A deadline is looming at the end of the year for Maryland to decide whether to keep or replace the troubled, for-profit company that provides medical care in state prisons and the Baltimore City jail complex.

For the past five years, a company formerly known as Corizon Health has been responsible for treating more than 15,000 people incarcerated in state prisons and about 2,000 people being held in the city jails and other pretrial facilities in Baltimore.

The company has been paid hundreds of millions of dollars, even as its care for people in state prisons and the city jail complex has come under fire from an independent monitor and dozens of prisoners who have filed lawsuits over medical malpractice.

YesCare is a spinoff of what used to be Corizon Health, which split into two companies as part of a highly controversial bankruptcy earlier this year. A group of nine U.S. senators described the restructuring as a misuse of the bankruptcy system in order to evade paying millions of dollars owed to hundreds of formerly and currently incarcerated people who sued over medical care.

YesCare’s contract to provide correctional health care in Maryland expires on Dec. 31 and while the state is promising to award new contracts by then, it’s unclear if the deadline can be met.

“The medical and mental healthcare contracts awards are the Department’s highest procurement priority and we will work thoroughly and expeditiously to ensure the new contracts meet all procurement, medical, and legal provisions under the Department’s purview,” wrote Morgan A. Wright, a spokesman for the state Department of Public Safety and Correctional Services, in a statement in response to questions from The Baltimore Banner.

Unlike the current contract structure, the state plans to award two separate deals: One for the prisons scattered across the state, and another for the jail and pre-trial complex in Baltimore. The contracts also seek providers that can offer both medical care and mental health care, as opposed to separating those out for different providers as they do now.

Just two weeks ago, the state issued a more than 200-page request for proposals from health care companies to provide both medical care and mental health care for up to seven years. There’s a Dec. 27 deadline for vendors to respond.

The city jails contract is on a quicker timeline, with an RFP issued in October that requires companies to respond by Dec. 4.

Those timelines leave very little time for state officials to review the bids from vendors and recommend a winner. The contracts ultimately will need approval from the state Board of Public Works, which has just one meeting scheduled in December, on the 13th.

State Sen. Mike McKay, who has state prisons in his Western Maryland district, said he’s concerned about the tight timeline for awarding such a massive and expensive contract.

The last correctional medical care contract, awarded to Corizon in 2018, was for $680 million over five years. With inflation, a longer contract term and more services covered, the new statewide contract could be significantly more expensive.

“It is such a large contract that you’ve got to give those who are willing to sharpen their pencil and put forth a good application time to do that,” said McKay, a Republican.

McKay said that when YesCare has to take incarcerated people off prison grounds for specialized medical care, the company has been slow to pay ambulance companies and treatment providers. And during the height of the pandemic, the company sought a huge influx of additional money from the state with little justification.

“I don’t think I could give them a letter of recommendation,” McKay said. “Why the State of Maryland put ourselves in such a predicament, and why the department would put the Board of Public Works in such a predicament, I just don’t understand.”

The government has a legal — and some argue, moral — obligation to provide adequate health care to incarcerated people under the U.S. Constitution’s Eighth Amendment protection against cruel and unusual punishment.

Additionally, the quality of medical care in the Baltimore jail complex is under court oversight as part of decadeslong litigation known as the Duvall case.

Comptroller Brooke Lierman, one of three members of the Board of Public Works, declined to comment specifically on the contracting process.

But the Democratic comptroller’s spokeswoman, Robyne McCullough, said in a statement that Lierman “believes that every Marylander, including those who are incarcerated, deserves access to quality medical care.”

“It is the responsibility of the state to ensure agencies are contracting for quality services, especially for vulnerable populations, and that those contracts deliver the best value for Maryland taxpayers,” the statement said.

Another Board of Public Works member, Democratic Treasurer Dereck Davis, declined to comment.

A spokesman for Gov. Wes Moore, a Democrat who is the third member of the board and whose administration oversees the correctional department, said the contracting process started under the prior administration of Gov. Larry Hogan.

“The Moore-Miller Administration has worked diligently to ensure that the solicitations for these services are released without further delay,” Moore spokesman Carter Elliott IV said in a statement.

Moore took office 10 months ago, in January.

The Moore administration “looks forward” to presenting a contract once the procurement process is complete, Elliott said. “Until then, the Administration will take all necessary measures to ensure that these vital services do not lapse,” the statement said.

Extension possible

If the new contract isn’t awarded and in place by Dec. 31, the state says it will take steps to have YesCare continue to provide medical care to incarcerated individuals.

How that would work wasn’t immediately clear. Wright, the spokesperson for the state corrections department, did not directly answer questions about the legal and contractual ability of the state to continue with YesCare past Dec. 31.

If the contract isn’t awarded by then, Wright wrote, “the State will ensure continuity of service using the process allowed in the current contract and the provisions of the procurement law.”

An extension of YesCare’s responsibility could stretch for an undetermined amount of time, as state officials anticipate the award of a new contract could get tied up in appeals and lawsuits. That’s exactly what happened the last time such a contract was awarded, when rival companies duked it out for more than a year before YesCare’s predecessor Corizon finally was awarded the contract.

“We are aware of the potential for vendor protests during the solicitation process, which could extend the award timeline,” said Wright, the state spokesman. “Even so, the Department is committed to ensuring that its incarcerated population has no lapse in care, regardless of the contract award process status.”

Only a handful of companies are in the business of providing health care for incarcerated individuals. It’s not clear how many of them will bid on either contract.

YesCare did not respond to a request for comment.

Neither did Centurion Health, which currently provides mental health care in Maryland’s prisons and the Baltimore pretrial complex and tried to win the medical care contract several years ago.

Wexford Health Sources, which used to have the medical contract but lost out five years ago, is weighing whether to bid, according to the company’s lobbyist.

“As the previous vendor, they are very interested in and desirous of bidding again on the state contract,” said Wexford’s lobbyist, Bruce Bereano. He said the company would carefully review the details of the request for proposals.

Improving collaboration

The new proposed contracts are designed to improve the care that’s provided to incarcerated people, according to the state spokesman.

The city jail complex is being split into its own contract separate from the state prisons because the needs of people incarcerated for shorter periods of time while awaiting trial often are “vastly different” from those spending years or decades in prisons, according to Wright, the state spokesman.

And having one provider responsible for both medical care for illness and injury and mental health care will aid in “removing potential barriers to the collaboration of medical and mental health,” Wright said.

One prisoners’ rights attorney who routinely tangles with the correction department over health care delivery in Baltimore jails said she appreciated those changes to how the new contracts will be structured.

Corene Kendrick, an attorney for the American Civil Liberties Union’s National Prison Project, said the jail system should indeed be separated from the prison contract. Combining the medical and mental health contracts under a unified provider, she added, was another improvement.

Kendrick said many of the patients in the jail have complex medical and mental health needs. With two separate providers, issues often arise such as delivering psychiatric medication, since that responsibility falls under the medical provider, she said.

“Sometimes you need this sort of interdisciplinary collaboration and treatment plan,” Kendrick said.

As for the crowded timeline, Kendrick said she anticipated seeing an extension of the medical provider YesCare. She questioned why the corrections department was not more concerned about the company’s legal history, having been spun off from a different entity as part of a controversial bankruptcy process known as the “Texas two-step” earlier this year.

Wright, the state spokesperson, said: “The DPSCS legal team is aware of the company’s issues and continues to closely monitor this situation.”