Big Beautiful Mess: Red State Public Safety Against Medicaid Cutbacks

Highlighted Stories

Editor's Note

This week’s highlighted stories from Utah are another example of a deep red state confronting the practical consequences of Medicaid cutbacks. As in the Idaho story we started covering last year, sheriff and law enforcement organizations in Utah are warning that these reductions will also harm public safety.

To understand what is at stake, it helps to get a bit technical. In 2017, CMS approved an 1115 waiver for Utah that allowed Medicaid to provide continuous eligibility to certain vulnerable adult populations. This became known as Targeted Adult Medicaid, or TAM. TAM extended continuous coverage to people who were chronically homeless, involved with the justice system, or in need of treatment for substance use or mental health conditions. For justice-involved individuals, this meant they would not face constant eligibility redeterminations, but could maintain coverage for a full year. That continuity matters. For populations already struggling with instability, gaps in coverage are not just inconvenient they are counterproductive.

In the first highlighted story, Kane County Sheriff Tracy Glover, president of the Utah Sheriffs’ Association, points out that a significant majority of people detained in her jail struggle with substance use disorders, mental illness, and housing instability. Those are precisely the populations TAM was meant to reach. Glover further states that the use of TAM to support reentry services for jail inmates has been associated with a reported 61% reduction in recidivism.

The problem is that the waiver expires next year, on June 30, and because of the One Big Beautiful Bill Act, CMS has informed Utah that renewal is unlikely—even if the state seeks only a short-term extension. CMS has indicated that waivers containing continuous eligibility are unlikely to be approved.

Which brings us to the other highlighted article and Utah’s proposed “homeless campus” which we have previously included in the Weekly Update. This facility is aimed broadly at people experiencing homelessness and, more specifically, at “high utilizers” of emergency and law enforcement services. The campus is being presented as a way to align with the intent of President Trump’s executive order, Ending Crime and Disorder on America’s Streets. But there appears to be significant overlap between the population targeted by the homeless campus and the population TAM was designed to serve.

That overlap is more than interesting. It is ironic. Medicaid cutbacks—one of the forces now pushing CMS to deny renewal of the TAM waiver—may create financial problems for the very system Utah is building in response to homelessness and public disorder. The people expected to receive treatment at the homeless campus may no longer have consistent coverage for those services. And if treatment is not voluntary, coverage may become even more uncertain.

So Utah now has what might best be called a big beautiful mess. The Utah Chiefs of Police Association and the Sheriffs’ Association have both sent letters urging the state to keep TAM alive. Salt Lake City Mayor Erin Mendenhall has also pointed to the contradiction: if the goal is to improve public safety, ending TAM is unlikely to produce better outcomes for people leaving jail.

Again, as in Idaho, public safety officials warned that the cuts would have consequences. In Idaho, tragedy followed. Utah now appears to be heading into the same contradiction—trying to build a more coercive system for people who may be losing access to the very healthcare coverage that might have made such a system less necessary in the first place.

Medicaid Cutbacks in Utah

A wide variety of Utah leaders — including sheriffs, police chiefs and Salt Lake City Mayor Erin Mendenhall — along with advocates for people experiencing homelessness and struggling with addiction or mental health are all rallying to save a Utah Medicaid program from being discontinued. Federal officials with the Centers for Medicare & Medicaid Services recently signaled to state officials that they won’t allow Utah to continue its Targeted Adult Medicaid Program, known as TAM. In a May 1 letter to Julie Ewing, Utah’s state Medicaid director, Sarah Aker, the acting director of CMS said the federal authority “does not anticipate” approving or extending section 1115 applications that allow for continuous eligibility — like TAM does — “beyond what is required or available under the Medicaid or CHIP statutes.” Both the Utah Chiefs of Police Association and the Sheriffs’ Association have sent letters to the Utah Department of Health and Human Services urging support of keeping TAM. “From a public safety perspective, TAM has proven to be an effective and practical tool in addressing some of the most persistent challenges facing law enforcement across our state,” Kane County Sheriff Tracy Glover, president of the Utah Sheriffs’ Association, wrote. “A significant majority of TAM participants are justice-involved individuals who often struggle with substance use disorders, mental health conditions, and housing instability,” he added. “These are the same underlying factors that frequently drive repeated law enforcement contacts, incarceration, and crisis situations in our communities.”

