Contracting for Correctional Healthcare
When it comes to picking a healthcare provider in corrections, the focus often falls on cost. Many local governments are required to award contracts to the “lowest responsive and responsible bidder,” but that does not mean the cheapest. Choosing the wrong provider based solely on price can lead to significant long-term expenses—both operationally and legally. From staffing shortages to performance issues, a bad contract can decrease quality of care. While some departments of corrections (DOCs) try to combat cost by providing in-house care, these jails face significant operational and quality challenges – and are sometimes fined – as a consequence.¹ Understanding how to contract for healthcare intentionally can help you ensure the decisions you make today won’t create bigger challenges tomorrow.
Identify the problem
Before entering into a contract, take a close look at the specific challenges within your jail and ask prospective providers how they plan to address them. How are staffing levels affecting healthcare delivery? Is your facility struggling to complete timely health assessments or keep accurate records? Understanding these problems allows you to focus on finding a provider who can offer specific solutions.
For example, a provider who can help you avoid costly lawsuits and attorney’s fees down the road will be a critical asset in keeping the facility’s healthcare budget in check. In fact, you may even be able to negotiate lower insurance premiums with a quality provider. Generally, many problems can be addressed by:
Staffing with qualified professionals
Training on correctional-focused care
Focusing on scope of practice
Tracking/reporting quality data and metrics
Once you've identified the problem, it’s time to take control of your contract. Remember: your provider works for you. The goal is to ensure your provider meets your needs and solves the issues you’ve outlined, not just in the short term but in the long haul. Identify the problem to find the solution that will make your life easier.
Pick a partner
While an attractive proposal may seem like a quick fix, make sure you are digging deeper and doing your homework on each provider. Request letters of recommendation and testimonials, but don’t forget to spot-check them for current and relevant information. You can even request contact information for a terminated contract to learn about past performance. Look for or request evidence of:
Financial Stability: Ask about the company’s debt to ensure the company is financially sound and won’t collapse mid-contract.
Experience and Reputation: Ask the company to discuss their 3 best clients and most recent 3 terminations.
Quality Metrics: Ask for data such as suicides, death rates, and lawsuits to demonstrate program effectiveness. Use our health care unit checklist as a guide to help you know what questions to ask.
Ownership: Find out who actually owns the business and who the decision-makers are – this will tell you if you’ll be able to make specific requests to those in charge.
Even if a partner checks all your boxes, make sure your contract has a termination clause you can live with, just in case things don’t work out. A termination clause should require appropriate notice from each party – you shouldn’t have to live with a provider that isn’t working for you, and you don't want to be abandoned if they fire you. Pick a partner based on past performance and quality data to avoid getting stuck in a toxic business deal.
Negotiate & request BAFO
A proposal is not the same as a contract and may be negotiated. Take what you know about each provider and request their best and final offer (BAFO). When negotiating services and pricing, make sure to think beyond upfront costs. Choosing the “cheapest” provider now may end up costing you later. Weigh cost vs. liability and ask yourself: is what I’m “saving” on this contract going to outweigh the cost of a potential lawsuit? For example:
“We’ll just have officers pass meds to save on nursing hours” equals lower cost now, higher liability cost later – and lower quality of care
“We only want to staff RNs in our facility” equals higher upfront cost with higher quality of care and lower liability cost later*²
*Internal data from 2016-2023 shows that sites with an RN versus an LPN had 84% fewer claims and 95% less in legal costs.
“We don't need an RN at intake” equals lower cost and quality of care upfront, higher liability cost later*³
*Most jail deaths from suicide or drugs occur within the first 72 hours. RNs at intake can help identify and prevent medical emergencies.
Don’t forget to negotiate beyond basic services. Ask about value-added services like training and officer wellness programs, behavioral health options, medical claims repricing (bill scrubbing), or electronic health/medical records (EHR/EMR) – which differ from an eMAR. Consider asking about pharmacy and medical supply partnerships as well, as counties can benefit from nationwide discounts.
These extras might cost a little more, but they can make a big difference in the long run by lowering medication costs and offsite visits. Quality healthcare is generally the most cost-effective option. Negotiate & request BAFO to get the proposal that fits your facility.
For more information, please contact training@sparktraining.us.
Prison Policy Initiative. (2025). New Prison Policy Initiative Report Explains Notoriously Bad Correctional Healthcare. https://www.prisonpolicy.org/blog/2025/02/19/healthcare_report/
Spark Training. (2025). Why Correctional Healthcare Should Shift to RNs. Corrections1. https://www.corrections1.com/why-correctional-healthcare-should-shift-to-rns
Nam-Sonenstein, B. (2024). Research Roundup: Evidence That a Single Day in Jail Causes Immediate and Long-Lasting Harms. Prison Policy Initiative. https://www.prisonpolicy.org/blog/2024/08/06/short_jail_stays/
Disclaimer
All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis. When in doubt, send them out!®
