Report: Counties burdened by recurring pattern on inmate healthcare

Small to midsize counties face “extreme, triple-digit percentage volatility” in inmate healthcare costs while large urban counties have smaller percentage variations that still translate into massive cash deficits due to their sheer volume, the report said.

County budgets face unprecedented strain from an aging inmate population, volatile healthcare inflation,and complex behavioral health needs, the report found.

Some counties, such as Columbus and Sampson, spent more than twice as much on inmate healthcare as was budgeted in fiscal year 2023-24, the report found.

Unexpected medical needs were the key drivers of the cost overruns.

“The data show that while predictable on-site clinic costs, such as routine nursing hours, remain stable, external hospital services and specialty medications present significant fiscal volatility that complicates county budget planning,” the researchers concluded.

An aging inmate population is one factor in the rising healthcare costs. Another is the fact that inmates often had limited access to healthcare before they were imprisoned.

“individuals entering county detention facilities often come from environments with severely limited access to community-based preventive healthcare,” the report states. “As a result, local jails are forced to operate as default clinical stabilization centers for complex, chronic conditions that have already escalated to an acute crisis point prior to booking.”

That leads to more expensive emergency room visits and speciality drugs, the report concludes.

Federal funding for inmate care is limited by law, the report states, leaving local governments to foot the bill.

“Because federal dollars cannot cover primary, acute or psychiatric care within local jails, North Carolina counties must fund these mandated services entirely through local property and sales tax revenues," the report states. “This total reliance on local funding exposes local budgets to extreme financial risk when inmate care demands spike.”

The opioid crisis and the “mass closure” of state psychiatric hospitals are also cited as factors in the growing inmate healthcare costs.

In 2013, the Legislature passed a bill requiring counties to reimburse hospitals for healthcare at specified rates.

“This shift placed immense pressure on local county budgets that previously relied on hospitals to absorb these costs as charity care,” the report said.