“Healthcare in the Illinois Department of Corrections is in a state of crisis.”

That opinion came last week from Harold Hirshman, a Chicago lawyer who has worked as a part of team of litigators who have challenged the treatment of mentally ill inmates housed by the IDOC. The crisis developed in recent weeks as the state ended its two-year effort to renew a ten-year contract with Wexford Health Sources.  Adding to the crisis, is the recent resignation of IDOC Medical Director Dr. Steven Bowman. The state has initiated an emergency contract with Centurion Health, of Indiana, as it works to secure a new contract.

But the crisis, according to Hirshman, brings with it new possibilities for how mental and physical healthcare could be delivered to the state’s 28,000 detainees, including more than 12,000 with a mental health diagnosis.

“The Illinois Department of Corrections is at a crossroads. For the first time in decades, it has the opportunity to rethink how it delivers healthcare to prisoners,” said Hirshman, noting that the model of independent, for-profit healthcare, used by vendors like Wexford has been problematic. Wexford “butchered the job repeatedly,” said Hirshman.

The lawyer cites a June 2025 memorandum in which the IDOC appointed a Transition Oversight Committee to monitor the contract changes and ensure continuity of care.  The committee, he said, “should endorse a new model, and in replacing Dr. Bowman, find a seasoned medical professional to manage the transition.”

Several options are cited by Hirshman as healthcare sources the state should consider. Government agencies, university medical school centers and outsourcing to private community health nonprofits are all worthy options for providing healthcare. Each has been successfully used in jail and prison settings in Illinois and other states. The new Request For Proposals cycle to secure a new provider is “a crisis which should not be wasted,” according to the attorney for inmates.

The major reform to inmate healthcare that has been the focus of multiple federal lawsuits calls for consideration of these new solutions. The model of for-profit healthcare by Wexford and Centurion –both the target of allegations of substandard care and neglect—has failed to move inmate healthcare in the right direction.

I have attached a portion of Hirshman’s statement below in which he outlines the three potential solutions for the crisis facing the IDOC. I hope you will take a few minutes to read about the options open to Illinois.

“There are three viable alternatives to this correctional healthcare model. The first is contracting government health agencies as providers. This is a public model and therefore relies on public funding to provide services. New York and Los Angeles have both signed with public health organizations in the past to provide correctional health services in specific jails and prisons, including Rikers Island. However, publicly funded health providers have faced heavy criticism in recent years for understaffing and negligence, leading to a poorer quality of care. The second option is to contract with university medical school centers to provide care, a model called managed care. For example, in New Jersey, Rutgers University’s correctional healthcare division staffs correctional facilities; in Florida, prison rotation programs allow medical students to gain experience in correctional healthcare, which many students find rewarding. Some programs incentivize medical students to work in prison environments by instituting loan repayment programs.

One of the most successful managed care models emerged in Texas. In the Texas model, the state prison system contracts health services with state medical schools such as the University of Texas Medical Branch (UTMB) and Texas Tech University Health Sciences Center. This allows for care to be delivered on multiple levels and in multiple facilities throughout the state – for example, Texas uses infirmaries at strategic locations, providing specialized treatment programs for chronic conditions, and even operating a dedicated prison hospital. The managed care program allows for inmates to have access to timely care while reducing costs for the state prison system. As in Texas, Illinois has partnered with medical schools in the past to supply doctors and medical resources to prison facilities. In 2010, Illinois used an interagency agreement between the IDOC and the University of Illinois-Chicago to implement a Telemedicine Pilot Program for inmates with HIV and Hepatitis C. The program has continued and been successful. Additionally, the Southern Illinois University School of Medicine has a contract with the IDOC to monitor the quality of healthcare inside prisons. Southern also provides telehealth services to outlying rural and urban communities in Illinois, but this program should be expanded to include correctional populations.

If the university model is not implemented, there is a third alternative: outsourcing to private community health nonprofits. Private nonprofits retain the private-model advantages of innovation and competition while focusing on more socially beneficial outcomes. For example, Connections Community Support Programs ran Delaware’s correctional healthcare until 2020; Unity Health Care has provided healthcare for DC jails since 2006. This model has the potential to hold contracted entities accountable for the standard of care provided because nonprofits often have more transparent budget documents and make their data public. In analyzing what the best model is for providing quality healthcare, the IDOC might look to Social Purpose Corrections, a nonprofit correctional model founded by former prison warden Brian Koehn. SPC uses a performance-based contract model to retain the cost advantages and operational flexibility of private prison facilities while allowing for greater innovation in solutions. All net revenues from federal and state contracts are reinvested in the prison system and resident outcomes, rather than distributed to shareholders. Unlike the present for-profit model, SPC’s staff members are compensated in proportion to the success of their residents, encouraging high performance in key metrics.”