Nearly 783,200 of the total 1.3 million people incarcerated in this country are locked up in rural counties—areas that are more likely to face hospital closures, according to the Prison Policy Initiative. This nonprofit, nonpartisan research and advocacy organization works to expose the harms of mass incarceration.
The Trump administration’s changes to Medicaid in the 2025 budget reconciliation bill will make it harder for rural hospitals to stay financially afloat. For those in rural jails and prisons, the closure of rural hospitals is likely to worsen mortality rates. Incarcerated people already face higher mortality rates than the general population, due in part to a lack of access to basic medical care.
Since 2010, there have been three civil rights cases about insufficient healthcare in prisons and jails in Virginia alone.
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The closure of nearby medical centers will likely exacerbate these circumstances, according to the Prison Policy Initiative analysis. In the last decade, more than 100 rural hospitals have closed, while more than 700 are at risk of closure due to financial problems.
As of August 2025, 14% of all rural hospitals are at immediate risk of closing, representing a total of 322 rural hospitals. In Virginia, where 46% of the incarcerated population are in rural facilities, 19% of rural hospitals are at immediate risk of closure.
Data from the Prison Policy Initiative report comes from Vera’s Incarceration Trends, the Bureau of Justice Statistics, the Center for Healthcare Quality and Payment Reform, and Rural Hospitals at Risk of Closing. The definition of “rural” for this analysis comes from the Health Services and Resources Administration.
Texas has the largest number of people incarcerated in rural areas. In 2019, the latest year of available data, 117,000 people were in rural state or federal correctional facilities, making up about 68% of the total incarcerated population in Texas that year. Thirteen percent of rural hospitals in Texas are at immediate risk of closing, representing a total of 21 hospitals.
Idaho, meanwhile, has the largest share of incarcerated people who are in rural institutions. In 2019, 90% of Idaho’s incarcerated population were in rural facilities, representing a total of 7,000 people. One rural hospital is at risk of immediate closure in Idaho.
Coupled with the state of rural hospital systems is the changing demographics of our nation’s incarcerated population. People who are incarcerated are increasingly older than the general population, according to a 2023 Prison Policy Initiative report. People over 55 now make up five times more of the incarcerated population than they did 30 years ago. In 2021, 15% of the incarcerated population were older than 55.
Incarceration is unhealthy for anyone, but for people who are already more vulnerable to health issues—like older adults—being incarcerated can have outsized harm.
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If rural hospital systems continue to close, communities will increasingly bear the growing burden of providing healthcare for incarcerated people. In 2023, for example, the cost of 224 ambulance trips from the Chippewa County Correctional Facility was upwards of $430,000.
Correctional facilities are finding unethical ways to skirt the costs of caring for inmates, meanwhile. A 2024 report from the National Consumer Law Center found that some sheriffs released inmates on medical bonds before hospital visits to avoid being responsible for medical bills. After the person was discharged, they were rearrested and booked back into jail.
*This article first appeared on The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.*
https://www.minnpost.com/health/2025/11/limited-hospital-access-disproportionately-harms-people-incarcerated-in-rural-areas/