Even if individual county jails rely on the same third-party provider to supplement their health care services, their contracts with these providers could stipulate different levels of cost, care and coverage.
Advanced Correctional Healthcare, which contracts with roughly half of all Illinois jails as of 2024, offers varying levels of medical and mental health care depending on the size of the county. Annual increases in compensation and liability insurance are also inconsistent.
The McLean County Jail, which reported an inmate population of 179 in 2024, agreed to pay $995,979.42 to ACH in its 2022 contract renewal. This includes 168 hours of on-site nursing coverage a week and Health Services Administrator on site 40 hours a week.
However, the Sangamon County Jail, which reported 257 detainees in 2024, paid $1,029,979.11 to ACH as part of its 2022 renewal. In exchange, it would receive 168 hours of on-site nursing coverage a week and a qualified mental health professional on site 80 hours a week.
Smaller counties like DeWitt and Menard only offer an onsite registered nurse for four hours a week and a QMHP on site one or two hours a week.
Annual payment increases are written into ACH contracts based on the rolling 12-month Consumer Price Index for hospital and related services.
In McLean, payments can increase by the CPI rate or 5%, whichever is higher. But in Champaign County, the increase is based on whichever number is lower. Sangamon Countyβs contract stipulates that its annual increase will not exceed 2.75%.
ACH or its subsidiary may also maintain professional liability insurance, including civil rights liability, in the amount of $1 million per occurrence and an annual aggregate of between $2 million and $3 million.
HIPAA violations in 2025: Staff mistakes and vendor blind spots
Some contracts also stipulate that ACH maintain workersβ compensation and employerβs liability insurance covering its employees while on jail premises.
Although larger counties like McLean, Sangamon and Champaign have liability insurance written into their ACH counties, this was not included in Illinois counties with a population under 100,000.
ROCK ISLAND COUNTY
Rock Island County pays roughly $1.1 million, according to Sheriff Darren Hart, for healthcare services through ACH. The jail utilizes the Rock Island County 708 Mental Health Board for a $200,000 mental health and substance abuse services contract with Robert Young Center.
βWe want to make sure that we take care of these individuals that are in our custody,β Hart said. β...regardless of the offense, we are tasked with their care and thatβs important to us.β
Hart
The board was established as a result of Illinois House Bill 708, which enables the county to collect and allocate revenue for mental health, substance abuse and developmental disabilities for Rock Island County Citizens.
βIt helps that Robert Young and our medical provider work hand in hand together to make sure that individuals that are suffering from a mental health illness, that are maybe going through withdrawal, that need additional services that maybe we can provide here,β said Hart.
But there are still occasions where jail staff have to spend extended periods of time at the hospital waiting for inmates to receive medical services that canβt be performed at the jail or at Robert Young. Hart says they have had to provide security for several days at a time while individuals receive treatment.
βWe don't have a full 24-hour coverage with medical professionals that are here,β Martin said. βJust trying to have enough hours to cover things and enough financial resources to get people in place to cover those has been challenging.β
Martinβs deputies have to send inmates to the hospital regularly to treat HIV and AIDS, symptoms, cancer, diabetes and other health concerns. And with already slim staffing, the frequent hospital trips make things more difficult.
βIn the last month, weβve gone out to the hospital with inmates probably half a dozen times,β Martin said.
MACON COUNTY
Macon County previously had a contract with Crossing Healthcare, a local medical provider in Decatur. At the start of the COVID-19 pandemic, Crossing administrators notified the Macon County Sheriffβs Office that they would no longer be providing the jailβs medical services, according to Belcher.
βThey, by their contract, gave us a 90-day notice that they were leaving,β Belcher said. βWe had to hurry up and try to find somebody to provide medical services.β The county continued to work with Crossing in a smaller capacity through programs offered to help transition inmates back into society.
The Macon County Board approved in the 2024 budget a $1.3 million contract with Alabama-based company Quality Correctional Health Care for medical services including pharmaceutical needs and 24/7 staff. But the jail does not currently have staff onsite 24/7.
The jail operates with nine nurses, one doctor and one nurse practitioner. Of those, eight are LPNS, which are responsible for basic patient care and comfort. The jailβs health services administrator is also an RN.
Nurses are available 24 hours per day, 4 days per week and from 6 a.m. to 11 p.m. or midnight during the other three days. However, finding more medical employees remains a challenge.
