Medicaid Cutbacks and Trump’s Homelessness Executive Order: A Policy Collision

Highlighted Stories

Editor's Note

This week we take a look at how states are attempting to align with President Donald Trump’s executive order, Ending Crime and Disorder on America’s Streets. When the order was first released in July 2025, we presented arguments both for and against it. Among its most enthusiastic supporters was Utah Rep. Tyler Clancy, who memorably compared the effort to turning around the Titanic—a vivid metaphor that invited attention.

Utah has been among the first states—perhaps the first—to attempt implementation. As reported in a October 29, 2025 article in The New York Times, the state proposed a 16-acre “service campus,” reflecting the administration’s campaign promise to move homeless populations out of urban centers. From the outset, homeless advocates raised concerns, warning that the proposed mega-shelter could resemble a detention facility more than a treatment center.

Turning to this week’s Times article, we see how far that proposal has progressed: not far at all. The project has been halted—at least for now—amid concerns about cost, civil liberties, and what critics describe as inadequate planning. Estimates placed construction at $75 million, with annual operating costs around $34 million, figures some believe are understated. More fundamentally, basic questions remain unresolved: who would qualify for placement in such a facility, and under what legal authority?

Supporters of the initiative appear to be reacting against the “Housing First” and behavioral health approaches that have guided policy across administrations of both parties. Their emphasis is on requiring treatment for mental illness and addiction. Yet that shift has already encountered legal limits. A federal court blocked the administration’s attempt to redirect approximately $600 million from Housing First programs toward short-term initiatives that would promote—or mandate—treatment. Still, Tyler Clancy, now serving as Utah’s homeless coordinator, continues to insist that some form of detention-based approach will move forward.

Both Times articles (May 4 and October 29, 2025) also raise another complication: the impact of Medicaid cuts on financing such facilities. Questions remain about whether detention-based treatment models could meet Medicaid requirements, particularly where care is compelled. The urgency in Utah recalls a recent development in Idaho, where legislators moved aggressively to cut Medicaid despite warnings from the state’s sheriffs. After several deaths were linked to those cuts, the state was forced to reconsider its approach.

Our second highlighted article, from Louisiana, suggests that Utah is not alone. There, officials are pursuing a similar detention-based model. Advocates warn that such facilities risk becoming indistinguishable from prisons, while also questioning policies that would fine individuals whose homelessness is rooted in lack of resources.

Which brings us back to the Titanic metaphor. It may not have been the most apt comparison. The Titanic did not turn in time. Despite warnings of ice ahead, it continued forward at speed—some say in pursuit of a record crossing—with well-known consequences: lives were lost. In Idaho, warnings were also issued and largely disregarded. The pattern is familiar: full steam ahead!

Ending Crime and Disorder on America’s Streets & Medicaid Cutbacks

A Utah proposal to move 1,300 homeless people to a campus on the outskirts of Salt Lake City, many to face forced treatment for addiction or mental illness, has been set aside amid fears about costs, civil liberties and inadequate planning for a site that critics called a detention camp. On the surface the plan’s demise is a setback for the Republican governor, Spencer Cox, as well as for President Trump, who campaigned on a similar plan and exhorted states to follow his lead.

On April 28, a Louisiana Senate committee advanced a homelessness criminalization bill brightly titled “Streets to Success.” The legislation would make public camping a misdemeanor and funnel those convicted of violations into a “Homelessness Court Program,” the premise of which is that people living outside need treatment for substance use, mental illness or both. HB 211 came before the Senate Judiciary C Committee. Convictions could be penalized with up to six months in jail and a fine of up to $500.

Follow Ups

YesCare/Tehum Care/Corizon

Editor's Comment: Now where were we the last time we talked about Tehum Care/YesCare/Corizon? Oh yes—last week, when we noted that Alabama had booted YesCare after the company failed to meet payroll. This week, we return to the company’s ongoing bankruptcy troubles.

As a reminder, Tehum Care/YesCare/Corizon had reached a $75 million settlement to compensate unsecured creditors as well as personal injury and wrongful death claimants. Earlier this year, reports surfaced that payments had stopped—raising the possibility that the company could lose its bankruptcy protections. A revised deal set a new deadline of March 4 to resume payments. March 4 came and went. No payment was made, and the settlement collapsed.

Now, according to reporting from Bloomberg Law and the Wall Street Journal, the fallout has begun. Two creditor trusts—led by Matthew Dundon and Michael Zimmerman—are suing Tehum affiliates, YesCare, and insiders, including Isaac Lefkowitz, a central figure in the restructuring.

