Mississippi’s private contract for prison medical services has come under growing scrutiny this year as complaints mount about care and oversight. 

The allegations are nothing new. Mississippi has cycled through five private prison health vendors over the past three decades amid recurring concerns about staffing shortages, weak oversight, unpaid bills to hospitals and inadequate care provided to patients. One report published nearly two decades ago by the Legislature’s watchdog committee echoes many of the questions raised by state lawmakers this year. 

Meanwhile, Mississippi Today’s Behind Bars, Beyond Care series has documented alleged routine denial of health care in Mississippi prisons: potentially thousands of people living with hepatitis C going without treatment, an untreated broken arm that resulted in amputation and delayed cancer screenings one woman said led to a terminal diagnosis. One ex-corrections official said people are experiencing widespread medical neglect in Mississippi’s prisons. 

The Legislature appropriated $690,000 this year for monitoring and review of its current prison health contract, held by Kansas-based VitalCore Health Strategies, Inc. A report is due to legislators by Dec. 15. 

Mississippi Today took a closer look at Mississippi’s contracts for medical services and asked experts what changes can be made to strengthen them. 

How long has Mississippi relied on private medical contractors?

Incarcerated people are one of the few groups in the United States with a constitutional right to health care. In the 1990s, faced with frequent lawsuits filed by incarcerated people, consent decrees and ballooning prison populations, an industry of private companies sprung up to shoulder the state’s responsibility of providing health care to people in prison. 

The Mississippi Department of Corrections began contracting out its medical services in 1998 after years of providing health care itself. The University of Mississippi Medical Center was the first entity chosen to provide the services, and since then, the department has held contracts with four other companies. 

Mississippi selected VitalCore for a three-year contract worth over $357 million in 2024. The company won out over Wexford Health Sources and Centurion of Mississippi, both companies that have held the contract for prison medical services in the past, in a competitive bidding process. VitalCore was awarded over $315 million in emergency, no-bid state contracts from 2020 to 2024.

VitalCore holds correctional health contracts in several other states, including Massachusetts, Michigan and Delaware, and it has faced legal battles and scrutiny in other jurisdictions. 

VitalCore was sued last year by its former chief officer medical of operations in Vermont, who alleged the company forged his signature on policy documents and fired him after he raised alarm bells about conditions in the state’s prisons. A 2019 lawsuit alleges that a 48-year-old with documented heart problems collapsed and died in a New Mexico county jail after VitalCore staff failed to properly monitor his condition. And significant understaffing of medical positions in Massachusetts prisons led VitalCore to pay back $1.4 to $1.7 million a month to the state, according to reporting by the Boston Institute for Nonprofit Journalism.

Dan Mistak, the director of health care initiatives for justice-involved populations at Community Oriented Correctional Health Services, described the process of states contracting corrections medical companies as a “revolving door.” 

When a new company is awarded the contract, it often rehires many of the same staff members. If controversy arises over the quality of care or another issue, the company carries the blame and either receives more money from the state to fulfill its obligations or leaves. A new company then rotates in. 

“Rinse, cycle, repeat, over and over again,” Mistak said. 

Centurion, a company previously tasked with providing health care to Mississippi’s prisoners, terminated its contract with the corrections department in 2020 amid an ongoing legal battle with prisoners, arguing that the state’s failure to invest in infrastructure and correctional staffing prevented the company from performing its duties. Centurion was brought in under an emergency contract, like VitalCore, in 2015.

The prior contractor, Wexford, was accused of funneling consulting fees to a former Mississippi state legislator, Cecil McCrory, who pleaded guilty to bribing a Mississippi corrections commissioner, Chris Epps, in exchange for Epps’ efforts to steer state prison contracts. The state collected $4 million from the company in a lawsuit. 

How have prison health care costs changed under the new contract? 

Mississippi’s per capita spending on prison health care has risen steadily over the last 25 years, according to reports by the Legislature’s watchdog branch, the Performance Evaluation and Expenditure Review Committee. 

In 2000, the state spent $5.07 per day on health care for people in its custody. In 2024, the cost was three times as high – $16.03 per day. In recent years, spending on basic medical care has risen starkly while the costs of specialty care have grown more slowly or dropped. 

