Medicaid & Correctional Officers: Policy Meets Implementation Hurdles of Staffing Shortages

Highlighted Stories

Editor's Note

This week’s highlighted story comes from North Carolina and explores the intersection between healthcare delivery for incarcerated individuals and persistent staff shortages. We’re featuring this piece—along with a follow-up from the Marshall Project—to encourage our subscribers to consider how Medicaid, whether through 1115 waivers or the statutory entitlement under Section 5121 for juveniles, is adding new responsibilities and pressures to correctional facilities and their staff.

It may not be immediately obvious, but correctional officers play a crucial role in facilitating healthcare behind the walls. They are responsible for escorting incarcerated people to medical appointments—an essential function that becomes strained when staffing is inadequate. As noted in last week’s Follow Ups, seven deaths in New York state facilities may be linked to the recent wildcat strike by correctional officers, underscoring the real consequences of these shortages.

As our subscribers know, healthcare in jails and prisons is often uneven and directly tied to the resources available—whether delivered by correctional health staff or private contractors. Medicaid, by providing an external grievance process and affirming the rights of incarcerated beneficiaries, introduces new obligations for correctional institutions. How these changes will play out remains uncertain, particularly in light of potential shifts in Medicaid policy under the current Trump administration. But it’s a trend that warrants close attention.

Correctional Officers Shortage

The North Carolina Department of Adult Correction is constitutionally required to provide medical, mental, and dental care to the state’s 31,000 incarcerated people, but these services come at a growing cost. In fiscal year 2023-24, health care expenses totaled $429.1 million—about a quarter of the department’s $2 billion annual budget—marking a 36% increase over the past five years. Incarceration accelerates aging and worsens health, with studies showing that a 59-year-old in prison can have the same morbidity rate as a 75-year-old in the community. Chronic illnesses and life-threatening conditions often emerge earlier in prison populations. Staffing shortages further strain health care delivery: the department’s overall vacancy rate is 24%, rising to 28% for healthcare jobs. Nurse vacancies are especially high at 37%, while over a third of the 8,000 correctional officer positions remain unfilled.

The Cuyahoga County Jail underwent two inspections in 2024, revealing some improvements, while also noting other long-term problems inside the oft-criticized facility. A November 2024 jail inspection by Donald Leach, a corrections consultant hired as part of a civil lawsuit settlement, found the facility continues to address longstanding issues such as officer training and food quality. However, the report illustrates other issues in the jail’s medical grievance procedures. In January, The Marshall Project - Cleveland reported that the Ohio Bureau of Adult Detention placed the Cuyahoga County Jail on a corrective action plan in April 2024 after staff ignored an incarcerated person’s pleas for medical help for several days.

Follow Ups

Editor's Comment: Once again topping this week’s Follow Ups is the ongoing Wellpath bankruptcy. The first two stories revisit the ripple effects of Wellpath’s non-payment for ambulance services in Michigan (see Editor’s Note of September 24, 2025 and November 12, 2025 ). These articles recount how Wellpath's payment failures continue to strain local EMS agencies, with some contracts for medical equipment replacements being canceled and now the EMS agencies are requesting the state to reimburse them for Wellpath's unpaid bills. In Arkansas, the Legal Defense Fund reports that its lawsuit settlement with Wellpath is on hold due to the bankruptcy proceedings. Meanwhile, Bloomberg Law reports that Wellpath is polling its creditors—including incarcerated individuals with personal injury claims—about its restructuring plan.

As has been noted in previous Weekly Updates proprietary healthcare providers promote their healthcare services as a cost saving measure for jurisdictions. Tell that now to Michigan or Arkansas where Wellpath is receiving $1.6 billion dollars for its services.

The last article in this week’s Wellpath series shifts focus to Turn Key Health Clinics (see Editor’s Note of September 17, 2024). The Oklahoma Supreme Court recently ruled that correctional healthcare providers like Turn Key have sovereign immunity, making it far more difficult to sue these companies in that state. It’s not hard to imagine that Wellpath might hope for similar rulings elsewhere.

Turning to Sacramento, California, where we have previously editorialized about the ineffectiveness of oversight—even under a consent decree. The Mays consent decree for Sacramento County was approved by a federal court in 2020 yet violations of its provisions persist. A stark example might be the death of David Kent Barefield. Mr. Barefield, visibly ill, was dragged into the Sacramento County jail but did not receive medical attention. Instead, he was handcuffed to a cart and reportedly received medical care only in his final moments. The county has now settled with his family for $3.5 million.