At the heart of the case is what was internally known as “Project Orange”: the division of Corizon into two entities—Tehum Care and YesCare. Tehum assumed the liabilities; YesCare retained the assets. In effect, liabilities were isolated while operations continued. This maneuver, often referred to as the “Texas Two-Step,” is now being challenged as a "sham bankruptcy" designed to siphon off assets and shield them from creditors.

At this point, the story has taken on the feel of a serialized drama. Each week brings another development, another turn. What the next installment of the Tehum Care/YesCare/Corizon saga will reveal is anyone’s guess—but the plot is clearly far from resolved.

Insiders and affiliates of defunct prison health-care company Tehum Care Services Inc. were sued for using a legal strategy called the Texas Two-Step to siphon valuable assets away from creditors while leaving liabilities in a shell company that would file for bankruptcy. Tehum director Isaac Lefkowitz, several businesses he controls, and former management of Corizon Health Inc. helped to enact “Project Orange,” which shielded company assets from mounting liabilities stemming from hundreds of medical malpractice and patient neglect suits from prisoners, according to a complaint filed by two creditor trusts Monday in the US Bankruptcy Court for the Southern District of Texas..

Prison healthcare contractor YesCare and its backers face a new creditor lawsuit alleging they executed a sham bankruptcy filing to shield themselves from tort lawsuits and other liabilities. Click the Listen button at the top of the page for the article's audio.

Armor Health

Editor's Comment: If you thought Tehum Care/YesCare/Corizon were experts at navigating legal obstacles, Armor may be just as adept. The recent ProPublica article reads almost like a case study in corporate survival.

In our March 31 Editor’s Note, we discussed NaphCare being banned from New York State for five years and noted that Armor Correctional Health Services had also been barred from the state in 2016. What the ProPublica reporting makes clear is that Armor’s difficulties were hardly limited to New York.

In Milwaukee, a jury in 2022 found Armor guilty of seven counts of falsifying records and one felony count of abuse of a resident of a penal facility. Such a conviction would seem likely to affect the company’s ability to obtain or retain contracts. Nowhere would that matter more than in Florida, where Armor has held numerous contracts and where state law requires companies to disclose such convictions—failure of which can result in disqualification.

According to the Florida Department of Management Services, Armor did not report the conviction. Instead, it reconstituted itself under a new entity, Armor Health Management LLC. A network of related LLCs then proceeded to secure contracts with at least seven Florida jails. Notably, these entities share the same CEO and street address in Miami as Armor Health.

The details are worth reading in full in the ProPublica article. What stands out for our purposes—placed alongside the Tehum Care/YesCare/Corizon story—is the extent to which proprietary providers will go to preserve their position. With contracts often reaching into the hundreds of millions—and in some cases, billions—of dollars, the incentives are clear.

After years of reporting on lawsuits, bankruptcies, and restructurings, the question remains: when, if ever, will one of these proprietary companies be able to strike a sustainable balance between the provision of healthcare and the demands of profit?

In 2022, a Milwaukee jury convicted Armor Correctional Health Services on all eight counts — including a felony charge of abuse of a penal facility resident — stemming from the death of an inmate who died of dehydration. Under Florida law, companies convicted of crimes directly related to transactions with government agencies must report the conviction within 30 days and are barred from working with Florida public entities. But the Florida Department of Management Services told reporters in 2023 that the company never reported its conviction. Armor had already begun maneuvering around the verdict before it came down. After being charged but prior to conviction, the company converted itself into a new Florida corporation, Armor Health Management LLC. When the verdict landed, it was against a company that no longer legally existed. A series of new LLCs under the Armor Health umbrella — sharing the same CEO, address, and by the company's own admission in court, the same liabilities — then signed new contracts with seven Florida jails. Within three years of the conviction, six of those seven jails had ended their Armor contracts, at least two before they expired, citing poor performance, contract violations, or simply that termination was in the county's best interest.

Arkansas

Editor's Comment: If Follow Ups had a title, this one might be called The Difference State Legislators Can Make. In the February 3rd Weekly Update, we noted a story from Mississippi in which state legislator Becky Currie raised questions about that state’s correctional healthcare provider, VitalCore: “Why are people getting sicker when we’re paying millions for medical care?”. As an aside, we also mentioned that an Arkansas legislator, Bryan King, was raising concerns about his state’s provider, Wellpath—describing the arrangement as “fraud and corruption.”

After winning his Republican primary in March targeted by a Prison PAC, King turned his attention elsewhere, referring to the proposed new prison in Franklin County as a “scam.” This has been a long-running point of contention between King and Governor Sarah Huckabee Sanders. As the article below reports, that project has now been halted.

Meanwhile, Wellpath remains the healthcare provider for Arkansas’ Department of Corrections.

