Sheriffs Warn Medicaid Cuts Risk Public Safety; New Mexico's 1115 Waiver Pilot; Medicaid Legislation; Mississippi's Travails With VitalCore

Highlighted Stories

Editor's Note

This week’s highlighted stories begin in Mississippi, where correctional healthcare vendors are once again under scrutiny. We’ve covered Mississippi’s troubles with its revolving door of providers before—particularly when Rep. Becky Currie, a registered nurse and chair of the House Corrections Committee, toured the state penitentiary and was horrified by the lack of treatment incarcerated people were receiving (see Follow Ups of August 5, 2025 and the Editor’s Note of June 24, 2025).

As Mississippi Today reports, VitalCore—the latest company in a long succession that includes Centurion and Wexford—is now facing questions about its performance. The article lays out, quite clearly, how these contracts are structured and why jurisdictions repeatedly cycle through vendors with little measurable improvement. COCHS’ own Dan Mistak was interviewed and reiterated a familiar COCHS theme: states rarely enforce their contracts because they fear the vendor walking away.

And that leads us, once again, to the perennial issue of oversight. As COCHS has said repeatedly, oversight embedded within correctional systems are often ineffective (see Editor’s Notes of January 14, 2025). As we noted in the Weekly Update just before Thanksgiving, Medicaid would establish independent, outcome-driven accountability—something correctional systems structurally fail to provide).

The second highlighted article, from R Street, joins the Medicaid bandwagon. It reviews the history of the Medicaid Inmate Exclusion Policy and discusses the Due Process Continuity of Care Act, which aims to prevent the bureaucratic disruptions that cut off coverage for individuals detained pretrial. The piece also covers the Reentry Act, which would allow Medicaid activation 30 days before release—mirroring what the 1115 waivers achieved in the previous administration. What the article does not note is that both of these bills have been introduced in prior Congresses (see Editor’s Note of July 25, 2023).

Speaking of 1115 waivers, our third highlighted story reports that the New Mexico Health Care Authority plans to launch its reentry pilot program in spring 2026—pending federal approval. This is a story we’ll continue to track.

And in the final highlighted article, the Idaho Sheriffs’ Association has issued a blunt warning to the governor and state legislators: Medicaid cutbacks to mental health services for people with severe mental illness will have consequences for public safety. In other words, the realities of what Medicaid reductions mean on the ground are beginning to surface. Another story we will follow—with trepidation.

Mississipi & VitalCore

Mississippi’s private contract for prison medical care is facing mounting scrutiny as complaints about treatment and oversight continue to grow. The Legislature set aside $690,000 this year to monitor its current provider, VitalCore, which won a three-year, $357 million contract in 2024—beating out prior contractors Wexford and Centurion. From 2020 to 2024, VitalCore also received more than $315 million in emergency, no-bid contracts. The company has faced controversy elsewhere: last year its former chief medical operations officer in Vermont sued VitalCore, alleging officials forged his signature on policy documents and fired him after he raised concerns about prison conditions. COCHS' Dan Mistak described states’ contracting practices as a “revolving door,” noting Mississippi’s previous contractor, Wexford, had been accused of funneling consulting fees to former state legislator Cecil McCrory. McCrory pleaded guilty to bribing Mississippi corrections commissioner Chris Epps to steer prison contracts.

Medicaid

Every day in America, people detained pretrial lose Medicaid access even though they are legally presumed innocent. Care coverage can be suspended or terminated within days for individuals who cannot afford bail or who live in jurisdictions that rely heavily on pretrial detention. The Due Process Continuity of Care Act would address this inequity by ensuring coverage is not terminated during pretrial incarceration. The Reentry Act offers a straightforward fix by allowing states to activate an eligible person’s Medicaid benefits 30 days before they leave custody. Similar to the Due Process Continuity of Care Act, the Reentry Act does not expand Medicaid eligibility or alter who qualifies. Instead, it helps ensure that those who are eligible do not return home with piles of paperwork and other hurdles standing between them and the treatments needed for successful reintegration. States piloting pre-release Medicaid activation via Section 1115 waivers (currently approved in 19 states) have documented reductions in overdose deaths, higher engagement in behavioral health services, and lower emergency room utilization.

