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Texas Prisoner Health Care Underfunded

On average, Texas spends less on prisoner health care than other states – about half the amount that California spends. However, medical care for California prisoners was found to be unconstitutionally inadequate, leading a federal court to order reductions in the state’s prison population to the point that sufficient care can be provided. That order was upheld in 2011 by the U.S. Supreme Court. [See: PLN, July 2011, p.1].

During the last legislative session, both the University of Texas Medical Branch at Galveston (UTMB), which provides health care for about 80% of Texas prisoners, and the Texas Tech University Health Sciences Center, which provides or subcontracts health care services for the state’s remaining prisoners, complained that they were underfunded.
UTMB claimed it had lost around $45 million over two years by supplying medical care to prisoners.

A May 2011 financial analysis of UTMB’s cost of providing prisoner health care seemed to support the contention that insufficient funds were being appropriated. The report predicted prisoner medical care costs of between $879.6 million and $930 million over the next two years – up to 20% more than was appropriated by the state legislature.

Since 1993, Texas has used a Correctional Managed Health Care Committee (CMHCC), something like an HMO, to regulate and control the cost of prisoner medical services.
However, prisoners have complained that this system leads to the denial of health care by accountants rather than the practice of medicine by doctors.

At the same time, state officials have criticized spiraling prison medical costs. In February 2011, for example, the Texas State Auditor’s Office issued critical reports after examining the expenditures of UTMB and Texas Tech for prisoner health care. [See: PLN, Dec. 2011, p.10].

According to Allen Hightower, executive director of the CMHCC, an increasing number of older prisoners with age-related health problems, and the rising cost of drugs used to treat chronic illnesses such as HIV and Hepatitis C, are causing higher health care costs.

While the financial analysis report supported UTMB and Texas Tech’s claims of being underpaid for providing medical care to prisoners, it also stymied Governor Rick Perry’s attempt to privatize prisoner health care. Perry’s aides had been lobbying state lawmakers for months, claiming privatization would save money. Prison officials and legislators balked at the idea, however, citing inadequate care and lack of savings when other states had privatized prison medical services. The report gave them an additional argument against privatization.

“While it’s possible that some of the functions of [prisoner health care] could be done more cheaply, I don’t think this report is going to help the rush by some to privatize,” said House Corrections Committee Chairman Jerry Madden. “Tax-payers are getting their money’s worth right now, it appears.”

Texas prisoners, however, apparently are not getting the medical care they need, and to make matters worse state lawmakers cut $75 million from the prison system’s health care budget during the last legislative session. The largest budgetary reduction was for hospital and clinical services, which were slashed 28%.

“We will have our work cut out for us in terms of developing levels of service, developing partnerships and rate structures so we can make these appropriation levels work,” said Brad Livingston, director of the Texas Department of Criminal Justice (TDCJ).

“In addition, we’re working hard to make certain hospital resources we have will be spread appropriately. We have a challenge making sure all this fits and works but we have an obligation to do so,” he stated.

On February 10, 2012, the Texas Board of Criminal Justice approved a contract to lease nine beds at Huntsville Memorial Hospital for prisoner medical care – the first time the prison system has sought such services outside UTMB and Texas Tech. The 3½-year contract with Huntsville Memorial, valued at $46.8 million, also includes emergency room, surgical, physician and imaging services.

The TDCJ’s health care contract with Texas Tech expires in 2013, while its $430 million contract with UTMB has been extended through August 2012 as the state continues to negotiate future arrangements. UTMB, citing financial losses, has said it may transition out of providing prisoner health care.

Meanwhile, the legislature is considering a bill (HB 26) that would require Texas prisoners to pay an annual $100 “health care services fee” if they seek medical care. The fee would replace the $3.00-per-visit co-pay that prisoners currently must pay. This is in the context that Texas prisoners have no legal way to earn money while in prison, as they are not paid for working.

Sources: Austin American-Statesman, Associated Press, Texas Tribune,

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