Elizabeth Foy, chief of staff for the Tennessee Department of Correction, told the Fiscal Review Committee that the department is statutorily required to provide medical and mental-health services to all people in its custody and now oversees care for just over 20,000 individuals.

"The department is statutorily required to provide health care to all individuals in our custody," Foy said, summarizing intake screening, sick-call access, chronic-care clinics, infirmaries and inpatient hospitalization available to incarcerated people.

Assistant Commissioner Jillian Bresnahan, who oversees clinical services, said the system is handling increasing demand and cost pressures. She told members pharmacy utilization rose 5.4% since 2023 and that average pharmacy costs have increased as much as 33.2% in the last year. The department reported that 55.4% of inmates are enrolled in chronic-care clinics and that almost 16% of inmates are infected or reinfected with hepatitis C.

"Treatment utilization for hepatitis C includes 12 weeks of treatment on average," Bresnahan said, adding that those courses can cost between $16,000 and $52,000 depending on the medication.

Committee members pressed the department on how it is preparing for long-term costs tied to an aging prison population and changes in sentencing law. Representative Mike Dixie asked what steps TDOC is taking to avoid higher future costs as more people serve longer terms. Foy and Bresnahan said the department is focusing on early diagnosis during intake, annual reviews, standardized chronic-care protocols and increased use of telehealth and in-prison treatment to avoid more-expensive outpatient care.

Representative Dixie: "How are we preparing to handle those costs of an aging population knowing that it's going to happen?"

Bresnahan: "By investing early when people come into the department's care ... and using robust measurements to anticipate what our population will be in the long run."

Representative John Bricken asked whether Tennessee's participation in a purchasing consortium could be subsidizing other states and whether Tennessee's incarcerated population is sicker than the national average. Foy said she would follow up with comparative data.

Foy also clarified the department's understanding of Medicare eligibility: inmates are prohibited from participating in Medicare while incarcerated; a person would only be eligible for Medicare once they no longer reside in prison, she said.

After the presentation and questioning, the committee voted to approve the corrections contract presented at the meeting.

Why it matters: Committee members said the cost trends and demographic changes suggest higher future state expenditures for inmate care. Lawmakers asked for comparative price information and other data to determine whether Tennessee's procurement and purchasing arrangements remain cost-effective.

What to watch: The department agreed to provide comparative data on Tennessee's per-patient costs versus national averages and to return with additional information requested by legislators.