A Tale of Two 1115 Medicaid Reentry Waivers; Harvard Looks at Correctional Healthcare Vendors

Highlighted Stories

Editor's Note

“It was the best of times, it was the worst of times.”

Charles Dickens may not have had Medicaid waivers in mind when he wrote those words, but they seem apt for describing the contrast between Montana’s and Oregon’s approaches to their respective Reentry 1115 Medicaid waivers. Montana is moving forward with its waiver, as made clear in an announcement on the state’s website. Oregon, on the other hand—as articles in previous Weekly Updates have hinted at—has decided to cancel implementation altogether.

Why these divergent paths? The Oregon article cites Medicaid cutbacks in the “One Big Beautiful Bill” and fears that the waiver might not be renewed by a future Trump administration in 2027. But that raises a question: why is Montana proceeding under the same fiscal concerns? One explanation might be scope. The Kaiser Family Foundation’s Section 1115 Waiver Watch page provides a useful comparison.

Montana’s waiver covers only adults in state prisons with substance use disorders or mental illness, providing services for 30 days before release and offering the minimum required benefits and clinical consultations. Oregon’s waiver, by contrast, was far more ambitious—covering adults and youths in state prisons, county jails, and youth correctional facilities, and including an expanded range of benefits: physical and behavioral health consultations, medication management, treatment services, lab and radiology work, family planning, community health worker services, and peer support.

Whether “small is beautiful” remains to be seen, but at the present moment, a more modest, manageable approach may have its advantages.

Turning to the next highlighted topic, the Harvard article—like the previous Weekly Update's Forbes piece—examines the outsourcing of correctional healthcare and the economic incentives that encourage providers to spend less on care. COCHS does take exception, however, to one assertion: that such contracts “protect governments from liability.” If that’s not a tacit acceptance of a myth, it’s close to one. COCHS has repeatedly shown that this claim is, frankly, hokum. As the last highlighted article demonstrates, there is no outsourcing escape hatch for jurisdictions.

And as readers will see at the very end of this perhaps overly full Weekly Update, two jurisdictions—along with their correctional healthcare vendors—are once again entangled in lawsuits. In one case, the jurisdiction paid a sizable settlement to the family of a severely injured man.

So, to mangle George Gershwin: It ain’t necessarily so, the things you read in the PR of correctional healthcare providers.

1115 Waivers: Montana & Oregon

Joined by Department of Public Health and Human Services (DPHHS) Director Charlie Brereton and Department of Corrections (DOC) Director Brian Gootkin, Governor Greg Gianforte today announced the launch of the Healing and Ending Addiction through Recovery and Treatment (HEART) Initiative Reentry Program. In 2024, the governor announced CMS approved a waiver sought by DPHHS to provide three new Medicaid funded behavioral health services for Montanans as a part of the HEART Initiative. The HEART Initiative was introduced by Gov. Gianforte in his first week in office and invests state and federal funding to expand treatment and recovery services for individuals with mental health and substance use disorders. The new program provides a targeted set of Medicaid services to eligible individuals with behavioral health needs starting 30 days before their release from incarceration. This proactive support is designed to bridge the gap between correctional and community-based care.

Oregon Health Authority this week notified state prisons and other officials that it no longer intends to implement a novel Medicaid initiative that would have provided targeted health services to those about to exit jail or prison. The move comes several months after health officials quietly placed the program’s launch on hold, anticipating the passage of sweeping changes to shrink federal Medicaid spending as part of the Republican-led tax cuts package, House Resolution 1, also known as the “One Big Beautiful Bill.” Oregon had originally planned to launch the reentry benefits program for incarcerated adults in early 2026. However, CMS' approval was part of a waiver that is only good through 2027, meaning it would have been up to the Trump administration to decide whether to renew it.

