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NDOC medical costs rise; hepatitis C treatment and statutory reimbursement changes drive budget questions
Summary
Medical administrators told legislators medical costs per offender are increasing due to greater use of outside providers and higher unit costs; the department described continuing hepatitis C treatment costs, a proposed policy change tied to NRS 209.2461 reimbursements, and a pending amendment to restore prior transfers to medical.
Russ Alfano, NDOC medical administrator, and Dr. Kenneth Williams, NDOC medical director, described rising medical expenditures at the prison system and answered legislators’ questions on treatment programs, staffing and proposed budget adjustments.
Alfano said prison medical services operate clinics and infirmaries statewide with the major regional medical facility at Northern Nevada Correctional Center. He presented long-term trends showing a moderate increase in total medical expenditures and a higher cost per offender driven by more frequent use of outside community providers and higher per-unit costs for specialty services.
On hepatitis C, Alfano said the department received a roughly $15 million class‑action settlement fund used to implement universal testing and treatment; the initial testing/treatment year cost about $9.1 million and later years were covered by remaining settlement funds as the program reached more inmates. Dr. Williams described a revolving intake population—Alfano estimated about 450 new admissions per month—and said a steady-state treatment demand remains because new entrants test positive at rates the department estimates could be roughly 40% of intake. Dr. Williams said NDOC prioritizes generic medications where clinically appropriate but noted pharmaceutical price dynamics have increased costs.
Alfano described two decision units of note: E270 would add funding for female offender health screenings (contingent upon enabling legislation) and was budgeted at approximately $145,000 in SFY 2026 and $150,000 in SFY 2027; E682 would eliminate the transfer/reimbursement mechanism that currently allows the department to recover medical costs related to injuries that qualify under statute (NRS 209.2461 subsection B). Alfano said NDOC was working with the Governor’s Finance Office to submit amendments to reverse both E270 and E682.
Legislators pressed the department for details. Senator Titus asked why hepatitis C costs would not decline after an initial treatment surge; Alfano and Dr. Williams explained that treatment was established with the settlement and that a revolving population with ongoing intake and evolving medication prices create a steady-state expense rather than a one-time drop. Dr. Williams said treatment protocols follow community clinical guidance and that some programmatic costs are ongoing as the department continues testing on intake and treating those who test positive.
On female health screening, Dr. Williams said NDOC is aligning screening and mammogram timing with community clinical guidelines (for example, standard mammography screening beginning around age 40 except where risk factors warrant earlier screening). On reimbursements, Alfano and Kitty D'Sosio described a budgeting “technical correction” and a pending Governor’s Finance Office amendment intended to restore prior practice after a misinterpretation during the budget build; Alfano emphasized that NRS 209.2461 permits the department to be reimbursed for certain qualifying medical expenditures.
Ending: NDOC requested legislative patience as the agency finalizes amendments and said it would supply additional clinical and cost breakdowns to the committee on hepatitis C treatment counts, ongoing treatment caseloads, and the fiscal effect of any statutory or administrative changes to the reimbursement mechanism.
