To give more seriously ill incarcerated people the opportunity to go home before they die, North Carolina lawmakers expanded the eligibility criteria of prison medical release in 2023. But data obtained by NC Health News shows that more people aren’t getting released.
Since 2008, medical release had been narrowly available for old or sick incarcerated people on several grounds. The original policy required that an incarcerated person must be so sick that they were likely to die within six months, have a condition that made them “permanently and totally disabled” or were at least 65 years old with a chronic, debilitating disease related to aging.
Everyone granted release also had to be deemed to “not pose a safety risk.”
The 2023 changes rolled back the eligibility age for “geriatric” medical release to age 55, expanded the timeframe for risk of death from a terminal illness to nine months, and decreased the risk standard guiding all releases. The new guideline says that people must pose “no risk or low risk” to public safety.
Advocates had hoped the changes would result in more incarcerated people being granted medical release — what they say would be a “win-win” for families and the North Carolina prison system.
“The person gets to be with their loved ones and in their communities during their last time on this earth, and [the Department of Adult Correction] has a good way to lower their medical costs and also see those sort of knock-on effects of fewer of these high care, high needs patients that have to be looked after,” said Luke Woollard, an attorney at Disability Rights NC who specializes in defending the rights of people with disabilities who are incarcerated. “It frees up not just financial resources, but also staffing resources and medical resources to care for the rest of the population that are in their custody.”
However, since the eligibility changes nearly two years ago, medical release is infrequently granted.
In 2024 — the first full year with the new eligibility criteria — the North Carolina Post-Release Supervision and Parole Commission granted early medical release to four people out of a total statewide prison population of about 32,000 people. So far this year, five people have been released, according to data provided to NC Health News by the Department of Adult Correction.
For advocates of early medical release, these numbers feel “disappointingly low.” They point to analysis that shows older people are less likely to commit crimes, and releasing them is one way to cut down on North Carolina’s ballooning prison medical costs.
“People who are sick and dying, who are simultaneously the lowest risk and the highest cost burden to the state, should be released,” said Molly Crane, a fellow focused on reforming compassionate release from prison at the national nonprofit FAMM, which aims to “create a more fair and effective justice system.”
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The N.C. Department of Adult Correction contends that early medical release is being used to its fullest extent and is supportive of granting release to individuals who meet the eligibility criteria.
“It’s great for the patients, it’s great for the family,” said Arthur Campbell, chief of Comprehensive Health Services at the Department of Adult Correction, who is involved in medical release decisions. “I think it’s a great program, and we are fully supportive.”
However, he said that the policy changes in 2023 don’t grant much more eligibility because the medical criteria remained unchanged.
“When the statute changed, it didn't substantially make a difference because of the ultimate determination of either incapacitation or debilitation,” Campbell said. “Because of that threshold, it really didn't significantly change the cases that we have.”
How medical release works
The Department of Adult Correction receives referrals for medical release from individuals themselves, family members, attorneys and advocacy groups. The Department of Adult Correction’s own staff also refers people they believe may qualify, Campbell said.
“We want multiple inputs into this process, so that we try to do our best to capture everyone who may qualify,” Campbell said.
Of the 465 referrals the Department of Adult Correction has received from January 2019 to Aug. 7, 2025, 179 cases or nearly 40 percent have been rejected for failing to meet conviction eligibility. Individuals convicted of class A, B1 and B2 felonies, such as first-degree murder, second-degree murder, death by distribution of certain controlled substances, or for an offense that requires placement on the sex offender registry are ineligible for release under the law.
Another third of medical release referrals received since 2019 have been ruled to not meet the medical criteria, according to analysis of medical release data provided to NC Health News.
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The medical criteria outlined in the law is broad, requiring that someone be “medically incapacitated” or have "permanent and irreversible physical incapacitation,” but do not further define the level of impairment.
Crane, who has studied compassionate release policies across the country, said many states define “incapacitation” in terms of activities of daily living — such as eating, breathing, toileting and walking — and how many of those a person is unable to perform independently. Georgia and Oklahoma gauge incapacitation based on whether a person requires assistance with two or more daily life functions, while Texas sets the threshold at three. But she said North Carolina is an outlier for not using this standard, which can make it unclear why someone does or doesn’t qualify.
Campbell said measuring incapacitation in terms of activities of daily living would be too rigid and that failing to meet a set number would not necessarily mean someone is “incapacitated.” Campbell noted that someone does not need to be completely bed-ridden to qualify for release.
“The statute does not define it, and so we are then required to make that assessment as best we can,” Campbell said. “We get folks that come into our custody having committed crimes, often violent crimes, that really probably certainly have some serious restrictions.
“It’s a very difficult determination to make. What we do in the documents we provide is simply try to describe what those limitations are. We don’t say he is or is not ‘debilitated,’ or is or is not ‘incapacitated.’”
Campbell said that most releases are meeting the “permanently and totally disabled” criteria, though as he sees it, the categories blend.
“If they are geriatric and their condition is such that they’re medically incapacitated, they’re almost by definition going to be permanently and totally disabled,” Campbell explained.
After the medical assessment, a separate group of prison staff evaluates the person’s potential risk to society, including the person’s history in prison and release plan. If the group endorses a case, it moves to the Parole Commission for final approval or denial.
The Parole Commission has granted medical release to 67 people since 2019. People released from prison under early medical release are not simply set free; they remain subject to state supervision until the date upon which they would have been released.
