Medicaid Cuts, Rural Jails As Psychiatric Facilities, and Trump's Executive Order: Ending Crime and Disorder on America’s Streets

Highlighted Stories

Editor's Note

From the many stories we have included in the Weekly Update, our subscribers have often seen how jails have become de facto mental health facilities in many communities. As the first three highlighted stories from Nebraska, Missouri, and South Carolina make clear, the shortage of beds in state psychiatric hospitals has effectively turned many rural jails into long-term psychiatric institutions.

What may further exacerbate conditions in these facilities, as the Prison Policy Initiative article points out, is that the One Big Beautiful Bill Act has drastically cut Medicaid funding for rural hospitals—institutions that many rural correctional facilities depend on for care. As that article notes: “Almost 60% of people in prisons and 25% of those in local jails are confined in rural counties, which are home to 3,000 of the nation’s correctional facilities.”

Adding to this shrinking pool of resources is President Trump’s executive order, Ending Crime and Disorder on America’s Streets. As the last highlighted article from The New York Times reports, Utah appears to be moving full steam ahead in implementing the administration’s intentions: using civil commitment to confine homeless individuals deemed mentally ill and to provide treatment. Assuming, as seems likely, a considerable overlap in the demographics between those who are homeless and mentally ill with the many people languishing in jails awaiting psychiatric placement, it is difficult to see, amid the impending Medicaid cuts, where the funding for these “new services” will come from.

Rural Jails

A report released last week by the Office of Inspector General of the Nebraska Correctional System raises concerns over mental health services and how inmates with mental conditions are handled. Inspector General Doug Koebernick's report says the department may be violating state law by placing inmates with diagnosed serious mental illnesses in longer-term restrictive housing. The department says it is not breaking the law. The report also discusses staffing shortages, living conditions, and programming.

A man jailed on felony drug possession charges has been waiting 469 days in the Clay County Detention Center for mental health services that could allow his case to move forward. It took him 75 days just to get a court-ordered evaluation from the Department of Mental Health. In September, an average of 487 Missourians were waiting for a bed in a psychiatric hospital run by the department. The waitlist has grown by a third since September 2024 and almost 88% since September 2023. In August, that average number reached 492, an all-time high. A year after the launch of the first jail-based competency programs, sheriffs, corrections medical staff and jail administrators say that although the new initiatives have helped address mental health needs, they aren’t enough to tackle the waitlist

Experts say more than half of those sitting in South Carolina jails right now are suffering from mental illness, but most facilities lack the resources to help them. Inmates inside jails throughout South Carolina are waiting for months, sometimes even over a year to receive court-ordered mental health treatment. And while waiting for help, inmates are committing suicide. Other than limited mental health resources inside jails, the only outside option for inmate help is one facility maintained by the Department of Mental Health in Columbia. That facility only has 200 beds available. The Department of Mental Health said as of Sept. 26, 129 people were on the waitlist for a bed in Columbia after a judge ordered them to restoration for 180 days. Twenty-two of those inmates have waited for over 200 days.

One Big Beautiful Bill Act

The “One Big Beautiful Bill Act” imposes significant cuts to Medicaid that slash funding for rural hospitals, which receive federal subsidies to stay afloat. Nearly a million incarcerated people depend on rural hospitals for routine off-site and emergency medical care. Almost 60% of people in prisons and 25% of those in local jails are confined in rural counties, which are home to 3,000 of the nation’s correctional facilities. Following massive cuts to Medicaid passed by Congress this year, many rural hospitals will be forced to scale back operations or close entirely. As a result, critical, lifesaving healthcare will be further out of reach for huge swaths of the incarcerated population and those who live and work nearby.

Ending Crime and Disorder on America’s Streets

To glimpse the future of homelessness policy in the age of President Trump, consider 16 acres of scrubby pasture on the outskirts of Salt Lake City where the state plans to place as many as 1,300 homeless people in what supporters call a services campus and critics deem a detention camp. State planners say the site, announced last month after a secretive search, will treat addiction and mental illness and provide a humane alternative to the streets, where afflictions often go untreated and people die at alarming rates. While the Utah effort began before Mr. Trump’s return to office, it mirrors his pledge to move the homeless from urban cores to “tent cities” with services. Critics of the new plan say that confining people to a site on the city’s outskirts threatens civil liberties and warn that the promised services may not materialize. The efforts coincide with deep cuts to Medicaid, which could thwart the project’s financing.