And finally, it appears the wildcat strike in New York State is truly over. We’ve included Gov. Kathy Hochul’s latest statement outlining the path forward. It’s worth noting that approximately 2,000 correctional officers did not return to their positions and are now barred from future state employment. However, as the Gothamist reports, the strike has created a backlog of convicted individuals at Rikers Island. With so many officers fired for failing to return, the state prison system is now operating at just 75% of its staffing capacity.

Wellpath Bankruptcy

Michigan ambulance providers are warning they may have to scale back local services because a state vendor has refused to pay them up to $6 million for visits to Michigan prisons in the past two years. At issue are ambulance costs that were supposed to be paid by Wellpath, a Tennessee-based company the Michigan Department of Corrections had contracted with for inmate health care services. The company was meant to reimburse ambulance providers for calls to Michigan’s prisons. However, officials say the company abruptly stopped communicating with EMS providers across the state nearly two years ago and has yet to pay between $4 and $6 million in bills. Emergent Health Partners CEO Ron Slagel, whose nonprofit operates six ambulance services in 14 counties across southern Michigan, including Jackson, said he has already had to cancel contracts to replace medical equipment because of the unpaid bills.

Emergency Medical Services (EMS) agencies across Michigan face a financial crisis after being left unpaid for two years for transporting inmates from state correctional facilities. The debt, totaling $6 million, has some agencies postponing purchases, cutting services and, in some cases, facing potential closure., Michigan Now reports. The issue stems from the financial collapse of Grand Prairie Wellpath, the company the state hired to manage prison healthcare. Grand Prairie Wellpath stopped paying EMS agencies approximately two years ago, according to the Michigan Association of Ambulance Services. The company later filed for bankruptcy, leaving EMS providers in the lurch. The MAAS has asked the state to pass a supplemental budget, appropriating up to $6 million to compensate EMS agencies. The state, meanwhile, points the finger at private-equity-backed Wellpath for the problem. The state has since filed litigation against Grand Prairie Wellpath

LDF filed a lawsuit on behalf of individuals incarcerated in the Arkansas state prison system, who were subject to increased risk of infection, illness, and death as a result of the failures of Arkansas prison authorities to address and protect against the COVID-19 pandemic. The lawsuit was originally against the State of Arkansas and Wellpath, Inc., its provider of correctional health services. At the time, Arkansas prisons had the highest death toll of any prison system in the nation. The lawsuit against Wellpath remains pending, but is stayed because Wellpath has filed for bankruptcy.

Troubled prison health-care provider Wellpath Holdings Inc. secured court approval to begin polling creditors, including inmates with personal injury claims against the company, on its restructuring proposal, pending revisions. The Friday ruling is a step forward for Wellpath as it works on a bankruptcy plan to resolve funded debt issues and about 1,500 tort claims from current and former incarcerated people and families of deceased prisoners.

The Oklahoma Supreme Court unanimously reversed a Court of Civil Appeals decision this week, ruling that Turn Key Health Clinics—a private company providing medical services in jails—is entitled to sovereign immunity under the Oklahoma Governmental Tort Claims Act. Sovereign immunity bars lawsuits against governments unless waived. The case stemmed from a lawsuit by the husband of a woman who died in the Creek County Jail in 2016. A district court initially ruled sovereign immunity blocked the claim; the Court of Civil Appeals reversed that, but the Supreme Court has now reinstated the immunity. The ruling makes it much harder to sue licensed medical professionals contracted by city, county, or state detention facilities in Oklahoma.

Sacramento County

The family of a man who died from an overdose in a Sacramento County jail after being left unattended for hours have agreed to a $3.5 million settlement. That man, David Kent Barefield Sr., 55, was dragged across a garage into the jail, not given a medical exam despite being visibly ill, handcuffed in a cart while awaiting booking and only offered medical aid in his final minutes, jail footage shows. Mark Merin, the family’s lawyer, said the footage revealed a widespread culture of neglect at the jail. “This shows a host of people who are supposedly experts humiliating and making fun of somebody who is in dire need of help,” Merin said.