Economics of Correctional Healthcare

Madaline Pitkin, suffering heroin withdrawal in Oregon’s Washington County Jail, repeatedly pleaded for medical help through sick call forms as her condition worsened. The next morning, she was found unresponsive. She had died from dehydration—a simple IV could have saved her. Corizon Health, the jail’s private healthcare contractor, later settled with her family for $10 million. Pitkin’s death reflects a national problem. County jails and state prisons frequently outsource healthcare to private vendors as a cost-saving measure—especially smaller counties with limited budgets. Such contracts also protect governments from liability, with clauses shifting responsibility to the provider. Most agreements use a fixed per-person, per-month rate that allows companies to profit when they spend less on care. The incentive to cut costs often translates into delayed appointments, denied treatment, and retaliation against whistleblowers. At Georgia’s Chatham County Detention Center, Corizon nurses who raised concerns were fired, and prescriptions were signed off by a psychiatrist who never examined patient.

Protection From Liability?

In a precedential opinion with sweeping implications for prison litigation and disability rights, the Third Circuit in Jose Montanez v. Paula Price (No. 23-2669, Oct. 8, 2025) revives a state prisoner’s Eighth Amendment and disability law claims arising from catastrophic spinal injuries and alleged denials of basic accommodations. The decision squarely holds that a state cannot evade its obligations under Title II of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act (RA) by contracting prison services to private vendors, and clarifies that health care, hygiene (toilets/showers), and beds/bedding are “services, programs, or activities” within the statutes’ coverage. The parties span Pennsylvania corrections officials (“Commonwealth Defendants”) and Wellpath Care LLC and its clinicians (“Medical Defendants”), the latter being the private contractor providing medical care in state facilities.

Follow Ups

Oregon

Editor's Comment: We find ourselves once again back in Oregon. As our subscribers know, the state’s prison healthcare system has been under intense scrutiny for the past two years. Earlier this year, COCHS reported on a series of alarming issues: long delays in cancer treatment, denial of medical equipment such as wheelchairs, and refusals to perform X-rays for suspected fractures. Adding to the turmoil, Dr. Warren Roberts, Chief of Medicine, and Joe Bugher, Assistant Director of Health Services, were both dismissed amid claims that their leadership had severely undermined care for both patients and providers.

The article below raises the pressing question: how can these issues be meaningfully addressed? A bill to establish minimum healthcare standards was shelved, and while the governor has appointed a new ombudswoman, her predecessor alleges he was denied staff support and forced to work alone. A report by Falcon Correctional and Community Services describes Oregon’s prison healthcare system as “fragmented, disorganized, and inefficient.” One can’t help but wonder: did these systemic failures play a role in the state’s decision to cancel its Medicaid reentry waiver?

This summer, the Oregon Department of Corrections pledged in court to improve prisoner access to medical care after a series of troubling reports. Lawmakers, however, shelved bills that would have set minimum healthcare standards, leaving unclear who will ensure accountability. A recent accreditation review found a backlog of 600 appointments for women at Coffee Creek Correctional Facility, including routine exams and screenings. Governor Tina Kotek appointed Kristina Rice as the new ombuds to investigate civil rights complaints. Her predecessor, Adrian Wulff, was fired after saying he worked alone and that repeated requests for staff support were ignored. State Sen. Deb Patterson, who chairs the Senate Health Care Committee, expressed hope for reform but said stalled legislation delays needed oversight. A July report by Falcon Correctional and Community Services described Oregon’s prison healthcare as “fragmented, disorganized, and inefficient.” More than half of U.S. states have faced court orders to improve prison medical care. Wanda Bertram of the Prison Policy Initiative said prisons remain “totally insular,” isolated from health and social agencies and excluded from federal Medicaid funding.

New York

Editor's Comment: Yesterday, a jury in Oneida, New York, found one of the three correction officers indicted in the murder of Robert Brooks last year at Marcy Correctional Facility, David Kingsley, guilty of second-degree murder. The other two officers, Mathew Galliher and Nicholas Kieffer, were acquitted of all charges. Previously former correction officers, Nicholas Anzalone and Anthony Farina admitted guilt to first degree manslaughter for killing Brooks

The New Yorker provides an in-depth look at the broader conditions within New York’s prison system, beginning with the killing of Brooks and detailing the beating which killed him. The article situates the murder within the larger context of the correction officers’ wildcat strike, the controversy surrounding the HALT Act’s restrictions on solitary confinement, and the lived experiences of incarcerated people—past and present. It also examines the economic dependence of rural towns on prisons and the racial tensions between a predominantly white correctional workforce and an incarcerated population that is roughly 50 percent Black.