Follow ups

New York

New York’s state prison system has been in crisis since March, when a three-week guard strike ended with some 2,000 officers losing their jobs. The prison agency has struggled to staff facilities at the level it says is necessary for normal operations, leaving thousands locked in their cells for long stretches. To many incarcerated people, dire conditions represent a new normal. Post-strike breakdowns have consumed their lives for eight months. While some facilities are running normally, others remain in states of effective lockdown.

ICE

Interviews with more than a dozen women at Immigration and Customs Enforcement (ICE) detention facilities in Louisiana and Georgia revealed disturbing accounts of pregnant people being placed in solitary confinement, denied medical care for miscarriages, and shackled in four-point restraints during medical transport. Although the detention of pregnant women violates ICE guidelines, several of the women were arrested after seeking law enforcement intervention for domestic disputes.

Early Release

As incarcerated individuals age, prison systems often struggle to provide appropriate long-term care. Compassionate release policies can address this gap by allowing seriously ill or aging individuals to transition to community-based care. Many nursing homes, however, are reluctant to admit individuals recently released from prison. This study examined how incarceration status affects nursing home admission decisions.

State Roundup

Alabama

Alabama Department of Corrections Commissioner John Hamm gave state lawmakers an update Wednesday on the state’s new prison, a 4,000-bed specialty care facility for men in Elmore County. Hamm told the Legislature’s prison oversight committee that the Governor Kay Ivey Correctional Complex was 75% completed as of September. The complex will include 54 buildings - 17 buildings for housing inmates, 12 medical buildings, 25 support buildings and 720 medical and mental health beds. Alabama’s prison construction plan is not intended to increase the total number of beds in the system but to replace beds in the state’s aging, overcrowded, and understaffed prisons. Ivey and legislative leaders have said the new prisons were an essential part of the solution to problems identified by the Department of Justice in a lawsuit over unsafe conditions in Alabama’s men’s prisons, filed in December 2020.

California

Trinity County Health & Human Services Agency presented a multi-department update on May 20, 2025, describing operational and funding changes for jail health services that officials said will improve medical care for inmates and create opportunities to recover costs through Medi-Cal and new state programs. HHS Director Liz Hamilton said the agency has added a second physician assistant and an LVN (licensed vocational nurse) to the jail medical team and is upgrading the jail medical suite. The department has contracted for an electronic health record (EHR) system tailored for corrections and arranged a health information exchange so outside providers' records are visible to jail clinicians when appropriate.

Maryland

According to a complaint filed in the Baltimore County Circuit Court, Lamont Mealy, who had a history of mental illness, was placed in cuffs, chains, and a suicide-prevention vest and taken to solitary confinement "on or about" June 30, 2023. After placing him there, two officers—neither of whom was wearing name tags or displaying rank insignia—inexplicitly shut off the water to the cell. Around July 2, the same two officers returned to the outside of the cell to taunt Mealy, asking him, "Are you thirsty?" Mealy repeatedly begged them for water but was never given any.

Massachusetts

Legislation targeting what advocates call a “humanitarian crisis” in Massachusetts prisons would enhance educational opportunities, mental health services, and other standards across the system, advocates say. The bill, introduced by Rep. Brandy Fluker-Reid of Mattapan, would create universal standards for conditions that would apply in state prisons, county jails, and houses of correction, said Jesse White, a policy director for Prisoners’ Legal Services of Massachusetts. Under the proposal, inmates would spend at least eight hours per day outside of their cells

A group of about 150 current and former inmates at a Massachusetts prison who accused correction officers of brutal abuse will receive about $6 million in a settlement, according to details of the agreement released by plaintiffs’ lawyers. The prison, roughly 50 miles west of Boston, has been the site of several fatal incidents over the past two decades. Correction officers beat and kicked inmates, gouged their eyes, grabbed their testicles and smashed their faces into floors or walls, the complaint said.

Minnesota

Otter Tail County will pay a former inmate, Ramsey Kettle, who was deprived of food, water and medical care $200,000 and will change several policies as part of a settlement agreement. The lawsuit said staff kept Kettle in solitary confinement in an unsanitary cell covered with human feces for days. Staff ignored him as he showed increasing signs of physical and mental distress, and denied him food and water until he cleaned his cell. Kettle is an Otter Tail County resident and a tribal member of White Earth Nation.

Montana

The Montana Department of Corrections announced crews have restored full water service at Montana State Prison near Deer Lodge. Multiple water pipes at the prison broke early this month, which forced the state to truck in water to the prison. Several different agencies have been involved with the continuing response at the facility and the National Guard was called to assist.