Wildcat Strike (New York State)

Governor Kathy Hochul today provided an update on the future of New York State’s correctional system following the end of the 22 day illegal work stoppage, creating a path to recover, recruit and rebuild the system moving forward. The end of the strike follows four attempts at an agreement between DOCCS and NYSCOPBA that seriously addressed concerns regarding safety and compensation. The Governor also signed an executive order barring the hiring into State service of individuals who are participating in the wildcat strike. “My top priority is the safety and well-being of all New Yorkers — and I have been working around-the-clock to end this illegal work stoppage and restore safety in our correctional system,” Governor Hochul said. “We have taken unprecedented steps to protect public safety, and I am grateful to the National Guard and DOCCS personnel who stayed on the job, going above and beyond to protect their fellow New Yorkers. Today, we can finally say this work stoppage is over and move forward towards making our prisons safer for all, supporting our correctional staff, and recruiting the correction officers of the future.”

Some 350 convicted people are crowded onto Rikers Island awaiting transfer to prisons upstate due to continued ripple effects from the state prison strike, according to jail officials. The backlog has led city jailers to seek permission to house more people in dorms than regulations allow — a situation advocates say will exacerbate conditions at the already notorious city jail complex. Even though the illegal strike ended this week, the state fired some 2,000 guards who refused to return to work and is operating with about 75% of its normal staff. State prison officials said they will re-evaluate accepting new prisoners at the end of the month, while advocates said incarcerated people are desperate to get off Rikers Island.

BOP

The Bureau operates 120 institutions, including seven federal medical centers (FMCs). While each facility offers medical care—often through community providers under contract—staffing shortages remain a persistent issue. A 2024 Office of Inspector General (OIG) report concluded that one federal prison, FMC Devens, for example, had "serious issues" in providing adequate healthcare to inmates. Federal inmates may apply for compassionate release, historically reserved for those with terminal illnesses and a life expectancy of only months. However, courts have expanded its use in cases where the BOP cannot provide adequate care. Courts often inquire whether the BOP can manage a defendant’s medical condition before sentencing. While judges may show leniency toward defendants with serious health issues, the BOP rarely, if ever, admits to being incapable of providing care.

ICE

Immigration detention facilities are facing shortages in food, clothing, hygiene products and staff as the Trump administration chooses to hold more people in custody, according to detainees in multiple states. People in the custody of Immigration and Customs Enforcement in California, New Mexico, Texas and Washington told “Beyond the Border” that since President Donald Trump took office, they’ve noticed a deterioration of already difficult conditions in facilities run by various entities including private prison companies CoreCivic and GEO Group as well as ICE itself.

For decades, detaining undocumented immigrant families has been a contentious enforcement tactic. Critics of “family detention” have said young children suffer in confinement. Proponents say that locking families up while they await likely deportation sends a stark message about the consequences of entering the United States illegally. Now, after falling out of use under the Biden administration, family detention is being resurrected by President Trump, as his administration marches forward on its promise to crackdown on immigrants. Two family detention centers in Texas are being run by private prison companies that contracted with U.S. Customs and Immigration Enforcement. Another site is operated by CoreCivic, can hold up 2,400 people. The other, a 1,328-bed facility in Karnes, is managed by the GEO Group.

Studies

As there is not a right for incarcerated persons to be permitted visitors during hospitalization unless the patient is terminally ill, incarcerated patients are often completely restricted from having visitors. These burdensome restrictions have the effect of disconnecting the incarcerated person from their support system during a time which is known to be emotionally and psychologically taxing. Even when terminally ill patients who are incarcerated are permitted to have visitors during their hospitalization, the visitor may be forbidden from engaging in physical contact with the patient. The effect of this policy is that a parent may be forbidden from holding the hand of their dying child, regardless of the magnitude of the crime in which they are incarcerated, just because he was under custody of the carceral system while dying.

Data & Statistics

BJS has released the 2021 National Corrections Reporting Program (NCRP) datasets through the National Archive of Criminal Justice Data. Through the NCRP, BJS collects offender-level administrative data annually on prison admissions and releases, yearend custody populations, and parole entries and discharges in participating jurisdictions. The collection gathers data on demographic characteristics, conviction offenses, sentence length, minimum time to be served, credited jail time, type of admission, type of release, and time served from individual prisoner records.