Unfortunately, the article is behind a paywall, but those with access to the print edition can find it in the October 13th issue of The New Yorker.

A jury found a former New York state corrections officer guilty in the brutal beating death of an inmate last winter in a Central New York prison, while acquitting two other co-defendants. The 12 jurors found the officer guilty of second-degree murder and first-degree manslaughter in the death of the inmate, Robert L. Brooks. David Kingsley was found guilty of second-degree murder and first-degree manslaughter. Mathew Galliher and Nicholas Kieffer were found not guilty of all charges. They had been indicted on charges of second-degree murder, first-degree manslaughter and second-degree gang assault. Nicholas Kieffer was also charged with first-degree offering a false instrument for filing

How two murders and a strike exposed a system at its breaking point. Incarcerated people have long talked about a “blue wall of silence” in prisons: an unspoken agreement among correction officers to cover up for one another’s abuses. New York’s prison population grew rapidly in the nineteen-eighties and nineties—reaching a peak of almost seventy-three thousand in 1999. Within the walls of New York’s prisons, solitary confinement was long operated as the ultimate means of control. The fight to pass HALT went on for a decade. [Corrections officers] said HALT made the prisons more dangerous. Prisons hide away many of society’s most intractable problems—violence, mental illness, addiction, but the officers who work inside spend their days face to face with them.

Second Chance Reauthorization Act

In an op-ed, Scott Peyton, Director of Goverment Affairs for Prison Fellowship, writes: Every day, more than 1,700 people are released from prison. In the decade I spent as a probation and parole officer, I saw how much is riding on their success. Overcoming recidivism can lead to relational healing, independence and restored potential. The bleak alternative comes at a steep cost to families, society, taxpayers, and — most devastatingly — the victims of crime. The Second Chance Reauthorization Act of 2025 offers a path forward for people leaving prison. By removing barriers to reintegration, Congress can help safeguard communities while upholding human dignity and potential.

Solitary Confinement

Solitary confinement, the practice of putting someone in isolation in a small cell, is not a topic you expect to hear discussed at church on Sunday. But on Oct. 12, at the Madison Christian Community, was a stop of the 18-city, nationwide Journey to Justice Bus Tour, that included two panel discussions focused on the topic, one with four state legislators, including two candidates for governor. Visiting the Journey to Justice bus, standing in a bathroom-sized solitary jail cell replica and hearing the real-life stories of those who had spent part of their lives confined in such spaces, visitors gained a visceral appreciation of the United Nations declaration that punishing people with more than 15 consecutive days in solitary is a form of torture.

Children incarcerated in Shelby County’s juvenile detention center are frequently held in solitary confinement. Tennessee law prohibits holding children in seclusion, a term often used interchangeably with solitary confinement, for longer than two continuous hours. But according to source accounts, the center has two solitary confinement units — D-pod and H-pod — where children as young as 13 are confined to their cells for 23 hours or more at a time, for periods of weeks or months.

A federal judge has ordered sweeping changes at the Mary Davis Juvenile Detention Home in Galesburg (IL) after finding that isolation practices at the juvenile facility likely violated children’s constitutional rights. The preliminary injunction, issued last week, bans the use of long-term solitary confinement and gives the facility until the end of October to implement an emergency mental health care plan for detained youth.

Solitary confinement, including but not limited to disciplinary confinement (DC), is practiced in a variety of correctional settings and continues to be a debated manner to address inmate violence. There is increasing evidence highlighting the detrimental effects of solitary confinement both on psychological and behavioral outcomes, including misconduct and recidivism. Particularly, DC, referring to the temporary placement of an inmate in a segregated housing unit as punishment following a rule violation, has shown mitigated results.

Statistics From Ice

Nearly 14,000 people were placed in solitary confinement in immigrant detention centers nationwide between April 2024 and August 2025. Researchers detailed an increase in solitary confinement placements and, for some populations, weeks-long isolation periods. Researchers also warn that ICE data is typically incomplete, suggesting there could be an undercount of solitary confinement placements. The report relies on ICE's data collection. Researchers warn that ICE data is typically incomplete, suggesting there could be an undercount of solitary confinement placements.

