Community Police & Fire

Medical care at jails gets more expensive as contractors pull out of Washington state

Penny Sapp gets through few meetings these days without someone bringing up the cost of medical care at the Kitsap County Jail. 

Prices have more tripled in the less than a decade and become a major contributor to the county’s multi-million budget deficit next year. Sapp, Kitsap County’s chief of corrections, says the escalation “feels almost personal.” But she knows there is almost nothing she can do. 

Federal law requires jails to provide medical care to those in their custody. But Washington facilities have had an increasingly difficult time fulfilling that obligation in recent years, threatening their operations and putting lives of the vulnerable population they incarcerate at-risk.

Restrictive insurance requirements and Washington’s legal system have left state jails in an almost monopolistic environment. Few public agencies have the financial resources necessary to offer medical care in jails. The large, often out-of-state contractors that do have been pulling out of the state, officials say, fearful of large civil penalties.

Those complicated dynamics are playing out right now in Kitsap County, which in many ways is a microcosm for jails across the state. Everhealth LLC, a subsidiary of the Alabama-based contractor NaphCare, was the only company that offered to fulfill Kitsap’s need for a medical provider at its Port Orchard jail. 

Without alternatives, the county agreed to pay the company $6.8 million in 2026. That is a more than $1 million increase from last year and more than double what the county paid five years ago. In 2029, the price will grow to $8.6 million.

“There is no other option,” Kitsap County Commissioner Christine Rolfes said of the situation. “We have to pay what the rate is.”

One of the medical exam rooms at the Kitsap County Jail on Wednesday, Oct. 29, 2025. 

Large contractors dwindle 

Even amid the price hike, Sapp is taking solace that Kitsap has a contract at all. Earlier this year, some worried that Everhealth/NaphCare would pull out of Washington, she said, “leaving us in a very serious predicament.”

Aside from being an obligation, Sapp says having sufficient medical care is crucial for successful reentry. Nearly every individual held at the jail has some form of medical need. About three-quarters of the population suffers from substance abuse disorders and 60% from mental health issues. For many, jail is the first place they see a doctor in years.

When EverHealth/NaphCare took over care in the jail in 2019, Kitsap had three companies bid to service medical care at its Port Orchard Jail, Sapp said. Since then the number of third-party providers offering to provide service in Kitsap County have dwindled.

Jails around the state face similar dilemmas. Many have received few responses to their requests for medical providers.

“Back when I ran a jail I’d put out an RFP (request for proposal) and there’d be eight, 10 responses,” said Ric Bishop, jail liaison for the Washington Association of Sheriffs and Police Chiefs, who was previously a correction chief in Clark County. “Today, my understanding from our members, it’s one or two.” 

‘It’s really a crisis’

Even large jails like the South Correctional Entity, owned by six cities in South King County, have had trouble finding medical providers to staff their jails, said executive director Devon Schrum. SCORE had been contracting with Wellpath, a Tennessee-based vendor which recently went through bankruptcy proceedings, but sought other options as their contract expired this year. 

Schrum sent inquiries to multiple vendors, but didn’t get a single response. About a month before its contract with Wellpath expired, SCORE inked a deal with contractor Mediko, out of Virginia. The facility receives the same services, but it now costs about $2 million more.

“It’s really hard for jails in Washington to attract vendors,” she said. “It’s really a crisis.”

A 1976 Supreme Court decision requires jails and prisons to provide medical care to inmates. Failure to do so violates the ban on cruel and unusual punishment under the Eighth Amendment of the Constitution, according to the Estelle v. Gamble decision. 

“A jail can’t operate if it can’t provide for medical needs,” Bishop said. “If it ever came to that – I don’t know if they’d close – but they have to have provided for medical services to operate. They just can’t do without it.” 

Large civil penalties drive out companies

Many point to Washington’s legal system as one reason large contractors are reluctant to do business here. Washington appears to be among only a handful of states that does not cap damages from medical malpractice lawsuits or tort claims, meaning companies can face significant civil penalties.

For example, in 2022 a jury ordered Everhealth/Naphcare to pay a $27 million penalty to the family of a woman who died in the Spokane County Jail, according to media reports. Then earlier this year – after failing to treat a man in the Pierce County jail, whose foot had to be amputated because of an untreated blood clot – a jury ordered the company pay a $25 million penalty.

Everhealth/Naphcare appealed that decision, a company spokesperson said. They added that the patient received “immediate and appropriate medical care, including urgent transport to a hospital.”

Steve Strachan, executive director of the Washington Association of Sheriffs and Police Chiefs, said the payouts from civil awards have skyrocketed in Washington, making it economically unviable for some of these companies to operate in the state.

“There’s this argument saying that people can write laws all day but ultimately things are going to be driven by the bankers and the insurance companies,” said Strachan, a former Bremerton police chief.

“When it comes to bankers  and insurance companies, right now the environment is getting increasingly worse in the state of Washington and it’s driven in part by the court and civil environment in terms of tort claims and tort awards,” he added.

Rising health care costs

Those penalties stoked the concerns that Everhealth/NaphCare would withdraw from Washington. The company decided to stay, but it came with a high price and an uncertain future.

Everhealth/NaphCare provides medical care in six jails in Washington, a public relations firm representing the company wrote to the Kitsap Sun and Gig Harbor Now in an email. By the end of next year, they plan to remain at only two jails, the spokesperson said without specifying which jails.