The medical release determination process can take up to two months. The Department of Adult Correction has 45 days to complete their medical and risk evaluations, followed by 15 days for the Parole Commission to decide whether to grant medical release for terminally ill individuals, or 20 days for those who are permanently disabled or geriatric, during which they independently assess the risk of violence and recidivism.
Since 2019, incarcerated people have died every year waiting for a decision to be made in their case. Campbell said the Department of Adult Correction has worked in recent years to expedite the process and proactively identify eligible candidates.
Barriers to release
One reason so few people qualify for medical release in North Carolina is the exclusion of people with certain types of convictions — a limitation acknowledged by the Department of Adult Correction and by advocates.
Campbell said the Department of Adult Correction now conducts system-wide reviews two or three times a year to pinpoint people who could qualify. He said just a few months ago, staff reviewed over 800 cases — including individuals housed in a long-term care unit, who were hospitalized or receiving chemotherapy. But he said most of the more seriously ill people in the Department of Adult Correction’s custody are automatically disqualified from consideration due to their convictions.
State compassionate release policies regarding conviction eligibility vary, but many states are not as stringent as North Carolina. For example, New York allows infirm people convicted of anything besides first-degree murder to be considered for release if they have served at least half of their sentence. Georgia’s policy doesn’t explicitly list any convictions that are ineligible for medical release.
Crane and other advocates would like to see North Carolina restrictions eased to allow more people to benefit from medical release.
“People who are sick and dying are costly and low-risk due to their age and incapacitation, and this is true irrespective of an individual’s conviction,” Crane said.
Another barrier to medical release can be inability to find appropriate aftercare plans for people who meet the criteria for release. Over the past two years, four people have been unable to be released for this reason, according to Department of Adult Correction data. Essentially, they had no place to go in the community where they could receive care.
It’s a new metric they’ve recently started to track.
Prison social workers work with incarcerated people to develop medical release plans that include details about the proposed course of medical treatment, documentation that medical providers are prepared to provide the needed health care and a suitable place to live.
“It requires an extensive amount of coordination… and, unfortunately, some of them prove quite difficult,” Campbell said.
The hardest placements can be for people requiring a long-term care facility — of which North Carolina has about 400. Campbell said prison social workers will call every single one trying to get a placement but can often run up against availability issues.
Pushing for more medical releases
Advocates have expressed disappointment that the 2023 reforms aren’t resulting in more releases.
“There is not the flow of people that we would like to see,” said Kristie Puckett, a lobbyist at Forward Justice, a nonpartisan law and policy center based in Durham.
Puckett and other advocates believe early medical release is not used enough in North Carolina. She argued that it can be a humane mechanism to ease overcrowded and understaffed prisons, while giving people dignity while dying.
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In an effort to increase the use of medical release, FAMM and the Wilson Center for Science and Justice at Duke Law launched a project in North Carolina in May to pair incarcerated people who have critical illnesses with lawyers and doctors to assist with their applications for release and help identify suitable release plans.
“The numbers are so low,” said Crane, who is leading the project. “People are dying in custody. We’re doing this project to try and help increase the likelihood that people are considered and granted release.”
Crane said she’s been contacted by dozens of people in the state who have severely ill incarcerated loved ones who want help seeking medical release. They have conditions ranging from heart and liver disease to dementia, cancer and chronic lung disease. Many are in wheelchairs, on oxygen, in diapers, or living in hospital units — requiring frequent, specialized care outside the Department of Adult Correction.
The project is actively working on five cases — starting small to see how the medical release process unfolds, Crane said.
“The reason we haven’t ramped up is because we’re still trying to figure out, can people move through this?” Crane said. “How can they overcome barriers? We don’t want to create false hope if they will just be turned down.”
Crane said the project’s first case is before the Parole Commission, and they expect to learn more about how the process is functioning pending the decision later this month.
To connect with the project for assistance applying for medical release in North Carolina, email statemedicalrelease@famm.org
Most of the sick, aging population will stay in prison
While the use of early medical release from prison has remained limited in North Carolina, the number of sick and aging incarcerated people has swelled.
In North Carolina, 8,560 people, or 26.6 percent of the total state prison population, are 50 or older, according to data from the Department of Adult Correction.
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Research shows that incarceration has adverse effects on health and accelerates aging. One study found that an incarcerated 59-year-old has the same rate of illness as a non-incarcerated 75-year-old. Other studies show that people face chronic and life-threatening illnesses earlier in prison than would be expected for someone outside.
Addressing the medical needs of this “graying” population is a growing demand.
Prison health care costs totaled $429.1 million — or about one-quarter of the Department of Adult Correction’s annual budget of about $2 billion — during fiscal year 2023-24, according to a presentation to state lawmakers in March. It’s a 36 percent increase in cost over the past five years, driven in part by the growing medical needs of the aging prison population.
To adapt to this changing demographic, Campbell said one of the greatest needs is for long-term care beds. In 2023, the Department of Adult Correction opened a dedicated long-term skilled nursing facility in Central Prison — after yearslong delays caused by funding and staffing challenges.
“Our long-term care population, unfortunately, an overwhelming majority of those — upwards of 90 percent of them — were folks that statutorily didn’t meet that classification criteria for early medical release,” Campbell said. “They’re folks that we are going to have to continue to provide care for. That is far and away the biggest challenge.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.