Prison health care costs up significantly as Minnesota’s incarcerated population ages

At Minnesota’s most secure prison, in Oak Park Heights, one wing functions more like a nursing home than a cell block. Men in hospital gowns sleep in adjustable medical beds, and wheelchairs crowd the hallways as nurses make quiet rounds. Board games clutter bookshelves on the second floor of the unit.

Minnesotans in prison are growing old — fast. Nearly 1 in 5 people incarcerated in the state is over 50, a figure that’s more than tripled since 1999. The oldest is 93. Thirteen others are in their 80s.

A decade ago, Minnesota ranked among the states with the highest annual per-capita prison health care costs. Those costs have more than doubled, to $16,273, since then. Prison health care costs have increased 45% in the past three years.

As the overall population ages, so do the people behind bars. Harsh sentencing laws from past decades also contribute to the aging population.

“Aging is costly, and it exists whether they’re here or in the community — it just depends on what source is the payment," said Jolene Rebertus, director of health care, recovery and programming at the Minnesota Department of Corrections (DOC). “We are obligated to provide the care regardless.”

About 1 in 6 Americans was 65 or older in 2020 — up from less than 1 in 20 a century earlier, according to 2020 census data. In Minnesota, the trend is even more pronounced: The Minnesota State Demographic Center projects the number of adults 65 and older will double between 2010 and 2030, meaning 1 in 5 Minnesotans will soon be an older adult.

The changing prison demographics have placed intense pressure on a system ill-equipped to manage chronic illness, geriatric care and end-of-life services.

Overall, health care spending for the DOC totaled more than $134 million in 2025 — up from $93 million just three years ago. The budget for fiscal year 2026 is $146 million.

Incarcerated Minnesotans who are 60 and older make up a significantly larger portion of medical referrals than younger age groups, contributing to the fast rise in costs. Medicare and Medicaid rarely pay for the medical care people receive in prison.

Christopher Uggen, a University of Minnesota sociology professor who has written a book on health in prison, said the aging incarcerated population is a fallout from established mandatory minimum sentences, “three strikes” laws, and laws that reduced parole eligibility and mandated life without the possibility of parole for certain offenses from the 1970s through 1990s.

“While no one thought about what it would cost to house this guy well into his 60s and 70s, that bill is now coming due,” said Len Engel, the director of policy and campaigns at the Crime and Justice Institute.

Some prisoners worry the changes are not coming quickly enough.

To Keith Simmons, 71, who spent the past three decades at Stillwater on a life sentence, the prison’s health care is “mediocre at best.” He uses both a wheelchair and a cane to manage arthritis that’s spread through his spine “like a vine.”

Bowers looked out at the yard on an August morning and counted 25 people in wheelchairs, noting the large number of elderly individuals at the facility.

Rebertus said her department — like corrections systems nationwide — lacks the “resources to care for our aging population.”

“We are working on multidisciplinary teams on the regular, trying to figure out how best to serve those who are aging and at multiple stages in aging,” she said.

At 93, Lester Lindquist is the oldest inmate in Minnesota’s prison system. He is serving time at Faribault, convicted of second-degree criminal sexual conduct.

“Prisons aren’t built for old people,” he said.

A Korean War veteran, Lindquist turns to poetry to make sense of his past. He keeps a thick binder close by, filled with poems he began writing after returning from the war in 1955, when he was 24. He will turn 94 on Sept. 28.

“We’re seeing a lot more chronic conditions coming in, a lot less individuals with health care on the outside,” said Kristin Grunewaldt, a registered nurse care coordinator who works in the TCU.

While acknowledging that caring for geriatric inmates carries “significant costs,” Republican state Sen. Warren Limmer, the ranking minority member on the judiciary and public safety committee, said the DOC has consistently absorbed those expenses. He emphasized that the department is legally bound to provide health care to all inmates, regardless of cost.

“I have not heard any alarm from DOC regarding whether or not they have enough money,” he said. “We seem to keep meeting rising expenditures at DOC.”

Rebertus said the department discusses geriatric care internally “constantly” and has met with the Minnesota Department of Health Services many times regarding the aging incarcerated population.

Inmates receive health care from both state employees and contracted vendors in a hybrid model, she said. The department’s main contractor is Centurion Health, which provides medical care like physician and psychiatric visits. Centurion, in turn, contracts with outside providers.

Still, “the quality of care is erratic,” said Uggen, the U professor.

Older incarcerated people pose significantly less risk to public safety than younger individuals, according to a report from the U.S. Department of Justice’s Bureau of Justice Statistics. If the likelihood of reoffending drops significantly with age, should some geriatric inmates be given earlier release?

Uggen says yes. So does Bradford Colbert, a law professor at Mitchell Hamline School of Law and a public defender, who said keeping people who are seniors and medically fragile is “purely for retribution” if they are not a threat to public safety.

Republican Rep. Walter Hudson, who last session introduced a bill to toughen penalties for repeat offenders, said he backs a stricter approach to sentencing but is open to “reforms that make both fiscal and criminal justice sense.” If someone is so ill they pose little threat and could be treated more affordably outside prison, “that’s something I’d be willing to consider, because it makes sense on two fronts.”

Limmer, who is on the public safety committee, said he thinks it is a “case-by-case” issue when it comes to releasing older inmates in Minnesota.

“If someone is just moving from a prison due to, let’s say, Alzheimer’s and moving to a nursing home, I don’t think the threat is that severe,” he said. “But ... even someone who’s 80 years old who’s been in for, let’s say, a sexual assault case, and they’re considered predatory — there are times when age has nothing to do with their behavior. They still will look for opportunities to assault someone."

Nationally, compassionate release, the process allowing incarcerated people to seek early release due to extraordinary or compelling circumstances such as terminal illness or old age, remains limited despite recent reforms.

In the first quarter of 2025, an average of just 13% of people who filed compassionate release motions nationwide were granted them. In Minnesota, just four of 36 applicants were approved.

As the costs go up and more inmates age, Minnesota will have to continue to assess both compassionate release and health care policies.

The Minnesota Rehabilitation and Reinvestment Act (MRRA), passed by the Legislature in 2023, offers inmates an opportunity to reduce their sentences by completing individualized rehabilitation programs. However, DOC officials said it could take up to two years to establish the system fully, and it is still not in place.

Limmer said he hopes the MRRA could generate “cost savings to other areas of corrections,” which could then be used for health care.

Ultimately, it will be an issue for the Legislature, said Vanessa Thompson, senior policy and campaign specialist at the Crime and Justice Institute.