\u02bbAIEA, Hawai\u2018i \u2014 Christian Alameda used a cane to push himself up out of bed in his cell at the Halawa Correctional Facility in Honolulu. He has been recovering in the prison\u2019s medical infirmary since a January stroke left the right side of his body mostly paralyzed.<\/p>\n
In February, Hawai\u2018i\u2019s parole board granted the now-52-year-old compassionate release, which allows prisoners to receive early probation to seek medical attention for severe conditions<\/a>.<\/p>\n But without a long-term care facility willing to accept him, Alameda has not been able to leave.<\/p>\n As of June, at least three other prisoners granted release to tend to their medical needs were living indefinitely in the infirmary after long-term care facilities were unwilling to accept them, primarily because of their criminal backgrounds, the state parole authority said.<\/p>\n \u201cThis is a challenge across the country,\u201d said Molly Crane, an attorney for FAMM, which advocates for fairness in prison policies<\/a>.<\/p>\n Every state allows compassionate release<\/a> for prisoners, though Hawai\u02bbi is the only one without a specific law, relying instead on an internal policy. The prisoners who typically qualify for compassionate release can\u2019t care for themselves or have terminal illnesses and may need an assisted living center, a nursing home, or hospice.<\/p>\n But many long-term care facilities nationwide decline to take such prisoners, leaving them incarcerated for months \u2014 or years \u2014 after they were granted release.<\/p>\n In Rhode Island<\/a>, a study found that rejections from nursing homes soared after they were told that a patient was coming from prison. In Colorado<\/a>, prisoners with extensive medical needs stayed an average of 200 days after being granted parole, because of denials from long-term care centers. And in New York<\/a>, prisoners granted parole sued the state when they couldn\u2019t get placed in nursing homes.<\/p>\n President Donald Trump\u2019s signature One Big Beautiful Bill Act further strains long-term care providers\u2019 ability to take people from incarceration. Prisoners don\u2019t qualify for Medicaid, so parolees often need to apply<\/a> after they\u2019re granted the release. The law, enacted last summer, reduces the window in which facilities can get reimbursed retroactively for new Medicaid patients<\/a> from three months to as little as 30 days<\/a> before they apply. That means facilities risk not getting paid for new Medicaid patients whose applications are not submitted within the reduced timeframe.<\/p>\n The Centers for Medicare & Medicaid Services \u201cencourages providers and beneficiaries to prioritize timely application submission to maximize coverage,\u201d CMS spokesperson Timothy Foster said.<\/p>\n \u2018Risk Is Just Too High\u2019<\/strong><\/p>\n Most nursing homes nationwide already have a waiting list for new residents, according to a 2024 report<\/a> by the American Health Care Association and the National Center for Assisted Living. Those waitlists are another hurdle to getting prisoners placed, said Bob Merce, a former attorney who advocates for prisoners\u2019 compassionate release.<\/p>\n \u201cWe tell the nursing homes that most of the people who we are talking about cannot hurt somebody,\u201d Merce said.<\/p>\n Some of the prisoners staying at the Halawa infirmary in June couldn\u2019t walk or dress themselves. One man couldn\u2019t recall what his illness was. Another with brain cancer couldn\u2019t coherently respond to questions.<\/p>\n Sean Sanada, the O\u02bbahu Region CEO with the Hawai\u02bbi Health Systems Corp., oversees the region\u2019s two state-funded long-term care facilities, Leahi Hospital and Maluhia. Sanada said that the health system has reviewed dozens of compassionate release referrals but has never accepted any of them.<\/p>\n Sanada said the facilities don\u2019t discriminate based on where the resident comes from. His main concerns, he said, were his staff\u2019s safety and the lack of resources to adequately care for the patient.<\/p>\n \u201cThe risk is just too high in most of those instances,\u201d Sanada said.<\/p>\n Violent incidents<\/a> in long-term care facilities have been well documented<\/a>. A 2024 study<\/a> observing 14 assisted living facilities found that in just one month, 15% of residents experienced resident-to-resident aggression.<\/p>\n When long-term care facilities refuse to accept prisoners who have been granted compassionate release, it leaves state taxpayers footing a larger bill. The annual cost to incarcerate an individual in Hawai\u2018i with complex needs is up to eight times the $112,505 average of housing one person in prison, according to FAMM. In comparison, the average Medicaid reimbursement for a long-term care patient at a Hawai\u02bbi Health Systems Corp. facility is about $135,000 a year<\/a>.<\/p>\n Even after being granted compassionate release, prisoners who cannot find placements at long-term care facilities can wait for months or longer in the infirmary at the Halawa Correctional Facility in Honolulu. (Ashley Mizuo\/KFF Health News)<\/p>\n Four states \u2014 Connecticut, Georgia, Massachusetts, and Vermont \u2014 contract with nursing facilities to take prisoners who are granted compassionate release, according to FAMM.