A controversial plan to build a 3,000-bed prison in Arkansas is on hold after a year and a half of steadfast opposition from the local community and a group of lawmakers. The plan to build a facility on 815 acres of Franklin County farmland, first unveiled by Republican Gov. Sarah Huckabee Sanders in 2024, had the support of several Republican lawmakers as a solution to Arkansas’ growing prison population. But bipartisan opposition in the Senate doomed efforts to pass an appropriations bill to start construction, and legislative leaders said before the 2026 fiscal session that prison supporters and opponents remained at an impasse.

ICE

Last month, the federal government awarded a $313 million contract to security firm GardaWorld LLC — with the goal of establishing a new ICE facility in the City of Surprise. Now, it appears those operations have stalled. A stop work order related to the project was issued to GardaWorld last week, according to a database maintained by the federal government. The planned ICE facility in Surprise has garnered pushback in recent months, often dominating discussion during City Council meetings. Attorney General Kris Mayes sued DHS Sec. Markwayne Mullin and Acting ICE Director Todd Lyons, accusing the top immigration officials of violating environmental regulations and other federal laws in their pursuit of the ICE facility.

Adan Gonzalez, a Cuban man detained by U.S. Immigration and Customs Enforcement (ICE) at the Stewart Detention Center in Lumpkin, Georgia, died from apparent suicide, according to an ICE news release. This death is the fifth apparent suicide among the 18 known deaths in ICE detention so far in 2026 and reflects a pattern of increasing suicides in a system where solitary confinement remains widespread, despite well-documented evidence of its severe psychological harms.

Over a dozen protesters stood outside of Marana Mayor Jon Post’s house on Saturday to call for a stop to an immigration detention center planned in the area. The event was organized during a fundraiser event for the Marana Unified School District (MUSD) that was being held on Post’s property. The event was part of a national day of action against the growing number of properties the federal government is obtaining to open more detention centers. Currently, Arizona has two large-capacity immigration detention centers in Eloy and Florence, while another is planned for Surprise. A fourth in Marana would have the capacity to hold 775 people.

Pregnancy

In a yearlong investigation, Mackenzie Mays, a Bloomberg Law reporter, and NBC News journalist Jon Schuppe uncovered 54 lawsuits from women and their families alleging severe mistreatment or medical neglect in jails. The babies survived in only 21 of the 54 cases examined by the reporters, and two mothers died. Most of the women had been arrested on low-level, nonviolent charges, and told the reporters their medical concerns were dismissed by correctional workers in emergency healthcare situations. Mays and Schuppe’s in-depth research and tenacious investigative reporting was recognized this spring with the Al Nakkula Award for Police Reporting, awarded by the journalism department of CU Boulder’s College of Communication, Media, Design and Information and the Denver Press Club.

Aging

Each year in the United States, more than 600,000 individuals are released from state and federal prisons, and 9 million people cycle through local jails. Among them are people with disabilities, people of color, and multiply marginalized groups; populations that are overrepresented in carceral institutions. Medicaid plays a critical role for most people leaving incarceration by providing access to healthcare coverage. For people with disabilities, Medicaid is even more important because it can cover home and community-based services (HCBS) that provide assistance with daily activities ranging from personal care to transportation to employment supports.

State Roundup

Alabama

The numbers are staggering. At least 202 people died in Alabama prisons in 2025, but still three times the national average. Drug-related deaths run seven times the national rate; homicides six times. Roughly 355 assaults were reported in 2025 alone. The state has spent millions defending corrections officers against civil rights complaints, and families continue to appear before the Joint Prison Oversight Committee to describe the harm their loved ones face inside. ADOC's budget has grown by 275% since 2002, consuming along with Medicaid roughly half of Alabama's entire General Fund. Last week, ADOC announced it would cancel its $1 billion healthcare contract with Tennessee-based YesCare, citing financial issues with the company --see this weeks first Follow Up editor's comment.

Connecticut

Members of the Connecticut House of Representatives debated and passed a bill that would make changes to prison health care and nutrition policies following reports of extensive health-related problems within the state Department of Correction. House Bill 5567 would give additional power and resources to the state’s correction ombuds to investigate complaints around medical care, including allowing the ombuds’ office to add a mental health clinician. It also would require changes to the way DOC maintains medical records, as well as how it handles medication distribution and provides incentives for nurses.

Indiana

On April 29, St. Joseph County Jail medical staff began treating 23 inmates for similar food poisoning symptoms, including diarrhea, dehydration and fever. The medical team determined the cause of the symptoms to be food born salmonella poisoning. County and State Health Departments were called and came to conduct an inspection and help determine a direct cause of the food poising. Test results were taken by the health department have not returned, and a cause has not yet been determined.