Utah’s controversial plan to build a remote “homeless campus” is being promoted in some quarters as a bold response to rising homelessness. But this report argues that the project’s purpose remains unclear. Planning documents variously describe the target population as people experiencing homelessness generally and, more narrowly, as “high utilizers” of emergency and law enforcement services, though little public data shows how many people would actually fit that definition. More fundamentally, the report questions whether large centralized facilities are effective at reducing homelessness. Drawing on evidence from similar projects elsewhere, the authors find no consistent link between such facilities and lower homelessness rates; where declines have occurred, they appear more closely tied to investment in permanent housing. Developed in the wake of President Trump’s executive order Ending Crime and Disorder on America’s Streets, the plan reflects a broader national shift toward centralized services, stricter enforcement against street homelessness, and expanded use of involuntary psychiatric and substance use treatment.

Follow Ups

YesCare/Tehum Care/Corizon

Editor's Comment: Ah yes, YesCare. As we have remarked before, the bankruptcy saga of YesCare/Tehum Care/Corizon increasingly resembles a serialized drama — and we find ourselves wondering whether we have finally reached the epilogue, or whether we are simply deep into another very long chapter, Chapter 11 — so long it required two parts. Chapter 11, Part One was a bankruptcy filing in Texas, deploying the Texas Two-Step strategy to shield assets. Chapter 11, Part Two became necessary when Part One failed to unfold as planned, sending the company to file again — this time in Florida.

The articles below tell several related stories. The first, from The Wave, provides a useful history of YesCare and its many incarnations — we covered similar territory last week. The follow-ups that follow document jurisdictions canceling contracts in the wake of the Florida filing, and healthcare providers in those facilities going unpaid.

And here we want to pause to express genuine sympathy for those healthcare providers — people doing difficult, often thankless work in some of the most challenging environments imaginable, now left holding the bill for someone else's financial engineering.

Which brings us to that financial engineering. Perigrove,a private equity firm, acquired Corizon and then divided it into two entities: Tehum Care, which absorbed the liabilities, and YesCare, which retained the assets. As The Wave reports, $200 million was transferred to YesCare and to entities affiliated with Perigrove before Tehum filed for bankruptcy on February 13, 2023. One might reasonably wonder whether some portion of that $200 million could have gone toward paying the healthcare providers now left unpaid? It seems that clever financial strategies are often lauded by analysts, while the same cleverness harms the people doing the hard work that generated profits.

YesCare was built from the remains of Corizon Health — once the largest prison healthcare company in the United States.By 2021, Corizon was drowning. The company faced more than 1,000 creditors and more than $775 million in personal injury and wrongful death claims from incarcerated people across the country — the result of years of allegations of substandard medical care.In December 2021, a private equity firm called Perigrove 1018, LLC — led by a man named Isaac Lefkowitz — quietly acquired Corizon. Within months, the new ownership executed what is known in legal circles as a Texas Two-Step.

YesCare, which provides medical care to prisoners in nine U.S. states, has seen its revenue fall by 80% since being hit with a $307.5 million jury verdict over allegations of substandard medical care. The verdict caused prisons around the U.S. to terminate their contracts with YesCare for outsourced medical services, YesCare ‌attorney Jeremy Johnson said at the company’s first court appearance after filing for bankruptcy in Fort Myers, Florida on Friday. The sharp decrease in revenue caused YesCare to miss payroll for its 1,500 employees on May 8, and the company does not yet have financing lined up to pay those employees, Johnson told U.S. Bankruptcy Judge Luis Rivera, who is overseeing the bankruptcy.

A new company will soon take over inmate medical care at Louisville Metro Department of Corrections after the jail cut ties with their last provider amid financial and contract concerns. Officials announced Comprehensive Correctional Care will handle medical services for inmates over the next year. The move follows the jail’s decision to end its agreement with YesCare. LMDC also accused YesCare of violating terms of its contract, though they did not publicly explain what those violations involved. The new agreement is a temporary solution. Over the next year, LMDC officials plan to seek proposals for a permanent contract.

The Lexington-Fayette Urban County Government has selected a new healthcare provider for the detention center after workers went weeks without pay. The Division of Community Corrections completed an emergency procurement process and selected 3C Comprehensive Correctional Care as its healthcare provider. The Kentucky-based provider will begin operations at the detention center next week. Workers who provide medical and mental health services at the Fayette County Detention Center entered a third week without a paycheck this week. Employees contracted through YesCare said they were supposed to be paid last Friday. YesCare filed Chapter 11 bankruptcy last week. An employee with the detention center said more than 100 employees have gone without a check.

