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| Shawn Weneta is the Director of Government Affairs at Cavalier Consulting in Richmond and previously held policy positions with the ACLU of Virginia and REFORM Alliance. |
Virginia is walking straight into a prison health care funding crisis, not because the problem is new, but because we have spent nearly a decade studying it, acknowledging it, and then doing almost nothing.
In 2017, the Joint Legislative Audit and Review Commission warned the General Assembly that prison health care costs were on a collision course with Virginia’s budget, driven by an aging prison population, chronic disease, and the uniquely high cost of delivering care behind bars. JLARC offered clear recommendations to avoid this outcome.
Eight years later, the warnings have largely been ignored, and the bill is coming due.
VADOC medical spending has blown past appropriations in consecutive years, overrunning the budget by $25.8 million in FY2024 and $23.7 million in FY2025. Annual medical costs now total $294.4 million, consuming more than 18% of the entire corrections budget and growing faster than any other expense.
This is not a management problem at the margins; it is structural.
Virginia now pays $1.3 million every week, more than $67 million a year, for offsite medical care alone, delivered under guard with transportation, security staffing and legal risk layered on top.
And the cost concentration is staggering. Just two incarcerated individuals are each costing Virginia more than $1 million per year in medication alone, illustrating how quickly a handful of high-acuity cases can overwhelm an already strained system.
Even more alarming, spending growth is now outpacing health care inflation itself. Senate finance staff found that VADOC’s medical expenditures exceeded inflation-adjusted projections in both fiscal year 2024 and fiscal year 2025, meaning cost growth is accelerating, not stabilizing.
Meanwhile, the consequences are rippling through the system. To cover medical overruns, DOC has diverted funds from security operations and facility maintenance and imposed a partial hiring freeze. In plain terms, Virginia is funding prison health care by short-staffing prisons, a trade-off that raises safety risks for staff and incarcerated people alike.
And yet, the worst is still ahead.
Virginia’s prison population is aging rapidly. People over 50 now make up less than a quarter of the prison population but account for 61% of all medical costs. The average annual medical cost for someone over 55 is more than $70,000 per year, driven by cancer treatment, dialysis, cardiac care, dementia and end-of-life services.
This demographic shift is locked in. Over the next several years, more than 12,000 incarcerated people will age into the highest-cost brackets. No amount of contract renegotiation or staffing tweaks will change the basic math: prisons are becoming de facto nursing homes, and the most expensive ones taxpayers could possibly operate.
If current trends hold, and recent data suggests they are worsening, Virginia is on track to spend well over $4 billion on prison health care over the next decade. That figure assumes continued annual growth similar to the past five years and does not account for emerging cost drivers like new specialty pharmaceuticals, expanding opioid-use disorder treatment mandates, or rising contract labor costs.
To put it plainly: prison health care alone is on a trajectory to rival major statewide education or transportation programs, without any dedicated revenue stream to support it.
At that scale, the question is no longer whether prison health care will crowd out other priorities, but when. If left unaddressed, these costs could force lawmakers to consider tapping Virginia’s rainy day fund, not because of a recession or natural disaster, but because we failed to act on a known, documented and foreseeable budget risk.
What makes this moment especially troubling is how little progress has been made since JLARC sounded the alarm. Many of the commission’s 2017 recommendations remain unimplemented or only partially explored.
Other states have moved aggressively to reduce costs by treating people in less restrictive, less expensive environments when public safety allows. Virginia has largely continued doing what it has always done: treating aging, chronically ill people inside prisons long after incarceration is the costliest and least effective option.
According to a new study, if current trends continue, as much as one-third of the U.S. prison population will be over 50 by 2030.
Returning people home, under supervision, with medical coverage shifted to Medicaid or Medicare, is not a silver bullet. But it is one of the few tools that actually changes the cost structure rather than rearranging it. Every person safely treated in the community is one fewer six-figure line item in the DOC medical ledger.
Virginia’s prison health care crisis is no longer theoretical. The costs are real, rising faster than expected, and already undermining the core functions of the corrections system. We were warned in 2017. We confirmed the warnings in 2024 and 2025.
The silver tsunami is coming. The bill is already arriving. And the longer we wait, the fewer responsible options remain.
If Virginia is serious about fiscal stewardship, affordability, and making government work, we must confront this crisis now, before prison health care becomes the budget emergency we pretend no one could have seen coming.
Harrisonburg's Daily News-Record publishes a monthly Justice Matters column provided by the Valley Justice Coalition. Shawn Weneta was a great help in getting the HB1030 parole reform bill passed that Delegate Wilt sponsored on our behalf.
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