U.S. States That Spend the Most on Health and Hospitals
U.S. States That Spend the Most on Health and Hospitals
Photo Credit: Monkey Business Images / Shutterstock
The challenges facing the healthcare sector in the U.S. are numerous. The U.S. lags behind other developed nations on many key metrics of health, including life expectancy, chronic disease burden, and avoidable deaths. The population has been growing older on average with the aging of the Baby Boomers, creating increased demand for health services. Longtime public health challenges like obesity, substance abuse, and mental illness have wide-ranging impacts on Americansβ overall health and well-being. And in the last few years, the COVID-19 pandemic has placed unusually heavy strain on healthcare providers and hospitals.
With these many interlocking and compounding challenges, the U.S. spends heavily to support the healthcare system. According to federal data, national health expenditures in the U.S. total $4.1 trillion per year, making up nearly 20% of the nationβs GDP. The bulk of this spending comes from the federal government, which contributes 36.3% of expenditures, and U.S. households, which account for 26.1%.
Often underappreciated in discussions of the U.S. health system is the role of state and local governments. States and localities frequently fund public hospitals, health inspections, mental health and substance abuse programs, water and air quality programs, and payments to private hospitals for public health services. State and local governments funded 14.3% of total national health expenditures in 2020.
Health and hospital spending accounts for nearly 10 percent of state and local government budgets
This spending is one of the most significant budgetary responsibilities of state and local governments. Health and hospitals represent the third largest spending category for state and local governments, behind only public welfare and elementary and secondary education. Collectively, governments spend $345 billion on health and hospitals each year, accounting for nearly 10% of all state and local spending.
Health and hospital spending per capita is up over 50 percent
State and local spending on health and hospitals on a per-capita basis has also grown over time. In the year 2000, state and local governments spent $678 per capita on health and hospitals in inflation-adjusted dollars. By 2020, that figure had risen to $1,040βan increase of more than 50%.
Vermont and Utah saw the largest increases in health and hospital spending over the past decade
However, this trend has not played out the same in all locations. In fact, 13 states have seen a decline in health and hospital spending per capita over the last decade, led by Arizona, where spending has declined by more than 50%. In contrast, other states have seen rapid growth in health spending. Vermontβs inflation-adjusted state and local spending per capita more than doubled between 2010 and 2020, from $355 to $730, and Utahβs 96.2% rate of growth was not far behind.
Just as trends in health spending have varied by geography, total spending also looks different from state to state. Nationwide, states and localities spend around 9.9% of their budgets on health and hospitals, at a total of $1,047 per capita. But a number of states and localities spend well above these figures, including Wyoming, where the per-capita spending is nearly triple the national average, and South Carolina, where health and hospital spending represents nearly 20% of state and local expenditures.
The data used in this analysis is from the U.S. Census Bureau. To determine the states that spend the most on health and hospitals, researchers at HowtoHome.com calculated health and hospital spending as a share of total spending. In the event of a tie, the state with the greater total health and hospital spending per capita was ranked higher.
Here are the states that spend the most on health and hospitals.