Virginia's immigrant detention centers have been locking people away in solitary confinement at some of the highest levels in the country. The practice — which often unfolds out of public view — has spanned multiple administrations. Virginia's ICE facilities in Farmville and Caroline County have risen in national rank for placing more people in solitary confinement between 2023 and this past August. Both are now among the nation's top 10 for solitary confinement use despite being far smaller than other detention center sites in the U.S.

The use of solitary confinement in immigrant detention centers is climbing nationwide this year — with some detainees held in isolation for weeks at a time, new research shows. Arizona facilities had the third-most people of any state, behind Texas and Pennsylvania. The Eloy Detention Center, a private facility operated by CoreCivic that contracts with U.S. Immigration and Customs Enforcement in Pinal County, had more than 600 people in solitary confinement, and the Central Arizona Florence Correctional Center, another CoreCivic property, had about 270 during that time.

A Pennsylvania immigrant detention center that's come under scrutiny in recent months has held a high number of people in solitary confinement in 2025. Moshannon Valley has come under scrutiny in recent months following advocacy groups' allegations of civil rights abuses and the death of a Chinese national who'd been in ICE custody at the facility while awaiting an immigration hearing. Rep. Mary Gay Scanlon (D-Pa.) had attempted to conduct an oversight visit shortly after ICE officials reported finding the detainee hanging in August, but her office says she was turned away at the gates.

ICE

Immigrants in ICE custody at the Orange County Correctional Facility have faced "systemic" and "recurrent" deficiencies in medical care, according to a new report by New York Lawyers for the Public Interest. The report paints a damning picture of immigration detention at the local jail. Using medical data from 19 detainees, the report found "systemic medical failures" that allegedly worsened health outcomes and were a financial drain for the county.

For decades, enforcing immigration laws has been the federal government’s responsibility. But soon, most Texas sheriff’s offices will be required to help. It’s part of a new state law that will force counties that run or contract out operations of a jail to participate in an Immigration and Customs Enforcement (ICE) program called 287(g), named for a section in the Illegal Immigration Reform and Immigrant Responsibility Act of 1996. But right now, only about a third of Texas counties are signed on.

Correctional Officers

It's not news that there are problems in America's prisons, including mass incarceration and forced labor — but there is another crisis in those same prisons that doesn't always garner the same attention. There is an epidemic of correctional officers dying by suicide. The reason suicide rates are often higher for correctional officers than other law enforcement officers can be attributed to the "intense conditions for staff," which increases stress, anxiety and exhaustion. Those conditions are compounded by long hours, minimal emotional support and low pay. Overcrowding in prisons is another factor that contributes to stressful conditions and reducing this would decrease the overall strain on the system

As essential employees, federal prison workers in Minnesota are working through the shutdown without pay. Minnesota has four Bureau of Prisons (BOP) facilities, all located in Greater Minnesota: Rochester, Duluth, Waseca and Sandstone. At least 619 federal employees worked at the facilities as of 2024, according to federal data. In an already stressful workplace, morale drops fast during a shutdown, said Sandy Parr, who served as a local and national union leader during her 26-year career at Rochester’s federal medical center for BOP inmates.

Jail Conditions

Poor sanitation in jails has been the subject of civil rights lawsuits for decades. Plumbing issues, vermin infestations, feces-covered walls, and limited access to basic hygiene products, such as soap or tampons, are common complaints. Courts almost universally agree that a lack of basic sanitation violates detainees' constitutional rights. Despite widespread legal challenges, many jails across the country are still filthy. A county jail in Oregon had allegedly crowded a dozen women into a single intake cell, where they had to beg for toilet paper and menstrual products, and were denied showers..

Parole

Parole, the release mechanism which could significantly reduce the number of people behind bars, has reached a moment of reckoning. Dysfunctional in some states and banned in others, parole looks really different from state to state. But parole is a system worth having, if states can implement it fairly and broadly. This report is meant to serve as an essential resource for lawmakers, advocates, journalists, incarcerated people, and others interested in starting a deep dive into their own parole system and identifying impactful reforms.

Studies

Although the United States incarcerates nearly two million people, the epidemiology of psychiatric disorders in correctional populations is not well understood, and no study has examined temporal trends in psychiatric disorder prevalences within a single correctional system. This study assessed how psychiatric disorder prevalences have changed in the Texas Department of Criminal Justice (TDCJ), the largest American state prison system housing post-conviction, sentenced individuals.