YesCare whose $1 billion deal with the Alabama Department of Corrections was canceled after it failed to pay workers on time has now filed for bankruptcy. YesCare sought Chapter 11 protection in federal court in Florida, listing up to $500 million in liabilities and an estimated $50 million to $100 million in assets. Court records show at least 200 Alabama-based creditors, including medical practices, hospitals and ambulance services across the state. YesCare employees have now gone more than two weeks without pay.

Polk County (FL) Sheriff’s Office officials say they have terminated their long-standing healthcare services agreement with YesCare after the company filed for Chapter 11 bankruptcy earlier this month. According to the Polk County Sheriff’s Office, YesCare had served as the medical services provider for the Polk County Jail for 33 years before filing for bankruptcy on May 8, 2026. PCSO stated the bankruptcy filing constituted a breach of the healthcare services agreement and raised concerns about the company’s ability to reliably continue inmate medical care. Sheriff’s Office officials said executive staff determined YesCare was “no longer in a financial position to provide dependable medical services” within the jail system.

Revolving Door

Editor's Comment: Speaking of proprietary correctional healthcare providers — Kansas has signed an $89 million contract with VitalCore. The article caught our eye for several reasons. First, it references Mississippi's contract with VitalCore, which brought to mind Mississipi State Rep. Becky Currie's pointed question about why people were going untreated for hepatitis C: "Why are people getting sicker when we're paying millions for medical care?" Second, VitalCore is replacing Centurion — another turn of the revolving door we have commented on so often. Just last week we noted the same dynamic playing out between VitalCore and Wellpath. Now it is VitalCore and Centurion. Both companies with their own controversies.

The Kansas Department of Corrections signed a two-year contract with VitalCore. The deal with VitalCore Health Strategies would obligate the state to pay $88.9 million in the initial fiscal. News reports regarding VitalCore’s work in Mississippi prisons raised concern about the quality of care provided by the company. The contract with VitalCore was separate from a $2.3 million arrangement with the University of Kansas Medical Center to provide oversight and monitoring of contractors. The current prison medical care contract was held by Centurion of Kansas, which provided services to state inmates since July 2020.

Ending Crime and Disorder on America’s Streets

Editor's Comment: Twice in this week's Weekly Update we find ourselves commenting on articles touching on President Trump's executive order "Ending Crime and Disorder on America's Streets." This particular article examines the crackdown on harm reduction, and the threat it poses to nonprofits whose work is grounded in harm reduction. It bears a strong resemblance to a story we covered in our March 17 Weekly Update, in which the CDC informed recipients of overdose prevention funding that they were prohibited from using the Never Use Alone slogan — a tool specifically designed to prevent overdose deaths.

Not long ago, the idea of harm reduction was considered radical. Today, it is largely accepted by medical and public health professionals as a life-saving approach to the addiction crisis. But over the past year, harm reduction has become a political target tied up with rhetoric around crime-ridden streetscapes and open-air drug use. Directives from President Donald Trump and his appointees threaten to criminalize key harm reduction practices, throwing the future of nonprofits like Harm Reduction Sisters, and the people they serve, into uncertainty. In July 2025, President Trump signed an executive order titled “Ending Crime and Disorder on America’s Streets.” After decrying the “tens of billions of dollars on failed programs that address homelessness but not its root causes,” the order directed federal agencies to prioritize resources for states and cities that take a hard-line approach, for example by criminalizing “urban camping and loitering.”

Arizona

Editor's Comment: The article below from Arizona Family reports that the state's Independent Correctional Oversight Office exists in name only — approved by the legislature and signed into law, but never funded. The article references the receivership order issued by Federal Judge Roslyn Silver, a battle we have been following closely: the Arizona Department of Corrections and advocates for incarcerated people remain at odds over who the receiver should be and for how long, while the Department is simultaneously appealing the receivership itself. That the Independent Correctional Oversight Office has been left unfunded raises questions about the state’s intentions.

News Update: Coming across our desk yesterday, tuscon.com reports that both the department of corrections and advocates have agreed on a receiver, Annette Chambers-Smith, former Ohio corrections director. As a part of her due diligence, the judge is requiring a written report on Chambers from both parties. The judge is also planning on interviewing the candidate herself.

An independent oversight office created to bring accountability to Arizona’s prison system has no funding a year after it was signed into law. The Independent Correctional Oversight Office exists only on paper. Without funding, it has no office and no staff. The Independent Correctional Oversight Office was created by state lawmakers last year to help reform the Arizona Department of Corrections, Rehabilitation, and Reentry. “Given the costs that the state has been made to bear with lawsuits and now with federal receivership, it’s just really a great investment that will avert future costs,” Estrella Lopez of the Justice Action Network said. Earlier this year, a federal judge ordered a third-party takeover of prison health care, writing that inadequate care was leading to suffering and preventable deaths.