New Mexico's 1115 Waiver

New Mexico’s health care agency anticipates a program to enroll incarcerated people in Medicaid will go live by next spring, pending final federal approval. The program, which is being piloted in three prisons, will provide Medicaid-funded care to eligible, incarcerated New Mexicans up to 90 days prior to their release. The state launched the pilot program in July, but no one has been enrolled under the program yet because the state has been waiting for federal reimbursement approval.

Sheriffs Warn Lawmakers

Idaho sheriffs are warning elected officials that new state Medicaid cuts to critical mental health services for people with severe mental illness could pose a public safety risk. A letter by the Idaho Sheriffs’ Association is the latest in a string of concerns over cuts by a state Medicaid contractor that stem from the state’s attempts to avoid a projected budget shortfall. The contractor that runs Idaho Medicaid mental health benefits, Magellan of Idaho, plans to cut specialized mobile teams that treat patients with severe mental illness. It isn’t immediately clear whether the cuts are already in effect. In a letter to Gov. Brad Little and Republican leaders in the Idaho Legislature, Idaho Sheriffs’ Association President Samuel Hulse urged elected officials to recognize and address the situation. He called the state’s budget situation “self-inflicted.”

Follow Ups

San Diego County

Editor's Comment: The article below from the San Diego Union-Tribune lays out the many bureaucratic hurdles that prevent families and loved ones from learning how someone died in the county’s jails. As the article points out sometimes the only source for details concerning a death comes from other incarcerated people.

The article also notes that the Citizens’ Law Enforcement Review Board (CLERB) has recently been granted expanded authority, raising the possibility that its investigations may finally shed light on some of these otherwise opaque deaths. For those interested in the ongoing saga of CLERB’s strengthened oversight powers, see the Editor’s Note of December 10, 2024, and the Follow Ups from September 9 and September 16, 2025.

Public information about deaths inside San Diego County jails is extremely limited. Medical privacy laws mean the public typically learns only basic facts unless a family files a lawsuit. That secrecy is now under scrutiny following the death of 82-year-old Karim Talib. The county is already facing a class-action lawsuit over jail conditions, and attorneys in that case collected sworn statements from three incarcerated men who said they watched Talib deteriorate for days—lying in his own waste, barely moving, and unresponsive—while people in nearby cells yelled for deputies to help him. A 2017 state law, AB 2119, unintentionally tightened confidentiality around autopsy reports by preventing medical examiners from releasing any medical information they obtain. The Sheriff’s Office can also withhold details under the California Public Records Act’s investigative exemption, making it even harder to understand what happened. As of November 1, the county’s Citizens’ Law Enforcement Review Board (CLERB) now has expanded authority to review medical care in jail deaths. However, that authority does not apply to cases already under investigation—such as Talib’s—and it remains unclear how CLERB will present medical findings going forward.

New York

Editor's Comment: For the New York Follow Ups, legislators in New York State are pressuring Gov. Kathy Hochul to sign prison reform legislation that was passed earlier this year. As readers may recall from last week’s Follow Ups, the Department of Corrections and Community Supervision (DOCCS) has been urging Hochul to weaken those reforms. The governor now faces three options: sign the bill, veto it, or negotiate changes—the option DOCCS clearly prefers.

Another New York story, from The Marshall Project, adds an unsettling wrinkle to the already complex problems in the prison system: preventable deaths. Reports detail incarcerated people not receiving treatment for readily treatable conditions such as asthma, obstructed bowels, and infected epiglottis. Dr. Robert Greifinger, former chief medical officer for New York state prisons, is quoted as saying that the common thread running through these deaths is “cynicism, in the form of inordinate distrust of prisoner patients.”

New York State lawmakers this week called on Gov. Kathy Hochul to approve prison reform legislation that has been waiting months for her signature, citing an investigation by The New York Times that revealed an uptick in prisoners credibly accusing guards of violent attacks. The circumstances of many of the attacks resembled those that preceded the fatal beatings of two inmates in Central New York prisons, Robert L. Brooks and Messiah Nantwi, which led to criminal charges against 20 guards earlier this year. Watchdog officials and prisoners have linked the increase in part to anger among guards over recently enacted limits on the use of solitary confinement.

