Medical Care Levels in Federal Prison

Elizabeth Franklin-Best P.C. regularly helps clients obtain medical care in federal prison, which requires a firm understanding of the medical care levels in prison. This article discusses the latest guidance from Patient Care, Program Statement No. 6031.05 (2024) and Care Level Classification for Medical and Mental Health Conditions or Disabilities (2019) to help individuals and their loved ones understand how the BOP classifies both institutions and inmates based on medical and mental health needs. By the end of this article, you’ll have a clear, in-depth understanding of how the system works, how it impacts a person’s experience in federal prison, and what to expect at each care level.

Overview of the Federal Bureau of Prisons’s Classification System

When it comes to the Federal Bureau of Prisons, classification is key. Every inmate receives multiple designation aspects that shape their confinement experience, including:

• Security Level (Minimum, Low, Medium, or High)
• Medical Care Level
• Mental Health Care Level

Similarly, every federal prison facility receives corresponding classifications. Generally, inmates are housed in facilities that match (or exceed) their individual classification levels. For example, an inmate with a Medical Care Level 3 classification is typically placed in a Care Level 3 institution or higher.

While prison security level is often the most influential factor in an inmate’s daily life, Medical Care Levels in prison can be just as crucial—especially for those with chronic or severe medical conditions. When inmates face frequent medical interventions and specialized treatments or require around-the-clock care, placement in the appropriate care level can significantly impact the quality of care received and the overall prison experience.

Medical Classification Under Patient Care Program Statement No. 6031.05 (2024)

In Patient Care, Program Statement No. 6031.05 (2024), the BOP updated its guidelines for classifying federal institutions by medical care level and assigning medical and mental health care levels to inmates. This program statement emphasizes a four-level system designed to match inmates’ needs with institutions’ capabilities. It also details the staffing and resources required at each level.

Institution Care Levels

The Health Services Division (HSD) assigns each BOP facility a care level based on:

1. Physical Plant: The infrastructure available at the institution (e.g., clinic size, specialized equipment, etc.).
2. Community-Based Resources: The proximity to local hospitals or treatment centers that can provide advanced care.
3. Local Labor Market: The availability of qualified medical professionals in the area to meet inmates’ medical needs.
4. Impact on Other Correctional Programs: How medical services integrate with educational, vocational, or rehabilitative programs.

Inmate Care Levels

According to the Patient Care program statement, each inmate is also assigned a medical care level (1 through 4) based on:

• Chronicity of Condition: How long the condition has persisted.
• Complexity of Condition: Whether the illness is multifaceted and requires multiple types of treatment.
• Intensity and Frequency of Required Interventions: How often the inmate needs to see a medical professional or specialist.
• Functional Capability: The inmate’s ability to perform activities of daily living (ADLs).

Importantly, inmates with evolving or worsening conditions may have their care level designations adjusted as needed. The Clinical Director (CD) or a designee at each facility is responsible for continually reviewing and updating inmates’ medical care levels.

Care Levels in Detail: From 1 to 4

Care Level Classification for Medical and Mental Health Conditions or Disabilities (2019) reaffirms that each inmate and institution receives a care level designation. While those definitions remain largely intact, the Patient Care program statement clarifies and expands upon each level’s criteria:

Medical Care Level 1

Care Level 1 institutions typically serve inmates who are generally healthy and require only basic outpatient care. Here are key points:

• Inmates are usually under the age of 70 with minimal medical needs.
• Regular evaluations or clinical interventions might occur every 6–12 months.
• Common conditions include mild asthma, diet-controlled diabetes, and well-controlled hypertension with minimal or no medication requirements.

Proximity to Medical Facilities:

• Care Level 1 prisons may be one hour or more from a community hospital.
• They have on-site medical staff for basic care and can outsource urgent or complex care to local hospitals.

Percentage of the Population:

• Approximately 66.8% of federal inmates fall into Care Level 1. Although the percentages fluctuate, this remains the largest group.

Medical Care Level 2

Care Level 2 institutions offer more immediate access to advanced medical services due to closer proximity to large hospitals or specialized treatment centers. Inmates at this level:

• Have stable chronic conditions requiring routine clinical visits (monthly to every 6 months).
• Need regular, scheduled appointments but typically can self-manage their illnesses or conditions with minimal assistance.
• May require occasional specialized medical interventions.