Louisiana

Sheriff Susan Hutson and chief financial officer, Bianka Brown, overseeing a New Orleans jail where 10 inmates escaped in May 2025, setting off a multistate manhunt, were indicted on Wednesday, according to the Louisiana attorney general. Sheriff Susan Hutson of Orleans Parish, whose term is ending in the coming days, faces 30 counts of misconduct in office and Bianka Brown, the jail’s chief financial officer, faces 20 more.

Michigan

Nick Marco left his job as a corrections officer at a maximum security Upper Peninsula prison after being stabbed by an inmate who had a handmade weapon. “If you’re assaulted, you almost always have zero backup for a very long time,” he said. Stories like Marco’s can be told frequently across Michigan’s short-staffed Upper Peninsula prisons, where officers struggle to control inmates and often have little or no help when an assault happens. Michigan Department of Corrections data shows chronic officer vacancies throughout all of Michigan’s 26 prisons. Corrections officers say that’s because a third or more of positions remain open.

South Carolina

Hundreds of mentally ill people are languishing for months in South Carolina jails, deprived of needed treatment in a legal purgatory that feeds a cycle of incarceration, despair and avoidable deaths, a Post and Courier investigation has found. Since 2015, at least 102 mentally ill people have died in South Carolina jails from dehydration, suicide and other causes, according to a newspaper analysis of state, county and court records. Strong consensus exists at nearly every level that South Carolina’s criminal justice system is in the midst of a mental health crisis and in dire need of repair. But there is less agreement about how to fix the problem.

Texas

Amid a growing conversation on diversion, Bexar County officials say keeping people out of jail will take more than any single solution — as a wide-ranging discussion this week made clear there is no single “silver bullet” for the region’s growing mental health and criminal justice challenges. During a lengthy Commissioners Court briefing, county leaders pointed to years of investment in diversion and deflection programs designed to steer people away from jail and into treatment.

Washington State

A female inmate in Washington state is suing corrections officials after she says she was brutally attacked by a male-born prisoner housed in a women’s prison under the state’s gender-identity housing policy. Faith Booher-Smith, who is incarcerated at the Washington Corrections Center for Women, alleges in a federal lawsuit she was "violently attacked" by inmate Christopher Williams, a convicted sex offender who had been transferred to the prison after identifying as female.

Rikers Island

The city’s Department of Correction may soon begin to implement parts of a local law banning solitary confinement in the city’s jails, nearly two and a half years after the bill was first passed. The DOC recently began crafting a pair of pilot programs to implement two elements of Local Law 42, a controversial bill banning solitary on Rikers Island that has yet to be put into practice because a federal judge has ruled it would make the jails more dangerous.

One detainee was found dead with 66 pills in his cell. Another lay in distress for five minutes during an apparent overdose before staff administered Narcan. A third was left locked in his cell, unsupervised, for nearly half an hour as he spiraled into a medical crisis. Those were some of the damning findings outlined in the latest report issued by the city’s Board of Correction on Friday. The oversight board’s 25-page report highlights a familiar pattern: Rikers Island correction officers off post, missed safety checks, unsecured cells and a housing unit where rules appeared optional. The report also details how Correctional Health staff failed to properly care for detainees.

Lynelle Maginley-Liddie, who spent two years as the commissioner of the New York City Department of Correction, said Rikers used video games as part of its strategy to reduce violence with programming for good behavior. In 2024, the department bought 20 PlayStation 5 consoles and more than 100 PlayStation controllers for use on Rikers Island.

Correctional HealthCare Vendors

NaphCare

A Georgia man said Wednesday that he was traumatized by severe medical neglect at a problem-plagued jail in Atlanta that led to the amputation of his fingers and lower legs. Rashaad Muhammad was arrested in August and taken to the Fulton County Jail, where medical staff failed to provide antibiotics and other medical supplies he repeatedly told them he needed Less than two weeks later, his condition had deteriorated to the point that he could no longer stand and he was taken to a hospital, where he was ultimately told the amputations were necessary to save his life. His lawyer, Ben Crump, also faulted the jail’s medical provider, NaphCare, saying that its employees, along with jail guards, ignored Muhammad’s pleas for help. NaphCare should not still be providing medical services at the jail after another man held at the jail, Lashawn Thompson, died in a bedbug-infested cell in September 2022, said Crump, who also represented Thompson’s family.

QCHC

A wrongful-death lawsuit has been filed in Walker County (AL) over the death of an inmate at the Walker County Jail, with the complaint alleging serious failures in medical care and oversight. The complaint names multiple defendants, including nurses, doctors, medical contractor QCHC Inc., and Walker County Sheriff Daniel Vickery. The lawsuit mentions another Walker County inmate death the prior year, in which corrections officers deprived Tony Mitchell of medical care, which caused his death.