Corrections Commissioner Burl Cain attributed the rise in costs to inmates overusing medical services. Speaking at a legislative budget hearing Sept. 24, he likened the business of providing medical services to people in Mississippi’s prisons to caring for animals.

“It just goes up, and these inmates go to the doctor for everything,” he said. “And the problem is, it’s like being, I hate to say it, sometimes it’s like being a veterinarian to say what really, what’s wrong with you.”

The Department of Corrections did not respond to questions about why costs are rising or what Cain meant. 

Marc Stern, a faculty member at the University of Washington and former assistant secretary for health care at the Washington Department of Corrections who serves as a medical adviser for the National Sheriffs’ Association and American Jail Association, said the rise in basic care costs may be the result of rising costs for salaries and medications. 

He said health care in jails and prisons in the U.S. is often not funded as well as it needs to be to ensure that people receive quality care.

“As a result, you get what you pay for,” Stern said. “… Is it the fault of the company or is it the fault of the legislature? I guess that’s a philosophical question.” 

Mississippi’s prison population is growing older, which can result in more costly care. The portion of prisoners aged 55 or older has grown by about 10% in the past 20 years, accounting for 12% of the population in 2019. 

Mississippi has one of the highest incarceration rates per capita in the world — 661 people per 100,000. About 19,500 people are currently incarcerated in state prisons. 

How does a fixed-rate model of health spending shape the care prisoners receive? 

VitalCore is paid a flat rate adjusted to reflect the number of people in custody, regardless of their medical needs. It is required to provide onsite care, including mental health, dental, dialysis, laboratory and optometry care, and cover the costs of offsite care at hospitals or for specialty care. In the first year of the contract, VitalCore is paid about $115 million, with adjustments of $53.54 for each inmate below 19,000 or above 19,600. The payment rates grow each year. 

This means that if a contractor spends less to provide health care to people in state custody, it reaps a larger profit. But, it loses money if it exceeds cost projections.

The fixed-rate model is more predictable for the state than other models, like reimbursing a contractor for the care they provide. While the state won’t see the savings if less is spent on medical services, it also won’t be required to pay extra if more is spent. It is the most common way to structure prison health contracts among all states, according to a report from Pew Charitable Trust published in 2015. 

This model can, in theory, reward preventive care measures that keep people healthy and reduce expensive interventions. But it can also encourage delayed or inadequate care, since contractors can save money by limiting the care they provide. Strong monitoring is the key to curbing these risks, experts said. 

Because about 95% of people will be released from prison at some point, communities absorb the consequences of delayed or inadequate care in the long term through higher emergency room use, worsening population health or infectious disease spread, Mistak said. 

This can burden hospitals and state safety-net programs, like Medicaid and Medicare, down the road. 

“Those costs are going to be borne by the state and the community,” he said.  

What if a company’s bid isn’t enough? 

In a competitive process for prison health care vendors, the company with the lowest bid usually wins the contract. But when correctional care providers propose a low budget to stand out during the procurement process, they sometimes can not afford the costs of care they proposed and still turn a profit, Mistak said. 

In some cases, contractors will return to government entities that contracted them to ask for more money. This has played out in Missouri and a county jail in Wisconsin in recent years. 

“You end up paying more anyway for a lot of these contracts,” Mistak said. 

That’s what happened in Mississippi. In May, MDOC requested $4 million for a “deficit appropriation” – money to cover a shortfall – for VitalCore, according to House Corrections Committee Chairwoman Becky Currie, a Republican from Brookhaven.

How do staffing clawbacks work?

If VitalCore does not meet staffing requirements outlined in the contract, the company must pay the corrections department back the average hourly wage for each unfilled hour of work, plus a 20% fee for employee benefits, according to the contract. 

“We’re really good at that,” Cain said Sept. 24. “We take back from the money that they didn’t spend on hiring people. They don’t get to keep it.” 

He said the department has used funds recouped from VitalCore for unmet staffing requirements to pay for improvements to buildings and infrastructure. 