Common Conditions:

• Medication-controlled diabetes
• Epilepsy
• Early-stage emphysema
• HIV (stable and requiring occasional specialist visits)

Proximity and Resources:

• Care Level 2 institutions are typically less than one hour from a major hospital or specialist center.
• They maintain medical staff to handle routine care and partner with community providers for advanced treatments.

Percentage of the Population:

• Around 28.6% of federal inmates fall within Care Level 2. This group has grown slightly in recent years due to an aging inmate population but remains relatively stable compared to Care Level 1.

Medical Care Level 3

Care Level 3 represents a step up in both the complexity of health needs and the resources required by the institution:

• Inmates at this level are often fragile outpatients with multiple chronic conditions that demand frequent medical appointments or specialist care.
• They might require assistance with activities of daily living (ADLs) such as bathing, dressing, or toileting, though inmate companions (sometimes called “orderlies”) can often provide this assistance.
• Periodic hospitalization may be needed to stabilize more severe or recurrent issues.

Examples of Conditions:

• Advanced HIV disease
• Cancer in partial remission (within the last year)
• Severe (NYHA Class III) congestive heart failure
• End-stage liver disease
• Severe mental illness in remission (on stable medication regimen)

Facility Resources:

• While a Care Level 3 institution might offer some specialized treatments on-site, it often relies on partnerships with a nearby Care Level 4 facility or a local hospital for advanced procedures.
• These institutions typically have a higher ratio of medical staff to inmates, reflecting the frequent clinical contacts needed.

Percentage of the Population:

• Approximately 2% of the BOP population falls under Care Level 3. Even with an aging inmate population, this group remains one of the smallest due to the prevalence of more routine care needs at Levels 1 and 2 and the highly intensive care provided at Level 4.

Medical Care Level 4

Care Level 4 institutions—commonly known as Federal Medical Centers (FMCs) or Medical Referral Centers (MRCs)—are the highest level of medical care within the BOP:

• These facilities provide inpatient care and are staffed for 24-hour nursing.
• Inmates with severe limitations (e.g., quadriplegia, dialysis-dependent individuals, or those undergoing active cancer treatment) require the robust services available here.
• Some Care Level 4 inmates need daily living assistance such as feeding, toileting, and dressing.

Examples of Conditions:

• Advanced cancer on active treatment
• Chronic renal failure requiring dialysis
• Debilitating stroke or major head injury
• High-risk pregnancy
• Patients recovering from major surgery who need extensive medical follow-up

Special Capabilities:

• Certain FMCs are affiliated with top medical schools and offer specialized services, such as oncology (FMC Butner, NC; FMC Lexington, KY), dialysis (FMC Devens, MA), nursing care (FMC Fort Worth, TX) or complex mental health services (FMC Carswell, TX; FMC Rochester, MN; MCFP Springfield, MO).
• The BOP has a limited number of these facilities because Care Level 4 resources are the most intensive and expensive.

Percentage of the Population:

• Fewer than 1% of federal inmates require Care Level 4 treatment. This percentage has remained relatively constant, although incremental increases may occur as the inmate population ages.

Designation and Classification Process

The BOP uses two main offices for initial designations based on medical and mental health needs:

1. Designation and Sentence Computation Center (DSCC)
   • Primarily designates Care Level 1 and 2 inmates.
   • Relies on information from the presentence investigation report and other available records to assign a provisional care level in SENTRY (the BOP’s internal tracking system).
2. Office of Medical Designations and Transportation (OMDT)
   • Handles designations for inmates who meet Care Level 3 or 4 criteria.
   • Evaluates medical records, presentence reports, and other documentation to determine if an inmate’s condition necessitates a higher level of care.

Upon arrival, the institution’s Clinical Director (CD) or designee reviews the inmate’s provisional care level assignment and updates it to a nonprovisional care level if necessary. Should an inmate’s medical or mental health needs change while in custody, the CD (or Chief Psychologist) can reassess and upgrade or downgrade the care level accordingly.

Mental Health Care Levels in Federal Prison

In addition to Medical Care Levels, the BOP assigns Mental Health Care Levels. This system, which ranges from Level 1 to Level 4, mirrors the medical classification system. Each institution has a corresponding mental health care level designation, although some institutions may span multiple levels for mental health services (particularly for Levels 3 and 4).

