Inadequate Data Collection and Cost Recovery Practices Limit Economy of Healthcare for Safekeepers (October 2018)

County inmates who are referred by county sheriffs to be temporarily housed at a state prison are known as Safekeepers. The Program Evaluation Division found that the Department of Public Safety (DPS) does not systematically collect, analyze, or report data on usage of healthcare services by Safekeepers, which prevents DPS Health Services from determining if their medical needs exceed the capabilities of county jail facilities, conducting analysis of the rationales for admissions, and calculating healthcare costs. The State can recoup state Safekeeper costs by withholding Statewide Misdemeanant Confinement Program (SMCP) payments for services provided by counties for state inmates; however, counties are not required to participate in SMCP. The General Assembly should (1) modify state law to change the per diem rate for counties that fail to reassume custody of their Safekeepers in a timely manner and direct DPS Health Services to collect additional data, update the rates charged for medical services, and require that all facilities bill counties for Safekeeper services and (2) modify state law to prohibit non-SMCP-participating counties with past-due balances from transferring Safekeepers to prisons for medical purposes and modify the process by which Safekeepers are admitted to prisons for medical purposes.

Final Report

Executive Summary


Full Presentation with Audio Narration (YouTube)

Presentation of Findings and Recommendations


Report Series Digest

Relevant Legislation:

  • Session Law 2019-171 directs DPS Health Services to maintain records of Safekeepers; specifies that the county from which a prisoner is removed for the purposes of receiving health care outside of the prison facility shall pay (1) transportation and custody costs associated with transfer at the same mileage reimbursement rate and hourly custody rate that are reimbursed pursuant to the SMCP and (2) the cost of sick call encounters at the rate charged to state prison inmates; and modifies state law related to the processes by which Safekeepers are admitted to prisons for medical or mental health purposes.