The company cited the rising cost of supplies, services and salaries needed to be competitive  as contributors to its price increase in Kitsap County, saying health care costs rose across all sectors. Health care staffing remains a challenge in Washington, the company said, and the “remote location” of the Kitsap jail and competitive labor market make hiring difficult.

“Everhealth remains committed to providing high-quality, correctional healthcare services and technology for incarcerated populations in Washington and Oregon,” a company spokesperson said. “However, in order to be able to meet the needs of our patient population in Washington state, we have had to increase prices.”

Local agencies can’t fill the void

Brynn Felix, the chief corporate affairs and legal officer for Peninsula Community Health Services, wanted her agency to step in to provide medical care in the Kitsap County Jail. PCHS, a federally qualified health center, provides medical care to individuals in Kitsap, Mason and rural Pierce County regardless of their insurance.

Kitsap County Jail.

PCHS staff had already been working with the jail for over five years on transitional services, connecting with individuals near the end of their sentences about post-release medical care. The idea was to ease inmates’ transition into the community by connecting them with PCHS clinics.

Local officials believed having PCHS provide care in the jail would make the process even smoother and help reduce rates of recidivism. A person’s health care is frequently disrupted when leaving jail as they must switch between providers, who may lack their full medical history.

PCHS planned to bid to provide medical services at the jail, but it couldn’t find an insurer willing to cover their providers.

“The problem is it is nearly impossible for community-based providers to obtain the necessary insurance to provide care in jails,” Felix said during a state committee meeting earlier this year. “Many of us have tried and failed to obtain private insurance to provide care in jails.”

Malpractice insurance

Gaelon Spradley, CEO of Chehalis-based Valley View Health Center, recounted his agency “simply walked into” the Pacific County Jail after it lost its medical provider and started offering primary care. They also could not get insurance.

“We had to withdraw our services,” he said at the hearing. And “then we couldn’t respond to an RFP from Lewis County, which like many counties is facing an enormous budget crisis this year.”

Virtually no private insurance companies are willing to provide malpractice coverage to medical agencies working in prisons or jails. Most companies that provide health care in carceral facilities are self insured. That financial barrier excludes most agencies outside of large corporations from bidding on jail contracts.

Washington state prisons avoid this dilemma by self-insuring through an account maintained by the state’s Office of Risk Management. No such fund is available for the state’s nearly 60 jails, which unlike prisons are locally owned by their respective jurisdictions.

High-needs patients

Insurance companies’ rationale is driven in part by the high needs of those coming into jails, many of those whom have undiagnosed or untreated conditions. The threat of federal civil rights violations also makes them hesitant, according to a report from the Washington Office of the Insurance Commissioner released last year.

PCHS would provide a cheaper alternative to Naphcare/Everhealth based on its own estimates, said CEO Jennifer Kreidler Moss. But she says it’s an “apples and oranges” comparison, because those numbers do not include malpractice insurance and the agency does not have all the same services.

Still, having PCHS in the jail would almost certainly improve a person’s continuum of care once they leave jail, Sapp says.

“We’re lucky here in Kitsap. We have a great community health provider that’s willing to do that and maybe open to being our medical provider,” she said. “In a lot of jails in our state, medical providers want nothing to do with them.”

Asking the state to take liability risk

State Rep. Tarra Simmons, D-Bremerton, says she has wanted to get PCHS working in the jail for years now. Although the cost has become an issue, she says her main motivation was to help reduce recidivism.

“I want people to be successful when they leave,” said Simmons, the first formerly incarcerated person to serve in the state legislature. “The breakdown where we have a contractor providing care and then warm hand off to a community health clinic is causing people to not get their medications or relapse or not have that continuity of care.”

Simmons introduced legislation this year outlining a process where the state would provide reimbursement to protect community-based health care providers working in local correctional facilities. The bill asked the state to provide reimbursement for judgments or settlements in excess of $50,000. It did not get out of committee.

Simmons acknowledged it is a tough sell as the state continues to face budget challenges and has unpaid sundry claims, but plans to reintroduce the policy when legislators reconvene in January.

Simmons says she hopes to convince her colleagues that it is worth the risk. Providing a path for local providers to work in jails would offer counties millions in savings, she said. That could relieve the budget challenges they face and open up funds for other priorities like housing or behavioral health.

“This helps everybody,” she said. “We all benefit when we’re not making large corporations more money. Because we’re all in a budget crisis, we need to be thoughtful about how we spend money right now.”

Priority for counties

Brad Banks, a contract lobbyist working on behalf of the Washington Association of Counties, said Simmons’ bill was a fairly modest proposal that served as a good starting point for an issue that has been a large cost escalation for many counties.

The association, a nonprofit serving as a collective voice for the state’s 39 counties, has elevated jail-based medical costs to one of its priority issues for the 2026 legislative sessions, recognizing how it has disrupted budgets across the state.

“Many counties are really left with few choices,” he said. “They may end up contracting with a large out state company that has the financial resources to pay for that level of liability protection and that comes at a steep increase in price.”

Until a solution is ironed out Sapp remains fearful of the future sustainability of local jails.

“There’s going to come a day when we don’t have anybody bidding on our jail medical,” she said. “Then what are we going to do? We have to provide medical care.”