. “It was so hard on her, because of how expensive it was going to be to stay on.”

Already in withdrawal from hard drugs, Omps suddenly found herself in withdrawal from the medication that was treating her addiction. On Oct. 18, she entered the steam room of a YMCA in Charleston, West Virginia’s capital city, then collapsed and died as she got up to leave. She was 34 years old, and though she officially died of a heart attack, Victoria and others who knew Ashley told Bolts they have no doubt about what killed her.

“I think it was entirely about her having to come off of suboxone,” Victoria said. “The withdrawal was so hard. That was the reason she was even in the steam room, so she could try to sweat it out of her pores.”

The so-called unwinding of Medicaid coverage has, as of late last month, led to the disenrollment of more than 17 million Americans, according to a Kaiser Family Foundation analysis. West Virginia has been hit particularly hard: It is one of the poorest states in the country, and thus has one of the highest rates of Medicaid enrollment. The return to normal Medicaid rules has led to the removal of nearly a quarter of all West Virginians who’d been enrolled as of last spring, the Kaiser analysis shows.

Those who work in drug treatment and addiction recovery in West Virginia say this drop-off in coverage has endangered people with substance use disorder and compounded a larger crisis in a state that has already led the country in overdose death rate every recorded year since at least 2014, according to federal data. 

As patients like Omps lost access to addiction treatment, advocates pressed state leaders to expand Medicaid eligibility and treatment options in the state. Instead, even in the face of this crisis for drug treatment and recovery, many West Virginia lawmakers have turned to a different approach, pursuing new punishments for people addicted to illegal drugs in a state that already incarcerates more people for drug possession than for almost any other charge. 

The state legislature, which is controlled by Republican supermajorities, already restricted syringe exchange programs in 2021; this year, it considered bills to outlaw syringe exchanges entirely, as well as to ban methadone—a medication that treats opioid addiction, as suboxone does—and the distribution of clean drug supplies. West Virginia lawmakers also have repeatedly advanced legislation to turn simple drug possession from a misdemeanor to a felony offense punishable by up to five years in prison. 

“We’re trying to be proactive here,” Republican state Senator Vince Deeds, the sponsor of that proposal, told Mountain State Spotlight in January. “Right now, if you have someone go in for simple possession, they’re back out and they’re committing more crimes to feed their habits. The idea here is to have early intervention with these end-level users.” (Deeds did not respond to multiple requests for comment from Bolts.)

Deeds’ bill passed the state Senate both in 2023 and this January, but it stalled in a House committee last week as lawmakers declined to pass it. Instead, House Republicans decided to study higher penalties for drug possession in the future, which would push this focus on increased penalties into coming years. 

Many who advocate for those struggling with addiction in West Virginia feel frustrated seeing lawmakers focus during their limited time—the 2024 session is already set to end this week—on such solutions. These advocates argue that treatment offers more public safety benefits than harsher punishment, a position bolstered by years of research showing that incarceration does not deter drug use. 

“Instead of putting the money and funds into increasing access to treatment, increasing resources and funding to organizations helping with drug treatment, they’re talking about throwing good money after bad by increasing penalties and increasing incarceration rates,” said Kenneth Matthews, a recovery coach who is himself in long-term recovery from addiction. 

“There’s not enough money put into treatment facilities,” he said. “Never in the history of people committing crimes has anybody in the midst of their substance use said, ‘Oh, they just increased the penalty, so I’m not going to do this.’ As someone who was formerly incarcerated and in long-term recovery, when I was in the midst of substance use I wasn’t following the legislature and I really didn’t care.”

David Foley, the chief public defender in Mingo County, a rural area in the southern part of West Virginia that The Guardian once called “the opioid capital of America,” said he sees a host of other criminal charges that seem to stem from untreated addiction. “I see so many crimes where, if they are not drug offenses, they are fueled by the desire to get money to get drugs, or it’s people so down on their luck because of drugs,” Foley said. “It just seems like the entire spectrum of criminal charges are in some way influenced by substance abuse.”

Mingo County Sheriff Joe Smith, a Republican, confessed that he sometimes wonders whether arrests and incarceration for certain drug charges are doing any good for people suffering addiction. Smith told Bolts that he and his deputies often arrest the same people over and over again for the same drug-related crimes, and added that even if he could arrest every single person who sells drugs in the area, he doesn’t think Mingo County could solve its problems related to addiction through enforcement alone.

“Out of every crime we work, 80 percent is drug-related. We’ll arrest someone who stole grandma’s earrings, but when you get to the root of it, it was to sell the earrings for a hit of meth or some fentanyl,” Smith said. “It’s a sad situation. I’ve arrested people, and arrested their kids, and worked overdoses off people who I’ve begged to get help.”

Overdose deaths are a regular occurance in Mingo County, which has a population of just over 20,000. Rebecca Hooker, who runs a social services organization in the county, told Bolts that, recently, on a single day in a single 10-mile radius, her community saw four people die of suspected overdoses. “The people in the sector of harm reduction or prevention or rehabilitation really need more money,” Hooker said. “Right now it’s just catch and release.”

Matthews said his work as a recovery coach is particularly difficult these days, now that he must contend with the fact that many of his clients, who are already at high risk of incarceration or overdose—or both—are also trying to navigate the ongoing Medicaid mess. He talked about one client who had to leave a treatment facility because they lost Medicaid coverage, then spent months re-establishing eligibility, only to find that the treatment facility had no bed space for him to return.

“I was worried he’d have a fatal overdose,” Matthews said. “People lost their health care and had to leave their residential programs because they no longer had the ability to pay for it through Medicaid. Some of them were able to hold on and some were not.” 

West Virginia’s state Medicaid office has faced criticism for not doing enough to help people keep coverage after the rules changed. In a letter last summer, the federal Centers for Medicare and Medicaid Services admonished the state for keeping people on hold for long periods of time when they called in for help, and warned that this and other forms of administrative dysfunction would lead to many eligible people losing coverage. 

Rhonda Rogombe, health and safety net analyst for the West Virginia Center on Budget and Policy, said administrative hurdles have been a particular problem for people needing treatment for substance use disorder. “This is a very vulnerable group of people,” she told Bolts, “and they’re being disconnected from programs they were enrolled in, or could be eligible for.”

Deborah Ujevich, who works at a detox facility outside Charleston, and was close with Ashley Omps, says people have been scrambling over the past year to find addiction treatment after losing Medicaid coverage. “People would call us for a bed and you look their Medicaid up with the system, you go look at member eligibility, and you see no enrollment found,” Ujevich said. “So you can’t take them, and they can’t get meds because the pharmacy isn’t going to fill their protocol.”

Omps’ death while searching for treatment was sadly not unique, Ujevich said, adding, “We have had a number of past patients die because they aren’t getting the care that they need.”

She finds it frustrating that the state continues to pursue harsh enforcement despite little evidence that incarceration is helping to stem substance abuse, especially after so many lost access to addiction treatment under Medicaid.

“They are doubling down here on bad policy and they are not taking into consideration what is actually happening. It’s very, very, very out of touch,” Ujevich said. “We’re really going backward.”

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