In this qualitative study with 54 participants, prison medical directors and clinicians identified pragmatic strategies to improve cancer care delivered in prisons through screening, centralized and prison-based cancer treatment, and improved care coordination, communication, and symptom management. Individuals diagnosed with cancer while incarcerated in US prisons have worse mortality than nonincarcerated individuals. Incarceration poses numerous barriers to care, and optimal strategies to improve cancer screening, diagnosis, and treatment are needed.

This study examines how the scarcity women experience returning to the community after prison affects cognitive functioning, leading to impulsive decisions that harm their health. It examines: (1) effects of hypothetical scarcity during incarceration on transient cognitive, craving, and clinical variables; (2) real-world changes in cognitive and clinical variables from baseline through release and their correlation with scarcity. Exposure to hypothetical scarcity during incarceration resulted in reduced cognitive persistence and increased craving for drugs or alcohol but did not induce immediate effects on other outcomes.

Individuals with mental illnesses are disproportionately incarcerated in jails, which have become de facto mental health institutions across the US. Yet there is limited research describing mental healthcare practices from entry to release among multiple jails and states. The study found: Initial mental health screenings were often restricted to the detection of suicidality and history of treatment and medications as opposed to current mental health symptoms. Use of validated mental health screening forms was uncommon. Jails reported mental healthcare as challenging to manage, with high volumes of individuals with mental health needs, yet limited resources, especially regarding staffing.

Telemedicine provisions for MOUD greatly expanded access to MOUD for persons who previously could not engage in healthcare settings during critical times. Few rapid access, multidisciplinary transitional services exist to capture people in the immediate post-release period and address barriers to treatment engagement and retention. This quality improvement project describes the RIvER Clinic in Pittsburgh, PA which is a transitional post-incarceration clinic that provides multidisciplinary care services including a novel telebridge MOUD program.

Hepatitis C

America has struggled to keep up with the “stupendous” increase in Hepatitis C cases in the last 25 years. Roughly 1 in 3 people with active HCV infections pass through prisons and jails each year, putting thousands at unnecessary risk of liver damage, cancer, and death and fueling a public health crisis. The rate of Hepatitis C infections in correctional facilities is substantially higher than in the general population, with some studies showing incidence to be as high as one-third of any given institution, or about 10-20 times the national rate. Meanwhile, there is a highly effective cure for this disease. The national efforts toward elimination have failed because we are not reliably testing and treating incarcerated populations.

Only a fraction of Mississippi inmates diagnosed with hepatitis C receive treatment, which has allowed the treatable infection to develop into a life-threatening illness. As many as 845 people incarcerated in Mississippi Department of Corrections facilities were confirmed to be living with hepatitis C between January and March of this year, records show. During the same period, 48 people – or less than 6% with documented diagnoses – received treatment. But in private, officials have at times cited a much higher caseload – 5,000 cases out of about 19,000 people incarcerated by the state.

State Roundup

California

Assembly Bill 1108, introduced by Assemblyman Gregg Hart, D-Santa Barbara, will require the Sheriff’s Office to hand over investigations of deaths that occur in its custody to independent coroners in different counties or hire a private independent examiner. California is one of three states in the country that allow for elected sheriffs to also act as coroners. The Forensic Accountability, Custodial Transparency, and Safety (FACTS) Act of 2025 will apply to deaths in county jails, state prisons and law enforcement custody. It was also amended to include the deaths of people being arrested by federal immigration authorities if the case falls under county jurisdiction.

It’s been nearly a year since Californians overwhelmingly approved Proposition 36, a tough-on-crime measure providing what backers called “mass treatment” for those facing certain drug charges. But few defendants have found a clear path to recovery under the law, according to data released by the state. In the first six months, roughly 9,000 people have been charged with a treatment-mandated felony, according to a report released this month by the state’s Judicial Council. Nearly 15% — or 1,290 people — elected treatment. So far, of the 771 people placed into treatment, 25 completed it.