15. Indiana
Photo Credit: Agnieszka Gaul / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $999
- Total health & hospital spending: $6,747,518,000
- Total direct expenditures: $62,806,487,000
14. Virginia
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $1,061
- Total health & hospital spending: $9,112,433,000
- Total direct expenditures: $85,243,956,000
13. Michigan
Photo Credit: Photosbykaity / Shutterstock
- Health & hospital spending as a share of total: 11.2%
- Total health & hospital spending per capita: $1,078
- Total health & hospital spending: $10,748,283,000
- Total direct expenditures: $95,700,844,000
12. Texas
Photo Credit: Roschetzky Photography / Shutterstock
- Health & hospital spending as a share of total: 11.3%
- Total health & hospital spending per capita: $1,013
- Total health & hospital spending: $29,753,376,000
- Total direct expenditures: $263,279,685,000
11. California
Photo Credit: Andriy Blokhin / Shutterstock
- Health & hospital spending as a share of total: 12.2%
- Total health & hospital spending per capita: $1,677
- Total health & hospital spending: $66,029,051,000
- Total direct expenditures: $541,102,413,000
10. Utah
Photo Credit: photo.ua / Shutterstock
- Health & hospital spending as a share of total: 12.8%
- Total health & hospital spending per capita: $1,289
- Total health & hospital spending: $4,190,560,000
- Total direct expenditures: $32,812,538,000
9. Iowa
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,557
- Total health & hospital spending: $4,925,808,000
- Total direct expenditures: $35,283,924,000
8. Washington
Photo Credit: mahaloshine / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,623
- Total health & hospital spending: $12,487,009,000
- Total direct expenditures: $89,455,201,000
7. Missouri
Photo Credit: picsbyst / Shutterstock
- Health & hospital spending as a share of total: 14.2%
- Total health & hospital spending per capita: $1,208
- Total health & hospital spending: $7,431,898,000
- Total direct expenditures: $52,380,770,000
6. Kansas
Photo Credit: Henryk Sadura / Shutterstock
- Health & hospital spending as a share of total: 15.5%
- Total health & hospital spending per capita: $1,561
- Total health & hospital spending: $4,548,137,000
- Total direct expenditures: $29,333,928,000
5. Mississippi
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 17.1%
- Total health & hospital spending per capita: $1,597
- Total health & hospital spending: $4,736,972,000
- Total direct expenditures: $27,688,049,000
4. Alabama
Photo Credit: Rob Hainer / Shutterstock
- Health & hospital spending as a share of total: 18.7%
- Total health & hospital spending per capita: $1,687
- Total health & hospital spending: $8,302,347,000
- Total direct expenditures: $44,406,818,000
3. North Carolina
Photo Credit: Jon Bilous / Shutterstock
- Health & hospital spending as a share of total: 18.8%
- Total health & hospital spending per capita: $1,665
- Total health & hospital spending: $17,650,732,000
- Total direct expenditures: $93,667,411,000
2. Wyoming
Photo Credit: Jacob Boomsma / Shutterstock
- Health & hospital spending as a share of total: 18.9%
- Total health & hospital spending per capita: $2,936
- Total health & hospital spending: $1,709,488,000
- Total direct expenditures: $9,029,287,000
1. South Carolina
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 19.3%
- Total health & hospital spending per capita: $1,787
- Total health & hospital spending: $9,326,575,000
- Total direct expenditures: $48,273,596,000
U.S. States That Spend the Most on Health and Hospitals
Photo Credit: Monkey Business Images / Shutterstock
The challenges facing the healthcare sector in the U.S. are numerous. The U.S. lags behind other developed nations on many key metrics of health, including life expectancy, chronic disease burden, and avoidable deaths. The population has been growing older on average with the aging of the Baby Boomers, creating increased demand for health services. Longtime public health challenges like obesity, substance abuse, and mental illness have wide-ranging impacts on Americansβ overall health and well-being. And in the last few years, the COVID-19 pandemic has placed unusually heavy strain on healthcare providers and hospitals.
With these many interlocking and compounding challenges, the U.S. spends heavily to support the healthcare system. According to federal data, national health expenditures in the U.S. total $4.1 trillion per year, making up nearly 20% of the nationβs GDP. The bulk of this spending comes from the federal government, which contributes 36.3% of expenditures, and U.S. households, which account for 26.1%.
Often underappreciated in discussions of the U.S. health system is the role of state and local governments. States and localities frequently fund public hospitals, health inspections, mental health and substance abuse programs, water and air quality programs, and payments to private hospitals for public health services. State and local governments funded 14.3% of total national health expenditures in 2020.
Health and hospital spending accounts for nearly 10 percent of state and local government budgets
This spending is one of the most significant budgetary responsibilities of state and local governments. Health and hospitals represent the third largest spending category for state and local governments, behind only public welfare and elementary and secondary education. Collectively, governments spend $345 billion on health and hospitals each year, accounting for nearly 10% of all state and local spending.
Health and hospital spending per capita is up over 50 percent
State and local spending on health and hospitals on a per-capita basis has also grown over time. In the year 2000, state and local governments spent $678 per capita on health and hospitals in inflation-adjusted dollars. By 2020, that figure had risen to $1,040βan increase of more than 50%.
Vermont and Utah saw the largest increases in health and hospital spending over the past decade
However, this trend has not played out the same in all locations. In fact, 13 states have seen a decline in health and hospital spending per capita over the last decade, led by Arizona, where spending has declined by more than 50%. In contrast, other states have seen rapid growth in health spending. Vermontβs inflation-adjusted state and local spending per capita more than doubled between 2010 and 2020, from $355 to $730, and Utahβs 96.2% rate of growth was not far behind.