In the past decade, more than 30 people who were experiencing a health crisis in New York prisons died of preventable or treatable conditions, an investigation by The Marshall Project has found. A few men died from treatable infections. Several others succumbed to obstructed bowels. A prisoner with asthma died after he was denied access to an inhaler just feet away. Another man died in a Western New York prison after an asthma attack as his cellmates unsuccessfully tried to wake a sleeping nurse to bring lifesaving medicine. At Great Meadow prison north of Albany, a man died after not receiving treatment for water intoxication, which occurs when someone ingests more water than the body can handle, leading to organ failure.

ICE

On an August 7 earnings call, Damon Hininger, the CEO of CoreCivic, announced that the country’s largest private prison operator “is perfectly aligned with the demands of this moment…. We are in an unprecedented environment with rapid increases in federal detention populations nationwide and a continuing need for solutions.” Indeed, the Trump administration has delivered massive profits for private prison operators, with CoreCivic reporting an 18% revenue growth year-over-year for the third quarter and GEO Group, the largest contractor working with US Immigration and Customs Enforcement (ICE), boasting record-breaking third-quarter earnings up 13% over the same period last year.

More than 40 members of the U.S. House, including 15 representatives from California, are demanding answers from federal authorities about the record number of people who died in immigration detention this year. The letter, sent today to the U.S. Department of Homeland Security and U.S. Immigration and Customs Enforcement, or ICE, follows two recent deaths of Orange County men detained at the Adelanto immigration detention center, a GEO Group facility.

Alleging human rights abuses in two South Florida immigration detention facilities, Amnesty International released a 61-page report describing inhumane conditions at Alligator Alcatraz and Krome North Service Processing Center. The human rights organization accuses the federal government of “chronic medical neglect” at Krome, and the DeSantis administration of “torture and ill-treatment” of detainees being held at Alligator Alcatraz. At the makeshift tent facility in the middle of the Everglades, the report concluded that detainees did not have adequate access to medical care. It also alleged they were being detained “in inhuman and unsanitary conditions including overflowing toilets with fecal matter seeping into where people are sleeping, limited access to showers, exposure to insects without protective measures, lights on 24 hours a day, poor quality food and water, and lack of privacy.”

The inmates housed at the minimum-security state prison in McCook, Neb., could often be seen around town, working on road paving, weeding cemeteries, taking down Christmas lights and mowing the high school football field before games. For more than two decades, the prison, known as the Work Ethic Camp, was Nebraska’s only state prison geared solely toward rehabilitation. That changed this fall, after state officials announced that the Work Ethic Camp would be replaced with a 300-bed, high security Immigration and Customs Enforcement detention center to support President Trump’s national crackdown on illegal immigration.

Studies

Editor's Comment: The study below examines the relationship between schizophrenia and incarceration. The authors—including COCHS’ Dan Mistak—note that prior research has often been limited by small sample sizes. This study, by contrast, draws on data from a federated health research network that aggregates real-time electronic health records (EHR) from more than 100 million patients.

Schizophrenia is overrepresented in incarcerated populations, and incarceration may be a risk factor for schizophrenia presentation. While existing studies have highlighted a significant connection between mental illness and incarceration, their scope has often been limited by small sample sizes or by the biases inherent in national survey responses. There remains a critical need for larger, more methodologically rigorous studies to better understand the complex relationship between mental illness and incarceration and to inform more effective policy interventions. Schizophrenia was selected as the focus of this study because it represents a well-characterized mental illness with known genetic and environmental contributors and multiple effective treatment options.