State Roundup

California

During Patient Safety Awareness Week, Receiver J. Clark Kelso talks about the receivership and prison health care in this latest video. “The goal of the receivership has always been to build a health care system that is efficient, well-managed, self-monitoring, and sustainable,” he said. “At the core of this goal is patient safety. Fast forward to 2025 and I have delegated the medical care of 29 institutions back to the state of California. This is a true testament to the significant improvements you have all made creating a safer, more effective health care environment for incarcerated people.”

Illinois

DuPage County and county Sheriff James Mendrick have reached an $11 million settlement with the estate of Reneyda Aguilar-Hurtado, a 50-year-old mother who died in June 2023 after being held in the county jail for 85 days while awaiting transfer to a state-run mental health center. A county pathologist determined her death was due, in part, to “medical neglect.” The nearly 50-page complaint, filed a month after Aguilar-Hurtado’s death, cited about a dozen examples of other jail detainees — some who died while on medical watch, others who have sued the jail over health care complaints — in alleging a “widespread practice and policy of deliberate indifference to the health and safety of critically ill inmates suffering from life-threatening conditions under their custody and control.”

Minnesota

Officials in Dakota County unveiled the new Integrative Health Unit at the county jail Monday morning. That new facility provides specialized care, specifically for incarcerated individuals who are vulnerable or have dedicated needs. That includes those with medical, mental health or substance use needs. The new unit has space for up to 26 people. County officials say this new space is one of the first — if not the first — in the state. The new unit cost $14.4 million, funded by the American Rescue Plan Act. Leko says this new space will be a benefit to the community, and allow them to better help those who end up in their facility.

Oklahoma

The Oklahoma Legislature has taken a major step toward addressing long-standing problems in the state’s mental health and criminal justice systems. A consent decree seeks to resolve a 2023 lawsuit accusing the Oklahoma Department of Mental Health and Substance Abuse Services of violating due process for defendants deemed incompetent to stand trial. The class-action suit, filed by inmates at the Tulsa County Jail, claimed they were left waiting months in jail for competency restoration treatment. The resolution, recently passed by the Senate, includes increased training for forensic healthcare professionals, the creation of in-jail restoration programs, and expanded state resources.

Utah

Lockdown protocols have been activated in a portion of the Utah State Correctional Facility in Salt Lake City as over 100 inmates are being treated for scabies after one person tested positive for the skin disease. The Utah Department of Corrections said a total of 140 inmates in the prison's geriatric unit have been quarantined and will be treated, although all the inmates except the one infected individual have tested negative.

Wisconsin

Two women incarcerated at Taycheedah Correctional Institution have died following hospital stays that began Feb. 22. The Wisconsin Department of Corrections has shared limited information about their deaths, frustrating family members and those locked up at the maximum- and medium-security women’s prison. Online records showed the women had died but little other information. States including Minnesota, Iowa and Nebraska publicly announce prisoner deaths, sharing the person’s name, prison, where they died, and in some cases, details related to their cause of death. Wisconsin does not.

Correctional Healthcare Vendors

Wellpath

There are certain words no one wants to see used to describe them in a performance audit. “Persistent noncompliance” would be two big ones. Those words were bandied about with considerable frequency in a report the county supervisors were given about the quality of health care — mental and otherwise — in the two county jails. The measure that generated the most alarm from the county supervisors was the extent to which Wellpath, the jails’ private health contractor, met its contractual obligation to medically assess inmates placed in safety cells every four hours: only 13 percent. Likewise, mental health professionals managed to check on such inmates within 12 hours — as the contract calls for — only 67 percent of the time of the time. The audit found that Wellpath met its post-suicide-watch follow-up mileposts only 67 percent of the time. Based on audit guidelines, a 90 percent score was required to qualify as contractual compliance.

A former inmate is suing El Paso County after he said staff at the El Paso County jail denied him his prescribed chemotherapy medication. Court documents show McLaney was booked into the El Paso County Jail in March 2023 on felony drug offenses. The lawsuit said during the four months McLaney was in jail, he never received his chemotherapy medication despite multiple pleas to deputies and jail medical providers. The lawsuit was filed against El Paso County, Wellpath, the jail's former medical provider, Wellpath. In 2024, the sheriff's office cut ties with Wellpath and started a new contract with VitalCore Health Strategies.