<\/p>\n The iCare Health Network\u2019s MissionCare Health, which operates nursing homes for people coming out of prison, secured contracts in three of those states. David Skoczulek, iCare\u2019s vice president of business development and communication, estimated that its rates are $100 to $350 a day more per patient than the average nursing home rates in the states where they operate.<\/p>\n In Hawai\u02bbi, the correctional department determines recommendations to send to the parole board, which decides whether to grant the release. Prisoners who are granted the early probation can be released to family members who commit to caring for them or to a long-term care facility.<\/p>\n Corey Reincke, head of the Hawai\u02bbi Paroling Authority, said that in his 24-year career he couldn\u2019t recall getting anyone placed into a long-term care facility without family intervening, for instance by contacting facilities themselves.<\/p>\n \u201cParole has to find a facility that can meet their medical needs and is also willing to take them,\u201d Reincke said. \u201cThat\u2019s where we\u2019re hitting the roadblocks.\u201d<\/p>\n For one parolee, Reincke called more than 100 care homes, he said, but they all declined to accept the patient, over safety concerns. According to a 2024 state report, while Hawai\u02bbi\u2019s long-term care facilities use about 80% of their bed capacity,<\/a> workforce strains make it difficult to maintain even those levels.<\/p>\n Hawai\u02bbi Prisoners\u2019 Refuge: Family<\/strong><\/p>\n Last year, 69-year-old Paul Kupihea died at a hospital five days after the state granted him compassionate release to his family. He died before he could get on a flight to his home island.<\/p>\n In July 2025, Lahela Kruse, the mother of Kupihea\u2019s child, received a call from a Honolulu hospital informing her that his condition had become severe. By then he had been diagnosed with an incurable form of cancer and had been in and out of the hospital while still in custody.<\/p>\n Kruse and their daughter flew to O\u02bbahu to see him and were shocked when they saw how sick he was. Their daughter agreed to take him into her home in Hilo, on Hawai\u02bbi Island, despite not having a relationship with him for most of her life.<\/p>\n \u201cShe knew he was sick,\u201d Kruse said. \u201cI told her that, but she didn\u2019t know the severity of it. I didn\u2019t truly know.\u201d<\/p>\n Her daughter\u2019s willingness to take him prompted his compassionate release. But Kruse said the notification about Kupihea\u2019s illness came too late.<\/p>\n FAMM\u2019s Crane has been working on expanding compassionate release laws in states to allow for more prisoners to qualify and strengthen transparency in the process. Hawai\u02bbi lawmakers have tried for years to pass bills on compassionate release, but none has succeeded.<\/p>\n Crane said without a law that outlines a formal process and who qualifies, even family support isn\u2019t enough. Prisoners can still face life-threatening delays, she said.<\/p>\n \u201cThe absence of a compassionate release statute means that people who need compassionate release languish and even die in prison,\u201d Crane said.<\/p>\n Because Medicaid does not cover healthcare in prisons like the Halawa Correctional Facility, the high cost of care for sick prisoners is left to state taxpayers. (Ashley Mizuo\/KFF Health News)<\/p>\n In Alameda\u2019s cell, two beds stood about 3 feet apart, with a seatless metal toilet in the corner and a window looking out on a concrete wall. The smell of bleach permeated the room. Alameda said he hoped to see his daughter soon. She recently turned 5.<\/p>\n \u201cI made some mistakes in my life,\u201d said Alameda, who has been incarcerated since 2024 for drug possession, driving a stolen vehicle, and jumping bail. \u201cI tried when my daughter was born, but I know I\u2019ll change, because she needs me out of here.\u201d<\/p>\n Merce, the former attorney, is still trying to find a place for Alameda, who committed no violent crimes. Merce became aware of prisoners\u2019 struggles through his work as a trial lawyer. He said he has helped about 15 prisoners leave Hawai\u02bbi correctional facilities for medical treatment.<\/p>\n He said he\u2019s seen cases in which people have waited years to get out.<\/p>\n \u201cThe ones that stick with me, though,\u201d Merce said, \u201care the ones that I never found placements for.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This <a target=”_blank” href=”https:\/\/kffhealthnews.org\/health-industry\/sick-prisoners-compassionate-release-parole-long-term-care-hawaii\/”>article<\/a><\/a>; first appeared on <a target=”_blank” href=”https:\/\/kffhealthnews.org”>KFF<\/a> Health News<\/a> and is republished here under a <a target=”_blank” href=”https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/”>Creative<\/a> Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<img src=”https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2023\/04\/kffhealthnews-icon.png?w=150"<\/a>; style=”width:1em;height:1em;margin-left:10px;”><\/p>\n
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