Prison healthcare can be meaningfully improved through a combination of structural reforms, better staffing, technology adoption, and stronger links to community health systems. The evidence points to several strategies that reduce costs, improve health outcomes, and lower reincarceration rates. Most of these changes require policy decisions at the state or federal level, but some can be implemented at individual facilities.
Shift Medical Oversight to Public Health Authorities
One of the most impactful structural changes is moving responsibility for prison healthcare from corrections departments to public health agencies. When healthcare budgets are controlled by corrections administrators, medical spending competes directly with security, staffing, and facility costs. Separating the two gives clinicians more autonomy and protects healthcare funding from being redirected.
Several countries have already made this shift completely, including Norway, France, the United Kingdom, Italy, Finland, and parts of Australia, Spain, and Switzerland. Jurisdictions that have adopted this model report better healthcare quality, increased links with community health services, more coordinated responses to communicable infections, improved patient safety, and greater inclusion of incarcerated people in public health initiatives. Healthcare providers in these systems also report less professional isolation and more clinical independence. In the U.S., a similar approach would mean state health departments overseeing prison medical care rather than leaving it entirely to corrections agencies.
Expand Mental Health Diversion Programs
A large share of people cycling through jails and prisons have serious mental illness. Diversion programs that route these individuals into structured psychiatric treatment instead of standard incarceration produce dramatic results. In one prosecutor-coordinated program, people who completed treatment dropped from 25 days incarcerated in the prior year to just 4 days in the year after enrollment. Only 14% of completers were reincarcerated in the first year, compared to 42% of those who didn’t finish.
The long-term numbers are equally striking. Five years out, 37% of program completers had been reincarcerated, versus 67% of non-completers. Completers averaged 0.63 arrests per year over that period, while non-completers averaged more than three times that. Completing treatment reduced the likelihood of any future incarceration by 82%. Participants also showed measurable improvements in community integration, daily functioning, and symptom management within six months of enrollment.
These programs work best when they combine clinical treatment with case management and are coordinated across justice and health systems. The key variable is completion: people who drop out see only marginal improvement.
Use Telemedicine for Specialty Care
Prisons are often located far from hospitals and specialist clinics. Transporting an incarcerated person to an outside appointment requires correctional officers, vehicles, fuel, and hours of travel time, all while pulling staff away from facility operations. Telemedicine eliminates most of that burden.
A North Carolina program that implemented telemedicine for specialty consultations saved an estimated $1.2 million in the first year, with a net savings of nearly $684,000 after accounting for setup costs. In the first six months alone, the program saved more than 27,500 hours of correctional officer time that would have been spent on in-person transport. Over a full year, projections estimated 81,000 hours saved. Each avoided trip saved a median of 8.6 hours, with some trips saving up to 12 hours depending on distance.
Beyond cost savings, telemedicine reduces wait times for specialist appointments, which means conditions like diabetes complications, cardiac issues, and chronic pain get addressed sooner rather than worsening while patients sit on a waitlist.
Screen and Treat Hepatitis C Universally
Hepatitis C is far more common in incarcerated populations than in the general public. Traditional screening relies on risk-factor questionnaires, which miss a significant number of infections. Switching to universal opt-out screening, where everyone is tested unless they decline, catches two to three times more cases than risk-based approaches.
Models estimate that universal opt-out screening in U.S. prisons would identify more than 122,000 hepatitis C infections and prevent roughly 13,000 new prison-associated infections. A “test all, treat all” approach costs about $1,440 per person and results in a 23% increase in lifetime cure rates and a 54% reduction in cirrhosis cases. Because hepatitis C is curable with a short course of antiviral medication, treating it in prison prevents ongoing transmission both inside facilities and in communities after release.
Establish Independent Health Inspections
Without external oversight, prison healthcare quality is largely self-reported. Several countries require independent public health authorities to inspect and accredit prison medical facilities the same way they would a community clinic. Austria, Germany, and the Netherlands use health authorities to inspect hygiene standards and license healthcare personnel in prisons. This is especially important in facilities run by private companies, where cost-cutting incentives can directly conflict with patient care.