Gov. Gavin Newsom on Friday signed a bill to expand and streamline California’s process to get people who are mentally ill and homeless into mental health treatment and housing. CARE Court, which was implemented in counties beginning in the fall of 2023, has fallen short of expectations. When it was initially announced, Newsom’s administration estimated 7,000-12,000 people would qualify for the program. The changes, part of Senate Bill 27, would make it easier for criminal courts to refer someone to the CARE program and expand the criteria of the program from only people with a diagnosed schizophrenia spectrum disorder to also including people with bipolar disorder.

According to a multi-year rigorous study, California’s delivery of mental health care to the incarcerated population meets or exceeds national standards. This report conducted a systemwide study of the Department’s Mental Health Services Delivery System (MHSDS) and provided several recommendations, including improving staffing efficiencies, developing a comprehensive operations manual and expanding the use of tele-mental health services.

Colorado

A Denver judge is considering whether prison labor in Colorado constitutes involuntary servitude during a nine-day civil trial that began Tuesday. The case stems from a 2022 lawsuit in which state prisoners claimed the Colorado Department of Corrections’ approach to prison labor is coercive, illegal and ultimately amounts to involuntary servitude, which Colorado voters outlawed via Amendment A in 2018. At issue in the civil case is whether punishments for prisoners who refuse to work are so coercive that they actually force prisoners to work against their will.

Connecticut

The state’s correction ombuds is asking the Department of Correction to immediately suspend its contract with the firm responsible for what’s known as the Inmate Legal Aid Program, claiming it has done little to help people trying to file court cases from prison. Last week, DeVaughn Ward sent a letter to DOC Commissioner Angel Quiros asking that the department immediately suspend its contract with Bansley Law LLC of Old Saybrook, the firm hired by the state to administer the program. According to year-end reports from Bansley Law, the firm conducted only three professional visits and initiated four court cases in 2022-23, although it was contacted by 355 incarcerated people during that time.

Tyler Cole was being held on pretrial charges in Garner Correctional Institution in Newtown when he fatally overdosed last year, state officials said. One of Cole's nurses while incarcerated had no actual nursing degree and voluntarily surrendered his medical license three months after the 32-year-old died, state Department of Public Health documents show. The nursing license of Isaac Folorunsho and dozens of other nurses obtained their medical license by using a fraudulent degree received at a Florida nursing school now under federal indictment.

High indoor temperatures combined with a lack of cold drinking water and cooling fans in three of the state’s prisons during the summer months is risking the health of incarcerated individuals and may violate their constitutional rights, according to a new report from the Corrections Ombuds. Corrections Ombuds DeVaughn Ward said in the report that his office has received multiple complaints from incarcerated people and their families about the heat. One mother who wrote to the ombuds on July 24 complained that her son, who was housed at Osborn, had contracted scabies and was being frequently kept in his cell on lockdown without a fan or air conditioning.

Florida

Sounding as desperate as he ever has since being appointed four years ago, Florida Department of Corrections (FDC) Secretary Ricky Dixon asked a panel of state lawmakers for more than $512 million for next fiscal year to maintain the prison system. Florida houses more than 89,000 inmates, a population that has increased by more than 10,000 since 2021. That is expected to rise by another 4,100 over the next three years. Among some of the specific requests is $155 million in operational needs; $60 million in inmate health services; $56.4 million in new housing units; $45 million in drug costs; and $22 million in critical security equipment.

The fundamental human rights of Florida’s prison population could get a boost if a newly filed bill is adopted. Tamarac Democratic Sen. Rosalind Osgood filed the measure (SB 106), which aims to protect the basic rights of inmates within the state’s correctional system.The bill would establish essential requirements that would be guaranteed for all inmates in Florida, including proper ventilation, health products, sufficient food during emergencies, and a process for resolving inmate complaints.

Incarcerated people in Florida face an almost impossible choice at mealtime. They can eat the free but nutritionally poor meals served in the chow hall, buy a $25.99 combo meal from the private vendor iCare, or spend $7.46 at the canteen for a smaller meal from another company, Trinity. Either way, they pay steep prices for edible food—or endure the health risks of what’s freely provided.

Idaho

In Idaho prisons, more than two dozen women say guards prey on them with little fear of consequences — and those who speak up are often punished. Their accounts, gathered over an almost yearlong investigation, reveal the chilling reality of incarceration in a state that locks up women at the nation’s highest rate. Since 2020, there have been at least 59 documented allegations of staff sexually abusing imprisoned women. Allegations of sexual abuse in Idaho prisons are commonly not investigated by law enforcement, as the federal standards call for, but instead by the Idaho Department of Correction, which has kept most allegations hidden from the public.