Incarcerated individuals and those in immigration detention centres have higher rates of health care disparities and are disproportionately burdened by chronic disease: obesity, type II diabetes mellitus, hypertension, human immunodeficiency virus, substance use disorders, and mental illness. Ophthalmic care for patients in these vulnerable populations can be especially difficult; logistical, communication, and bureaucratic barriers exist in the carceral system, preventing timely and appropriate management of the aforementioned and ophthalmic conditions. A paucity of literature exists pertaining to ophthalmic care for patients in immigration detention centres. This is increasingly important given the changing political landscape in the United States, with higher numbers of migrants being placed in detention centres operated by privatized, for-profit organizations.

Nutrition

Food service company Aramark is leaving incarcerated people in West Virginia with empty stomachs and their loved ones with empty pockets, a federal class-action lawsuit alleges. The lawsuit, filed in a federal district court in West Virginia, claims that Aramark is exploiting incarcerated people at Mount Olive Correctional Complex by denying them adequate meals — instead pushing them and their families to spend money on food items and care packages they must also purchase from the same company.

BOP

Crumbling infrastructure has forced the closure of a low-security prison in San Pedro that has housed a host of infamous inmates over the years. Conditions at the Federal Correctional Institution Terminal Island, which houses nearly 1,000 inmates, have been a years-long problem. An assessment conducted last year by an architectural and engineering firm identified more than $110 million in critical repairs needed at the prison over the next 20 years. The prison, which opened in 1938, is the latest federal correctional facility to close over the past year amid serious budgetary and operational challenges, including severe staffing shortages, lack of funding to repair aging infrastructure, sexual assault of inmates and contraband across the prison system.

State Roundup

California

Young people at the newly reopened Barry J. Nidorf Juvenile Hall are once again urinating in bags, plastic gloves and the corners of their rooms because there is not enough staff to escort them to the restroom overnight, according to court testimony. That exact issue contributed to the state’s decision to close Nidorf in 2023 and was supposed to have been resolved when Los Angeles County consolidated that same year at Los Padrinos Juvenile Hall, where more rooms have sinks and toilets installed. But Los Padrinos, facing its own crisis, is now subject to a depopulation plan that has shuffled about 40 boys back to Barry J. Nidorf without the state’s permission.

Hawai'i

Retired Honolulu lawyer Bob Merce has worked for years to win the freedom of prison inmates with terminal illnesses so they don't have to die inside. Until now Merce has usually had to navigate Hawaiʻi's prison and healthcare bureaucracies alone, but this year he suddenly acquired some influential allies. Major players in the state correctional system are joining forces to push for a new law to simplify and codify a system known as "compassionate release" for sick and disabled prisoners that would simplify Merce's efforts. The bill would save the state an incredible amount of money." Behind bars, that cost is entirely borne by the Hawaiʻi correctional system, while the federal Medicaid program helps pay for care in community settings.

Idaho

For nearly a year and a half, Andrea Weiskircher has been pleading with prison officials, state leaders and law enforcement to look at the evidence. In the summer of 2024, Weiskircher accused five Idaho prison workers of sexually abusing her while she was incarcerated. She had sexually explicit texts, Facebook messages and emails from correction officers and a prison delivery man, Weiskircher told investigators. In a Nov. 21 email, Department of Correction Director Bree Derrick told Weiskircher that after reviewing only “a handful” of those messages, prison system investigators were able to substantiate Weiskircher’s allegations against one of those men. The decision to reopen the case comes after a series of reports from InvestigateWest exposing shoddy investigations into complaints like Weiskircher's.

Maryland

Corrections officials in Maryland are using solitary confinement far more frequently in the face of a staffing crunch and rising violence. Of Maryland’s 16,350 state prisoners, nearly 6,000 of them were placed in “restrictive housing” at some point in the fiscal year 2024, according to the most recent department figures. That’s a nearly 15% increase from the year before, and the largest single-year increase in six years.

Incarcerated individuals were transferred from a Maryland correctional facility in Baltimore after concerns were raised about the structure of the building, according to the State Department of Public Safety and Correctional Services (DPSCS). The emergency transfer took place after DPSCS was notified about the building concerns from an independent engineering consultant. The department said the decision to move from the building was "in the interest of the safety and well-being of the facility's staff and incarcerated individuals."