Federal Judge Rosyln Silver issued an order telling attorneys for the Arizona Department of Corrections, Rehabilitation and Reentry and lawyers for the inmates who sued to interview the former Ohio corrections director, Annette Chambers-Smith. Both parties agreed that she should get the job by the end of this month. Chambers-Smith was the only person recommended as a potential receiver by the Department of Corrections. The inmates' attorneys recommended two people as possible receivers, both former state corrections directors, but agreed to support Chambers-Smith. Nevertheless, Judge Silver said that she will also interview Chambers-Smith as part of her due diligence in picking someone for the job.

ICE

In a late-day order issued May 8 and updated May 9, a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit declined to revive a Department of Homeland Security (DHS) policy that required members of Congress to give seven days’ advance notice before visiting Immigration and Customs Enforcement (ICE) detention facilities. DHS had argued that surprise inspections created security and logistical burdens for facility operators, many of which are run by private contractors such as GEO Group and CoreCivic.

Six people died in California immigration detention centers over the past year as the crowded sites struggled to provide basic medical care, according to a new state investigation. The 175-page report offers the most detailed look to date inside the detention centers that are often in remote areas of the state and hard to access for attorneys, families, and advocates. It documents the highest death toll since the state began conducting inspections of the centers seven years ago. In 2024, there were zero deaths in California detention center. The deaths occurred as the Trump administration carried out a mass deportation campaign — starting in Los Angeles — that drove up the population inside detention centers by more than 150%.

Brawley Community Foundation, a California nonprofit, owns the Imperial Regional Detention Facility, a 781-bed ICE detention center. The facility is operated by for-profit contractor Management and Training Corporation, with most of the foundation's roughly $40 million in annual revenue derived from fees paid by ICE and the contractor. By leveraging its nonprofit status, the foundation has secured at least $6 million in property tax breaks since 2016 through California's Welfare Exemption — a provision intended for hospitals and houses of worship. The arrangement has drawn sharp criticism from nonprofit experts and immigrant rights advocates, particularly following the deaths of two detainees in 2025. Supporters argue the facility provides approximately 200 jobs and $13 million in annual salaries to one of California's most economically distressed regions.

The Trump administration has doled out billions of taxpayer dollars to corporations tasked with carrying out its mass deportation agenda. Many of these same companies have donated hundreds of thousands of dollars to sitting members of Congress. Over that period, executives at ICE’s biggest contractors donated more than $1.7 million to 168 members of Congress. Palantir CEO Alexander Karp outspent the other executives, donating a total of about $465,000, including nearly $200,000 to Democrats. Palantir has become a primary target of the anti-ICE movement. The tech company, which was co-founded by billionaire Peter Thiel, develops technology to stalk, abduct, and detain people who are not U.S. citizens or are suspected of not being U.S. citizens.

Sens. Richard Blumenthal, Mazie Hirono and Jon Ossoff urged the administration to restore a policy presuming the release of pregnant women from immigration custody except in extraordinary circumstances. The lawmakers cited reports of women suffering severe abdominal pain, vaginal bleeding and miscarriages while allegedly receiving limited or delayed medical care. At Camp East Montana, an ICE detention facility in El Paso, Texas, the senators said one pregnant woman experiencing vaginal bleeding was reportedly given only water, prenatal vitamins and a temperature check. The renewed scrutiny comes days after Rep. Sydney Kamlager-Dove reintroduced the Pregnant Women in Custody Act, legislation that would establish nationwide standards for the treatment of pregnant women in federal custody, including ICE and Customs and Border Protection detention facilities.

Federal immigration authorities included a detainee labor program in contracts for two warehouse detention facilities in December 2025: Williamsport, Md., and Surprise, Ariz. The Maryland warehouse, a roughly 825,000-square-foot facility near Williamsport, Md for $102.4 million. In Surprise, Arizona, the purchase of a 418,000-square-foot warehouse was for $70 million. The Volunteer Work Program is a standard feature of established detention facilities, where detained immigrants may perform jobs. Under ICE’s own detention standards, last codified in 2011, participation is voluntary except for basic housekeeping duties, and detainees must be paid at least one dollar per day. Contractor and any subcontractors are prohibited from making public disclosures about the agreement without ICE’s prior review and approval.