Just as trends in health spending have varied by geography, total spending also looks different from state to state. Nationwide, states and localities spend around 9.9% of their budgets on health and hospitals, at a total of $1,047 per capita. But a number of states and localities spend well above these figures, including Wyoming, where the per-capita spending is nearly triple the national average, and South Carolina, where health and hospital spending represents nearly 20% of state and local expenditures.
The data used in this analysis is from the U.S. Census Bureau. To determine the states that spend the most on health and hospitals, researchers at HowtoHome.com calculated health and hospital spending as a share of total spending. In the event of a tie, the state with the greater total health and hospital spending per capita was ranked higher.
Here are the states that spend the most on health and hospitals.
15. Indiana
Photo Credit: Agnieszka Gaul / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $999
- Total health & hospital spending: $6,747,518,000
- Total direct expenditures: $62,806,487,000
14. Virginia
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $1,061
- Total health & hospital spending: $9,112,433,000
- Total direct expenditures: $85,243,956,000
13. Michigan
Photo Credit: Photosbykaity / Shutterstock
- Health & hospital spending as a share of total: 11.2%
- Total health & hospital spending per capita: $1,078
- Total health & hospital spending: $10,748,283,000
- Total direct expenditures: $95,700,844,000
12. Texas
Photo Credit: Roschetzky Photography / Shutterstock
- Health & hospital spending as a share of total: 11.3%
- Total health & hospital spending per capita: $1,013
- Total health & hospital spending: $29,753,376,000
- Total direct expenditures: $263,279,685,000
11. California
Photo Credit: Andriy Blokhin / Shutterstock
- Health & hospital spending as a share of total: 12.2%
- Total health & hospital spending per capita: $1,677
- Total health & hospital spending: $66,029,051,000
- Total direct expenditures: $541,102,413,000
10. Utah
Photo Credit: photo.ua / Shutterstock
- Health & hospital spending as a share of total: 12.8%
- Total health & hospital spending per capita: $1,289
- Total health & hospital spending: $4,190,560,000
- Total direct expenditures: $32,812,538,000
9. Iowa
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,557
- Total health & hospital spending: $4,925,808,000
- Total direct expenditures: $35,283,924,000
8. Washington
Photo Credit: mahaloshine / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,623
- Total health & hospital spending: $12,487,009,000
- Total direct expenditures: $89,455,201,000
7. Missouri
Photo Credit: picsbyst / Shutterstock
- Health & hospital spending as a share of total: 14.2%
- Total health & hospital spending per capita: $1,208
- Total health & hospital spending: $7,431,898,000
- Total direct expenditures: $52,380,770,000
6. Kansas
Photo Credit: Henryk Sadura / Shutterstock
- Health & hospital spending as a share of total: 15.5%
- Total health & hospital spending per capita: $1,561
- Total health & hospital spending: $4,548,137,000
- Total direct expenditures: $29,333,928,000
5. Mississippi
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 17.1%
- Total health & hospital spending per capita: $1,597
- Total health & hospital spending: $4,736,972,000
- Total direct expenditures: $27,688,049,000
4. Alabama
Photo Credit: Rob Hainer / Shutterstock
- Health & hospital spending as a share of total: 18.7%
- Total health & hospital spending per capita: $1,687
- Total health & hospital spending: $8,302,347,000
- Total direct expenditures: $44,406,818,000
3. North Carolina
Photo Credit: Jon Bilous / Shutterstock
- Health & hospital spending as a share of total: 18.8%
- Total health & hospital spending per capita: $1,665
- Total health & hospital spending: $17,650,732,000
- Total direct expenditures: $93,667,411,000
2. Wyoming
Photo Credit: Jacob Boomsma / Shutterstock
- Health & hospital spending as a share of total: 18.9%
- Total health & hospital spending per capita: $2,936
- Total health & hospital spending: $1,709,488,000
- Total direct expenditures: $9,029,287,000
1. South Carolina
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 19.3%
- Total health & hospital spending per capita: $1,787
- Total health & hospital spending: $9,326,575,000
- Total direct expenditures: $48,273,596,000