Massachusetts

The state Department of Correction will debut a new wellness hotline for incarcerated individuals, as part of its response to a recent rash of suicides at two of its prisons. The DOC’s existing contracted health care provider, VitalCore Health Strategies, will operate the overnight hotline from 8 p.m. to 8 a.m., scheduled to roll out Dec. 1 across all facilities. Starting in 2018, the DOC was under investigation by the Department of Justice, which ultimately concluded the agency failed “to provide adequate mental health treatment to prisoners experiencing a mental health crisis and instead exposes them to conditions that harm them or place them at serious risk of harm.”

Mississippi

For years, guards in a jail outside Jackson, Miss., terrorized those in their care, according to dozens of people who say they endured, witnessed or participated in violent assaults. Guards dragged inmates into blind corners, where cameras couldn’t capture acts of violence. They beat people behind closed doors. And they encouraged favored inmates to join in on the brutality.

Missouri

Missouri has hundreds of people in jail awaiting a mental health evaluation to determine if they are competent to go on trial for their alleged crimes. State Rep. Brian Seitz, R-Branson, is proposing to require any person arrested and subject to an evaluation have one within 45 days of their arrest. “We have inmates that have been held, you know, in local municipalities, cities, and so forth, for upwards of a year awaiting a mental health evaluation,” Seitz said.

Oklahoma

Oklahoma County Commissioner Myles Davidson has provided a detailed update on the county’s new jail project, including projected costs, construction timelines, and potential funding sources. His remarks give the clearest picture yet of what remains to be built and how much taxpayers might expect to contribute. The county originally secured a $260 million bond in June 2022 to replace the existing Oklahoma County Detention Center. That funding was intended to cover planning, land acquisition, site preparation, and early construction phases but was never expected to finance the entire facility. Early estimates for the total construction cost ranged between $700 million and $750 million, later revised upward to $835 million when accounting for furniture, fixtures, and equipment.

Rhode Island

The First Circuit found that extended isolation and continuous sleep deprivation posed a clearly established risk of serious harm, allowing an inmate’s Eighth Amendment claim to move forward. Jerry Cintron received a total punishment of 450 days in solitary confinement. During his solitary confinement, Cintron was continually confined to his cell and deprived “of almost all human contact.” The court observed that prison “officials can justify removing a prisoner from the general population to improve the safety of other inmates, [but] they cannot – in the face of that prisoner’s deterioration – perpetuate the kind of social, sensory, and sleep deprivation that Cintron alleges.” The court ruled that with respect to defendants Aceto, Corry and Kettle, Cintron’s allegations, if proven true at trial, would establish an Eighth Amendment violation amounting to cruel and unusual punishment.

Texas

Texas voters approved Proposition 3 in November. It bars judges from granting bail to defendants accused of certain violent felonies. But the amendment, championed as a tough-on-crime measure, does not give magistrates the authority to require mental-health treatment or confinement for defendants who are clearly mentally ill, unstable, or a danger to themselves or the community. Judge Stewart said lawmakers inadvertently left out an entire population that routinely cycles through county jails: low-level offenders with serious mental illness. Data from Mental Health America ranks Texas 51st in the nation—last when counting D.C.—for access to mental-health care despite $1.6 billion in state mental healthcare spending in 2024.

Utah

Two new legislative audits paint a picture of inadequate and flawed mental health care in Utah’s state prison in Salt Lake City. The reviews found employees failed to properly monitor those at risk of suicide, and the impact is illustrated in several examples of self harm, with one person taking their own life. Auditors said a psychiatrist who assisted in the audit process concluded “inmates are often abandoned” because of a lack of consistent follow-up in care. They also recorded examples of some getting the wrong psychiatric medications and others missing doses.

Washington State

A former inmate with celiac disease has reached a $630,500 settlement over a lack of safe, gluten-free food during his time in jail. Gaven Picciano took legal action against Clark County, Washington, after he reported being malnourished over three weeks to the point of collapse. The man repeatedly disclosed that a gluten-free diet was a medical necessity. However, the lawsuit says the former Vancouver, Washington resident was not provided with food he could safely consume.

