ʻAIEA, Hawai’i — Christian Alameda used a cane to stand up in his cell at the Halawa Correctional Facility in Honolulu. He has been recovering in the prison infirmary since a stroke in January left his right side largely paralyzed. In February, Hawai’i’s parole board approved his compassionate release. This program allows prisoners early probation for severe health conditions. However, without a long-term care facility willing to accept him, Alameda remains incarcerated.
As of June, three other prisoners, released on medical grounds, continued to live in the infirmary. Care facilities cited their criminal histories as the reason for rejection, according to state parole authorities. “This challenge exists nationwide,” stated Molly Crane, an attorney for FAMM, a group advocating for fairness in prison policies.
Every state offers compassionate release. Hawai’i uses an internal policy instead of a specific law. Eligible prisoners often need assisted living, nursing homes, or hospice care. Long-term care facilities across the country typically refuse these prisoners. In Rhode Island, nursing home rejections increased upon learning a patient came from prison. Colorado prisoners with serious medical needs stayed an average of 200 days post-parole due to facility refusals. In New York, some have sued when nursing homes denied them access.
The One Big Beautiful Bill Act, enacted last summer, limits Medicaid retroactive reimbursements for facilities from three months to just 30 days. This reduces financial incentives for facilities to accept parolees, said CMS spokesperson Timothy Foster, highlighting the need for timely Medicaid applications.
Many nursing homes nationwide already have waitlists, according to the American Health Care Association and the National Center for Assisted Living report in 2024. This is an additional hurdle, explained Bob Merce, a former attorney and prisoners’ advocate. “We assure the homes that most of these individuals pose no threat,” added Merce.
The Halawa infirmary, part of Hawai’i’s only medium-security state prison, has six cells often used by those granted compassionate release. Some prisoners in June couldn’t walk or dress themselves, while others had severe cognitive issues.
Ashley Mizuo of KFF Health News noted the difficulty in placing these prisoners. Sean Sanada, CEO of the Oʻahu Region of the Hawaiʻi Health Systems Corp., manages Leahi Hospital and Maluhia, two state-funded long-term care facilities. Despite reviewing several referrals, his facilities have never accepted such patients. “The risk is too high,” Sanada explained, referencing the safety concerns and inadequate resources associated with these transfers.
Violent incidents in care facilities add to this risk. A 2024 study of 14 assisted living facilities showed 15% resident aggression in a month. Refusing these prisoners transfers the financial burden back to taxpayers. FAMM stated incarcerating an individual with complex needs in Hawai’i is up to eight times costlier than the $112,505 average of housing one person in prison. Medicaid reimburses around $135,000 annually for care patients.
States like Connecticut, Georgia, Massachusetts, and Vermont contract with facilities to accept such prisoners. The iCare Health Network’s MissionCare Health has contracts in those states, with higher rates than typical facilities. In Hawai’i, parole boards determine recommendations, processing releases to either family caretakers or suitable care facilities. Corey Reincke of the Hawaiʻi Paroling Authority highlighted the difficulties of placing parolees. For one patient, Reincke called over 100 homes, all citing safety concerns as reasons for rejection.
Prisoners often rely on family. Paul Kupihea, aged 69, died last year shortly after receiving compassionate release. Despite this, notification of his severe condition came too late for a timely homecoming. His relative, Lahela Kruse, explained her daughter’s shock at Kupihea’s state despite prior warning.
Crane of FAMM emphasized expanding compassionate release laws to enhance transparency and ensure timely processes. “Without a statute, necessary releases become delayed or life-threatening,” she stated.
Alameda, serving time for non-violent offenses since 2024, expressed a desire for change, motivated by his daughter, who recently turned five. Bob Merce continues his efforts to secure placement for Alameda and similar inmates needing medical care.
KFF Health News specializes in comprehensive journalism on health issues and is part of KFF’s core operating programs, a leading source for health policy research.
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