New Mexico

Bernalillo County ended a contract with Wellness Equity Alliance for addiction treatment at the Metropolitan Detention Center, according to an August letter obtained by the Journal on Wednesday. The county's CARE campus, which already runs a detox facility, will take over supplemental addiction treatment at the jail on top of the care University of New Mexico Hospital already provides. The cancellation comes after an audit found that WEA's mobile health clinic, Health Yeah!, which provided health care services for several middle schools, didn't comply with federal regulations.

South Carolina

Charles “Chuck” Wright, 60, the former sheriff of Spartanburg County plead guilty to three charges, conspiracy to commit theft concerning programs receiving federal funds, conspiracy to commit wire fraud and obtaining controlled substances by misrepresentation. Amos Durham 61, a former chaplain for the department pleaded guilty to conspiracy to commit theft concerning programs receiving federal funds. Lawson B. Watson 63, a former employee plead guilty to conspiracy to commit wire fraud.

South Dakota

A South Dakota legislative leader, Rep. Greg Jamison, predicted he can “almost assure” that “every legislator” will support reforms addressing inmate rehabilitation and recidivism. A legislative committee will finalize its list of recommended legislation at its next meeting, targeting rehabilitation, diversion and supervision issues that affect incarceration and recidivism rates.

Washington State

Senate Bill 5128 would clarify that confinement facilities operated by the Department of Children, Youth, and Families (DCYF) and county juvenile detention facilities are included in Medicaid suspension and reinstatement requirements and would require the Health Care Authority (HCA) to collaborate with managed-care organizations, DCYF and juvenile detention facilities to implement federal law on certain pre-release and post-release services. SB 5128 would remove DCYF confinement facilities and county juvenile detention facilities from the definition of “correctional institution” for this purpose and require HCA, until July 1, 2026, to collaborate to provide screening, diagnostic and targeted case management services to eligible juveniles before and after release.

Wisconsin

Democratic Gov. Tony Evers' sweeping plan to overhaul Wisconsin's aging prison system, which includes closing a prison built in the 1800s, moved forward Tuesday with bipartisan support despite complaints from Republican lawmakers that their concerns weren't being addressed. Republicans have opposed parts of the plan that would reduce the overall capacity of the state prison system by 700 beds and increase the number of offenders who could be released on supervision. The plan also proposes that the state’s oldest prison, which was built in Waupun in 1851, be converted from a maximum-security prison to a medium security center focused on vocational training.

Prison Contractors

During the 2024 presidential race, GEO Group, the nation’s largest private prison company, was the first corporation to max out donations to Donald Trump’s SuperPAC with $500,000, ultimately contributing over a million dollars to his campaign.This alliance highlights how private prison companies stand to profit from political promises of mass incarceration and a crackdown on immigrants and marginalized groups. GEO Group’s CEO estimated the company could earn up to $400 million annually by filling empty beds to meet the “future needs” of US Immigration and Customs Enforcement (ICE).

Telecommunications

The Federal Communications Commission, an agency controlled by appointees of US President Donald Trump, voted Tuesday to raise the maximum price for prison phone calls—a gift to telecom firms and private prison giants that profit from what critics have long described as predatory charges. The agency’s 2-1 vote rolled back a Biden-era cap on the price of prison phone calls, a limit that the FCC estimated would have collectively saved incarcerated people and their loved ones hundreds of millions of dollars a year.

Correctional Health Care Vendors

VitalCore

Christopher Boose's infection stemmed from a broken bone after Boose, then 38, fell off his bunk at the Central Mississippi Correctional Facility onto his arm. Left untreated for a week, the sepsis spread. “Cut it off,” he remembered the doctors shouting shortly after they had wheeled him into an operating room. “Cut it off so we don’t lose him.” The lawsuit targets VitalCore Health Strategies, a private company contracted to provide health care in Mississippi’s prisons. Systemic neglect gave way to “cruel and unusual punishment” prohibited by the Constitution, the lawsuit contends.

PrimeCare Medical

A Cumberland County Prison inmate has filed a lawsuit against Cumberland County and the company, PrimeCare Medical, that provides healthcare at its prison. Jason Robles, an inmate at the county prison, alleges a prison staff member used wart remover on his eyes. According to the complaint, Robles' eyes began to burn, and he started to scream in pain. He was then reportedly taken to the emergency room at Penn State Holy Spirit Medical Center. After receiving emergency treatment, Robles was still unable to see out of his left eye. According to the suit, he was then taken to Memorial Eye Institute, where a doctor recommended surgery. No surgery was performed, according to the suit, and Robles continues to have issues with his vision.

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