BOP

Sexual abuse is rampant within the federal prison system, and a new report from the U.S. Government Accountability Office attempts to address ways to improve prevention efforts. Between 2014 and 2022, there were approximately 8,500 allegations of sexual abuse from people incarcerated in the Federal Bureau of Prisons. Of the nearly 4,000 allegations against staff, 77 percent were found to be unsubstantiated. Alleging sexual abuse, especially against staff, can be dangerous for incarcerated people, and many incidents go unreported for fear of being placed in solitary confinement in retaliation or under the guise of protective custody.

SUD

The Model Involuntary Commitment for Substance Use Disorder Act establishes protocols and procedures for the involuntary commitment of individuals with substance use disorder that is separate and distinct from the procedure for the involuntary commitment of individuals with mental health issues.

Nutrition

The food on the trays doesn’t even look like food. In photos smuggled out of Georgia’s prisons, what passes for a meal is either grossly inadequate for a grown man, unrecognizable sludge, or both. The Georgia state prison system is awash in stabbings, beatings and death, with “near-constant, life-threatening violence functioning as the norm,” the Department of Justice wrote in 2024. Locks don’t work. Staffing is “grossly inadequate.” But one underlying cause of the extreme danger, say advocates, prisoners and their families, is the food.

Contraband

Attorney General Anthony G. Brown announced today that three former Correctional Officers were sentenced after pleading guilty for their involvement in three separate contraband smuggling schemes operating at Jessup Correctional Institution (JCI) in Anne Arundel County, Maryland. The investigations were led by the Maryland Office of the Attorney General’s Organized Crime Unit and the Department of Public Safety and Correctional Services (DPSCS).

A former Georgia warden is accused of being involved in a contraband smuggling operation tied to a gang inside the prison he oversaw, Attorney General Chris Carr said. Brian Adams, the 52-year-old former Smith State Prison warden is now facing charges of violating the Racketeer Influenced and Corrupt Organizations Act, tampering with evidence, making false statements, and violating his oath as a public officer.

Correctional Officers

A bipartisan bill aimed at expanding mental health support for correctional officers has been introduced in the Senate during National Police Week, with supporters highlighting a key protection designed to let staff seek help without fear of losing their jobs. U.S. Sen. Tammy Duckworth introduced the Corrections Officer Blake Schwarz Suicide Prevention Act of 2026, named for Blake Schwarz, a corrections officer at Federal Correctional Institution Thomson in Illinois who died by suicide at age 26 in 2023.

State Roundup

Michigan

A Michigan lawmaker is calling for the resignation of the director of the Michigan Department of Corrections after the death of a 28-year-old inmate at Michigan’s only women’s prison. Khaira Howard died Wednesday at the Women’s Huron Valley Correctional Facility just days before her scheduled release. Her death has intensified scrutiny over conditions inside the prison, which has faced years of complaints involving mold, inadequate medical care, and neglect.

Washington State

A Washington appeals court has revived a lawsuit that challenged the Washington State Department of Corrections (DOC) for punishing inmates after “unreliable” drug testing. The case, brought by Columbia Legal Services (CLS), involves a potential group of 1,000 people who were subjected to drug testing that had high rates of false positives

Telecommunications

A growing number of incarcerated people across the country now have access to free phone calls and other communication services, a shift some advocates say is strengthening family connections, improving prison conditions and easing reentry after release. A new report from Worth Rises, a nonprofit that advocates in opposition to the prison industry, found that an estimated 330,000 incarcerated people nationwide now have access to free prison or jail communication services, including phone calls, video calls and electronic messaging in some jurisdictions.

ViaPath receives approximately $1.5 million dollars a year from Dane County (WI) Jail residents. According to a fiscal analysis prepared for Dane County by WorthRises, a national nonprofit prison industry abolition organization, providing fully free communication in the Dane County Jail could cost as little as $284,000. The report adds that ViaPath could offer cheaper options than are currently offered.

People incarcerated in New Jersey make as little as a dollar a day working prison jobs, but New Jersey paid more than $28 million over the past decade to the for-profit company that provides video visits, electronic messaging, music, and other digital content on personal tablets designed for use behind bars. Now, the state is shifting to a new provider, ViaPath Technologies, saying ViaPath can offer the same services for cheaper price than JPay, which has supplied such services since 2014. Under the new ViaPath contract, incarcerated people can access some services on their tablets for free, such as educational content, legal tools, and reentry programming.

In Observation Of Memorial Day
COCHS Weekly Update Will Not Be Published Next Week