Maine's Somerset County Jail Wins $3.1M to Keep MAT Program Alive

Somerset County's jail will keep supplying monthly injections of an extended-release addiction medication to people in its custody, after county officials announced this week that the federal government is sending $3.1 million to carry the program for the next five years. The Substance Abuse and Mental Health Services Administration award arrives just as a separate change to Maine's Medicaid rules moves the same treatment onto a path toward reimbursement starting around 2028.

The grant goes to the Somerset County Jail in Madison, which drew national attention for switching in 2022 from daily doses of buprenorphine to monthly injections of an extended-release version of the drug, sold as Sublocade and, more recently, Brixadi. Sheriff Dale P. Lancaster said the money removes a yearly scramble for funding that had put the program at risk.

"We are saving many lives with this medication," Lancaster said in a statement Thursday. "And this grant provides the ongoing funding we need to purchase it, which saves the county taxpayers money."

What the money buys

The award is front-loaded. Somerset County will receive $729,380 this year and the same amount in 2027, then $635,164 in 2028, $557,414 in 2029 and $479,664 in 2030, according to figures County Administrator Tim Curtis prepared for the Board of Commissioners.

In the early years that covers most of what the program costs to run: an estimated $161,000 in labor and about $600,000 in medication, with the total budget for buying the drugs and staffing the clinic fluctuating with the number of people being treated at any given moment. Curtis put the typical annual cost near $1 million.

The money is not only for medication. According to the county's announcement, the grant will also pay for a new effort to respond to a sharp rise in methamphetamine-involved overdoses, expand outreach, referrals and reentry support for people leaving custody, and let the jail's addiction medicine staff provide technical assistance to other county jails in Maine.

"We are incredibly excited to receive this grant and to be able to build upon the remarkable work the jail is already doing," said Dr. Alane O'Connor, the jail's director of addiction medicine, who Lancaster credited with assembling the application.

The award came from a batch of $68 million in federal funding that was expected to go to 91 applicants, according to a SAMHSA grant database.

A bridge until Medicaid can be billed

County officials described the grant as a stopgap. In early October, the federal government approved a long-sought waiver in Maine's Medicaid program that will let correctional facilities bill MaineCare for clinical services, including addiction treatment, in certain circumstances. That change is not expected to take effect until 2028 or 2029, and the SAMHSA money is meant to hold the medication program together in the interim.

The grant also loosens the county's own budget. Somerset had been conserving most of its opioid settlement payments — a stream that runs through 2038 — while it waited to see whether it could win outside funding for the treatment program. To date the county has paid for the injections with a combination of grants and settlement dollars, including more than $3.2 million in grants that has now been almost entirely spent.

Extended-release buprenorphine

The distinction between daily and monthly medication matters more than it might appear. Daily buprenorphine, taken as a film or tablet, must be dispensed under supervision in a jail setting, and Lancaster has said the jail saw illicit activity around the daily version of the drug. Monthly injections remove that daily ritual and provide steady medication levels for weeks at a time.

Research on the jail's early experience found the injections reduced overdose risk after release and made it substantially more likely that people continued treatment once they left. The results attracted coverage from The New York Times and turned a small county facility into a case study for jails considering a similar switch.

Buprenorphine is one of three medications approved in the United States for opioid use disorder, alongside methadone and extended-release naltrexone. Federal guidelines direct jails and prisons to continue people on medication rather than force them to withdraw, because the weeks after release carry an outsized risk of fatal overdose.

The cost Maine counties carry

Maine requires its county jails to provide medication-assisted treatment, but the state does not pay for it. The expense falls on counties, which cover it through property taxes, grants and settlement funds. Maine's 16 counties spent $9.1 million on medication-assisted treatment in fiscal year 2025, according to a January report from the County Corrections Professional Standards Council — money that jail administrators have warned is unsustainable as pandemic relief and grant funding runs down. A separate accounting from that report put total jail spending on addiction and mental health care at roughly $12.6 million, part of a broader fight over who pays for treatment behind bars.

Some counties share the load. Waldo County boards some of its inmates at Somerset and reimburses the county for their medication.

Somerset's program operates at the small end of Maine's jail system, but its funding model — a five-year federal grant bridging the gap until a Medicaid waiver takes hold — is one that other rural counties are likely to copy, if only because the alternative is asking property taxpayers to absorb a cost that keeps growing.