But returning the salaries of unfilled positions isn’t enough, Stern said. To truly motivate companies to fill the position, they must face a financial consequence beyond the value of the vacant position. 

“Those penalties have to be stiff enough to be more than what the vendor saves from not filling the position,” he said. 

Why have legislators said VitalCore is ‘slow paying’ its bills to vendors? 

At the Sept. 24 budget hearing, Sen. Daniel Sparks, a Republican from Belmont, said that VitalCore delaying payments to vendors, including the University of Mississippi Medical Center, has been a “continual issue.” 

Currie told Mississippi Today that Bolivar Medical Center in Cleveland, about 25 miles from the Mississippi State Penitentiary at Parchman, has faced similar challenges. 

Neither hospital, the Department of Corrections or VitalCore responded to a request for comment. 

Cain said Sept. 24 the issue was due in part to hospitals billing VitalCore at rates higher than the agreed-upon costs for prison medical services. Deputy Commissioner of Administration and Finance Derrick Garner said the agency is monitoring the issue and aims to increase oversight of the payments.

Sparks said that VitalCore could pay the agreed-upon rate rather than waiting to negotiate rates. 

“But to not pay the bill at all, and let the bill get into the millions of dollars when that’s a state entity that’s supposed to be paid by a state entity and the intermediary is holding up the payment, it doesn’t settle well,” Sparks said. 

What kind of oversight does Mississippi use to monitor the contract? 

The Department of Corrections performs oversight of its contract with VitalCore. Monitoring tasks include reviewing service levels, quality of care and administrative practices, meeting with VitalCore to address issues, conducting site visits and inspections and reviewing third-party reimbursements, according to the contract. 

The state examining its own contract reduces the costs of bringing in an outside monitor and allows the state more control over what it tracks, said Stern. 

But the quality of monitoring depends on how willing the state is to hold a contractor accountable, and states may be less stringent out of fear that a contractor will bail. 

“The threats of leaving can really make a state gulp,” Mistak said. “…And so sometimes they lay off the gas when it comes to enforcing their own contract.”

The Mississippi Legislature has made several efforts of its own to scrutinize the medical care provided in state prisons. 

The Legislature tasked the health department with studying the challenges of providing health care to people who are incarcerated in 2024, and State Health Officer Dr. Dan Edney presented initial findings at the Capitol in January. The health department will produce a report roughly a year from now, including recommendations to MDOC, said spokesperson Greg Flynn. 

This year, the Legislature appropriated funding for the Department of Corrections to monitor and review the medical services contract, with a report due to legislators by Dec. 15. Cain said Sept. 24 that the contract for the report has been finalized. 

MDOC did not respond to questions about who was awarded the contract.

Currie, who has spent the last year probing for answers as to why inmates are getting sicker as the state increases its spending on medical care, said she is curious to see the report’s finding. She authored a failed bill this year that would have tasked the health department with conducting a sweeping review of medical care for people incarcerated in Mississippi at no cost. 

“Yet, we spend $700,000 on a report,” she said to Mississippi Today. 

Does privatizing prison health care make the system better?

Most states contract all or part of their prison health services with private companies. Several states provide their own prison health services through government agencies, like Louisiana.

If a state develops a strong oversight system, they can gain the expertise to manage the contract themselves, said Stern. Providing health care in-house can reduce costs for states, he said, because contractors must make a profit margin and less duplication of services exists between the state and the contractors. 

It also creates more opportunities for continuity between prison health care and community health care, which would make it easier for health providers to care for people when they are released, experts said. 

Some evidence shows that medical services run by government agencies may lead to lower death rates. A 2020 Reuters investigation of more than 500 jails in the U.S. showed that facilities with private healthcare contractors had higher death rates than those run by government agencies. 

Currie said she would like to see prison health care run by the state or a local hospital system, which she said would ensure stronger accountability and quality care. 

“I’m just not able to sit back and watch people die and be treated badly, no matter who they are,” Currie said. 

“…Most of these people are coming out. And the new law is that most of them will come out. And you know, we need them to be healthy and ready to go to work and lower our recidivism rate.”