Reviews of deaths in Pacific County jail on Dec. 13, 2022, and Oct. 7, 2024, have been quietly completed and submitted to the Washington State Department of Health. The reports make three formal recommendations: staff the jail around-the-clock with a registered nurse and other health professionals at least five days a week and keep them on call; immediately transport inmates who meet a specific medical criterion to another jail or facility that has a higher level of care; or close the jail and contract with another facility to hold inmates.

Reentry

The New Freedom Project, a Phoenix-based program that has supported more than 4,000 participants since 2023, approaches reentry not as a checklist of compliance requirements, but as a deeply human journey. New Freedom’s curriculum blends accountability, personal growth, and trauma-informed recovery, designed to help members rebuild stable and fulfilling lives. The program’s Peoria campus, once a 248-room hotel, has been transformed into a state-of-the-art, Joint Commission-accredited facility to serve 380 male members.

Technology

Ashland County Jail officials plan to track real-time medical updates of inmates using wristbands. The Ashland County Board of Commissioners on Thursday approved a nearly $42,000 three-year contract with 4Sight Labs for the company’s Overwatch program. The purchase means county jail staff will place three wristbands on inmates deemed to be medically at-risk, said Sheriff Kurt Schneider.

Correctional Healthcare Vendors

Wellpath

The comptroller’s office filed a lawsuit against the Hudson County (NJ) in August 2024 after warning them back in March of the same year that a fair, open bidding process had not been followed since only “several self-selected vendors” were asked to apply. The county appealed to Superior Court of New Jersey. On December 12, 2023, the New Jersey Office of the State Comptroller (OSC) issued an eleven-page written determination concluding the County had improperly relied on the professional services exception to the public bidding requirement and, therefore, failed to comply with the LPCL (Local Public Contract Law). The comptroller also noted that the county notified them of the $13,488,000, one-year contract with Wellpath even later in the process in 2023 than they did in 2018. Acting State Comptroller Kevin Walsh, who is fighting a state bill that would strip his office of their investigatory powers, celebrated the legal victory in a statement. “The Appellate Division’s decision affirms OSC’s authority to ensure major public contracts are handled fairly, openly, and in compliance with the law,” he said.

Centurion

The state government is rebidding the prison system’s healthcare provider contract, which is worth tens of millions of dollars each year. With the current contract now in its final year, bidding is open for the Kansas Department of Corrections’ comprehensive healthcare contract. Centurion of Kansas LLC is the current contractor, but the agreement expires at the end of the fiscal year on June 30. Centurion’s contract began on July 1, 2020, and is now in its final renewal period.

Dana Long worked at Jefferson City Correctional Center (JCCC) as a registered nurse for less than 50 days before quitting. Long regularly worked 60-70 hours a week, despite originally being hired to work three 12-hour shifts, she said.It was early October when Long, a registered nurse, realized she could no longer endure the environment. That was around the same time when several medical employees at JCCC suddenly quit. Due to the reduced staff, employees from surrounding Missouri prisons were brought in to support the medical department at JCCC. Medical employees in prisons across Missouri are employed by Centurion Health. There have been six lawsuits against the department or Centurion during the past two years, five of which are wrongful death or malpractice suits

Mediko

Two detainees at the Horry County jail in Myrtle Beach, South Carolina, died within months of each other. Their families are now suing both the jail and its medical provider, Mediko, which has been contracted at the facility since 2017. One lawsuit alleges that Mediko failed in its duty to ensure that a proper physical and mental health assessment was completed within 14 days of booking. In the second case, the county and Mediko are accused of failing to intervene in a timely manner and provide medical treatment to an incarcerated person suffering from opioid withdrawal.

MedFirst Staffing

A South Carolina inmate says medical staffing companies contracted with the state delayed the care he needed, leaving him with permanent optic nerve damage and blind in his right eye. In the lawsuit filed in Richland County court, the inmate, Marvin Lee Williams, says Condustrial, Inc. and MedFirst Staffing were medically negligent by failing to follow doctor’s orders, escalate his complaints, arrange needed follow-up care and advocate for him as a patient.