Illinois

After an elderly inmate died, the Tazewell County Jail is undergoing extensive testing and repairs to remove Legionella bacteria from its pipes. Tazewell County Sheriff Jeffrey Lower said he doesn’t know the final cost for the county yet. James Pate, 94, accused of killing his 80-year-old wife, Cheryl, in September, died Oct. 6 from Legionnaires’ Disease while being held in jail. Lower said the department is now working with the Illinois Department of Public Health to flush out the jail pipes, run chlorine through them, and change out the filters.

Kansas

A Kansas sheriff’s deputy who is charged with murdering a handcuffed jail inmate held his knee against the prone man’s back for 1 minute 26 seconds, court records say. Richard Fatherley, a deputy sheriff in Wyandotte County, Kan., was charged in September with second-degree murder or an alternative of involuntary manslaughter in connection with the death of Charles Adair on July 5 at the county jail in Kansas City, Kan. Mr. Adair, who had several medical conditions and was using a wheelchair, had been arrested the day before based on misdemeanor warrants concerning traffic tickets, according to an affidavit filed in the case.

Mississippi

The Mississippi Department of Corrections will review more than two dozen unprosecuted homicides inside its prisons, as well as deaths where causes were ruled as “undetermined." A prisoner advocacy group said revisiting past homicides won’t address the key reasons for the deaths in the first place — chronic understaffing of security officers. Revisiting past homicides is “sort of closing the door after the horse has left the barn,” said David Fathi, director of the ACLU National Prison Project. “What the commissioner also needs to do is figure out why this is happening and what to do to stop it.”

Montana

For nearly a week, Montana State Prison has been dealing with a water crisis. "Six or seven bottles of water is maybe what you should drink per day, but they're not factoring in every other thing that we have to use that for," said an inmate. Funding for the water system replacement was allocated by the 2025 Montana Legislature earlier this year. House Bill 5 provided $21 million to pay for the infrastructure replacement, which will serve new units under construction at the prison as well as existing structures.

Tennessee

The Shelby County Sheriff’s Office is urgently seeking support and emergency funding to address historic levels of overcrowding at the county jail. In a October 17 letter to Shelby County Commissioner Charlie Caswell, Jr., Chief Jailer Kirk Fields outlined the challenges, stating the jail population has reached 2,909, which is 109 inmates over capacity. The letter explains that the increase is largely due to the arrival of the Memphis Safe Task Force, which has led to a surge in arrests. The Sheriff’s office says they have been working to mitigate the impact, including transferring over 200 convicted prisoners to state facilities with the Governor’s office and Commissioner of Correction’s help.

Texas

An outside investigation cleared the Tarrant County Jail of criminal wrongdoing in the death of Kimberly Phillips — but advocates say her death was completely preventable with proper care. Phillips, 56, died of malnutrition and dehydration on Feb. 18, after three weeks in jail. Phillips told jail staff she couldn't eat the food she was given, and jailers noted she wasn’t eating, according to medical records. By the time she was sent to the hospital on Feb. 15, her kidneys were failing. If someone is not eating and is refusing care, jail is not the right place for them, said Dr. Homer Venters, a correctional health doctor who works as a federal monitor of healthcare in jails and prisons.

Two more people died inside the Harris County Jail last week, bringing the total of in-custody deaths this year to 15, according to the Harris County Sheriff’s Office. The Harris County Jail was found to be out of compliance with the state’s minimum jail standards in June. A report from the Texas Commission on Jail Standards found that jail inmates were held in a holding cell — which is typically used during the intake process — for longer than 48 hours.Thirteen other people have died in Harris County Jail custody this year.

The Harris County Jail is doing a better job watching over its inmates, but new complaints about the facility’s fire alarm system mean it’s still out of compliance with state standards, according to the Texas Commission on Jail standards. The commission's website indicated the jail was in compliance Thursday night when it removed Harris County from its list of non-compliant jails, but uploaded a new notice of non-compliance for the jail Friday morning. A recent inspection of the jail found that four of five fire control panels were in trouble mode, indicating a problem with the fire alarm system. The jail was cited for the same issue in June.