Effective oversight requires regular inspections that measure clinical performance and ensure care meets ethical standards. It also requires that healthcare professionals working in prisons have representation through national medical boards, giving them professional backup when security priorities conflict with clinical judgment.
Fix the Staffing Crisis
Chronic understaffing is one of the most persistent barriers to adequate prison healthcare. In California, the statewide vacancy rate for corrections employees was 18% in December 2024. For certified nursing assistants assigned to suicide watch, roughly one-third of positions were vacant. Federal courts have imposed requirements that certain clinical staff vacancy rates stay below 10%, with fines for non-compliance.
Staffing shortages have a cascading effect. When positions go unfilled, remaining staff burn out faster, sick calls go unanswered longer, and critical functions like suicide watch can’t be maintained safely. Some facilities are adopting specialized “resource teams” modeled after Norwegian prisons, where correctional officers receive training in mental illness, trauma, de-escalation, and motivational techniques. These teams aim to reduce isolation, violence, self-harm, and mental health crisis admissions by building a more therapeutic environment without requiring a fully clinical workforce.
Connect Prison Health Records to Community Systems
When someone enters or leaves a jail or prison, their medical history often doesn’t follow them. The majority of the roughly 3,300 jails in the U.S. lack electronic health record systems, largely due to cost. Even facilities that have digital records rarely connect them to community health information exchanges. The result is that community providers have no idea what treatment a patient received while incarcerated, and jail clinicians can’t see what medications or diagnoses existed before intake.
The most successful efforts to bridge this gap involve deliberate coordination between county governments, jail administrators, and regional health exchanges. In one documented case, bringing a jail into the community health exchange worked because multiple stakeholders recognized it as a way to improve care coordination for a high-risk, high-cost population. In a contrasting case, a jail that had achieved connectivity lost it when county officials failed to include health exchange participation in their contract with a new medical provider. The lesson: connectivity has to be built into institutional requirements, not treated as an optional add-on.
Activate Medicaid Before Release
Federal law has historically prohibited Medicaid from covering healthcare for incarcerated individuals. This means that people leaving prison, many of whom have chronic conditions, mental illness, or substance use disorders, face a gap in coverage right when continuity matters most. Section 1115 waivers now allow states to begin Medicaid-funded services before someone is released, bridging that gap.
As of 2025, 18 states have approved reentry demonstrations: Arizona, California, Colorado, Hawaii, Illinois, Kentucky, Maryland, Massachusetts, Montana, New Hampshire, New Mexico, North Carolina, Oregon, Pennsylvania, Utah, Vermont, Washington, and West Virginia. These programs vary in scope, but most focus on behavioral health treatment, substance use disorder care, and pre-release planning. For states that haven’t yet applied, these waivers represent one of the most practical tools available to prevent the revolving door of release, relapse, and reincarceration.
Current best practice recommends providing at least a 7-day supply of prescribed medications at release, or a prescription that can be filled immediately in the community. This minimum supply is meant to cover the period before a person can establish care with an outside provider.
Prepare for an Aging Prison Population
The number of older adults in prison has grown steadily for decades, driven by longer sentences and mandatory minimums. People in prison age physiologically faster than the general population, so health needs that typically emerge in someone’s 60s or 70s often appear in incarcerated people in their 50s. This creates demand for services that most prisons were never designed to provide.
Facilities need to plan for a full continuum of care: independent living, assisted living, and 24-hour nursing. New construction should incorporate age-friendly design, including low beds and toilets, wide doorways that accommodate wheelchairs and walkers, and housing located close to dining and medical areas. Functional screening should happen at intake for all ages and annually for anyone 55 or older, covering mobility, vision, hearing, and cognitive function. Correctional officers need training to recognize common age-related conditions like falls, incontinence, hearing loss, and dementia, and to understand how these conditions affect a person’s ability to comply with facility rules. Without these adaptations, facilities will increasingly face emergencies and lawsuits they could have prevented with planning.