Wisconsin

Wisconsin grants few applicants compassionate release, leaving many severely ill inmates in short-staffed prisons that often struggle to meet health care needs. Wisconsin courts approved just 53, or 11%, of 489 compassionate release petitions they received between January 2019 and June 2025 — about eight petitions a year, Corrections data show. Courts approved just five of 63 petitions filed in all of 2024. That’s as the state’s adult prison population has swelled past 23,500, eclipsing the system’s built capacity. A growing share of those prisoners — 1 in 10 — are 60 or older with increasingly intense health care needs.

Rikers Island

Former Gov. Andrew M. Cuomo announced a proposal to scrap the plan to close the Rikers Island jail complex, saying he would rebuild the jails and not relocate detainees to new borough-based jail facilities. The jail complex has been plagued by violence, dysfunction and death. Twelve people have died in city jails this year, including a man being held at Rikers Island who apparently suffered a seizure last month. Mr. Mamdani criticized Mr. Cuomo’s plan. “Andrew Cuomo’s proposal to take that which is broken, that which is morally bankrupt, that which is a stain on our city and to keep it open, it’s a betrayal not only of the law as it stands today, but also of what New Yorkers actually want,” he said.

Communications

The Federal Communications Commission (FCC) has proposed a revision of its historic regulations lowering the prices of phone and video calls from prisons and jails, which the agency put on hold in June. If approved, the updated regulations would involve “interim” caps, a new pricing structure for the smallest jails and bringing the prices for all facilities slightly closer to what they were originally. The office of FCC Chairman Brendan Carr announced the news October 3.

CoreCivic

South Central Correctional Facility, a privately run Tennessee prison operated by CoreCivic, houses a supportive living unit (SLU) for people with mental or behavioral health conditions. Unlike the state’s other SLU prisons, its residents are not separated from the general population. In late 2024, 128 SLU prisoners were told their relocation for construction was temporary, but it became permanent. Mixing them with the general population exposes vulnerable individuals—often struggling with mental illness or addiction—to theft, exploitation, and drug trafficking.

Correctional Healthcare Vendors

Wellpath

Wellpath Healthcare, a national provider of medical and mental health care to inmates and others, has announced plans to permanently close its five Nashville locations, impacting 91 workers, according to state records. The company, which declared bankruptcy last year, filed an official Worker Adjustment and Retraining Notification (WARN) Oct. 6 with the Tennessee Department of Labor and Workforce Development to announce the Nov. 7 closure of its Nashville offices.

Alameda County’ s latest audit of Wellpath LLC at Santa Rita Jail didn’t just expose poor performance — it confirmed total failure. Scoring a devastating ZERO, Wellpath has once again proven that corporate healthcare profiteers cannot be trusted with the lives of incarcerated people. This is not just about numbers on a report. This is about human suffering, neglect, and the loss of lives that should have been protected. At the September 29, 2025 Joint Health and Public Protection Committee meeting, Dr. Kathleen Clanon’ s report made it clear: Wellpath’ s services remain below par, and the trend is worsening.

A trial date has been set for the lawsuit against the Shelby County Government and the Shelby County Jail’s healthcare provider following the death of 42-year-old Ramon McGhee, who died due to severe neglect while in custody. McGhee was found unresponsive in the Shelby County Jail on January 10, 2024. McGhee was covered in insects and died two days later at the hospital from severe malnutrition. McGhee’s mother, Lisa Shahan, filed a lawsuit in January 2025 against Shelby County Government, the jail’s healthcare provider WellPath LLC, and the WellPath staff who were responsible for McGhee’s treatment and care.

CFG Health Systems

Essex County and its jail medical contractor, CFG Health Systems, have agreed to pay $8 million to settle a civil rights lawsuit brought by the family of Jayshawn Boyd. Boyd was beaten into a coma by fellow inmates at the Essex County Correctional Facility in 2021. The family accused Essex County and CFG of systemic failures in inmate classification, mental health care, and supervision by both county officials and medical staff. According to the complaint, Boyd, who had been diagnosed with schizophrenia, recently returned from a psychiatric hospital and was still in the throes of serious mental illness.