Mental Health Care Level 1

• Inmates do not require regular mental health interventions.
• Inmates with a history of mental illness may be placed at this level if they are currently stable without needing consistent therapy or medication.
• Institutions designated Mental Health Care Level 1 provide minimal psychological services, usually with few psychologists or limited mental health staff for crisis response.
• Approximately 92.5% of federal inmates are classified within this care level.

Mental Health Care Level 2

• Inmates require routine outpatient mental health care (e.g., monthly or quarterly counseling and medication management).
• Institutions at this level typically have a fully-staffed Psychology Services Department and Care Coordination and Reentry (CCARE) Teams.
• Example cases include inmates with depression, anxiety disorders, or bipolar disorder managed by medication and periodic therapy sessions.
• Approximately 3.6% of federal inmates are classified within this care level.

Mental Health Care Level 3

• Inmates require significant mental health interventions but do not need full-time inpatient care.
• Institutions offering Mental Health Care Level 3 services provide more frequent and intensive outpatient treatments, often weekly or multiple times per week.
• Special residential treatment programs (e.g., the STAGES program for inmates with serious mental illness or personality disorders) may be available at these sites.
• Approximately 0.5% of federal inmates are classified within this care level.

Mental Health Care Level 4

• Inmates have acute mental health needs necessitating inpatient psychiatric care.
• Typically located in a Federal Medical Center (FMC) that also meets Medical Care Level 4 standards.
• Designed for inmates who are gravely disabled, psychotic, or otherwise incapable of functioning in a general population setting, even at a Mental Health Care Level 3 institution.
• Approximately 0.3% of federal inmates are classified within this care level.

Impact on Prison Life and Why It Matters

Medical Care Levels in prison aren’t just technical designations—they can profoundly affect day-to-day life for incarcerated individuals. Here’s how:

1. Access to Necessary Care:
   • Higher medical care levels ensure frequent check-ins, medication management, and specialized treatments.
   • Inmates with chronic or severe conditions are less likely to face life-threatening delays.
2. Staffing and Facility Resources:
   • Care Level 3 and 4 institutions typically have a higher ratio of medical staff per inmate.
   • These facilities may offer unique programs, such as specialized units for dialysis or oncology.
3. Housing Assignments and Community Ties:
   • If inmates need a Care Level 4 facility, they might be housed far from family and friends because few such facilities exist nationwide.
   • This distance can impact visitation and emotional support.
4. Potential Sentence Implications:
   • While the BOP generally decides inmate placements, defense attorneys can submit medical documentation to request designations that address serious health issues.
   • Presenting comprehensive health information at sentencing can influence the judge to recommend a specific care level or facility.
5. Quality of Life:
   • Proper designation can mean the difference between consistent treatment and preventable medical crises.
   • For many inmates, receiving the right level of care is a matter of life or death.

Private Federal Prisons and Medical Care Levels

Private prisons (contract facilities operated by entities such as the GEO Group or CoreCivic) also classify inmates by medical and mental health needs. However, they may follow slightly different internal policies for medical care provision. If you or a loved one is designated to a private federal prison:

• Official BOP standards still apply, but the specific on-site services may vary.
• Check the private prison’s website or facility handbook for details on how they manage medical and mental health care.

Frequently Asked Questions (FAQs)

Your Medical Care Levels in Prisons Team

Understanding Medical Care Levels in prison is vital for anyone navigating the federal prison system. These classifications directly influence the quality and frequency of medical services, the types of programs available, and where an inmate will serve their sentence. Per Patient Care, Program Statement No. 6031.05 (2024) and Care Level Classification for Medical and Mental Health Conditions or Disabilities (2019), the BOP aims to match inmates’ medical and mental health needs with appropriately resourced institutions.

For individuals with chronic illnesses, mental health concerns, or complex medical conditions, correct placement can significantly improve both immediate care and long-term health outcomes. If you or a loved one is facing federal incarceration and you believe that a serious medical condition should influence your designation, consult Elizabeth Franklin-Best P.C. to discuss possible legal strategies. We can help gather and present the necessary documentation, advocate for an appropriate care level, and, when warranted, explore sentence reductions or other remedies.

Ultimately, being informed is your best tool. By knowing how the Medical Care Levels work, you can better prepare for the challenges of federal prison and ensure you or your loved one receives the care and attention needed to maintain health and dignity during incarceration.

Published Feb 22, 2018 by Christopher Zoukis, JD, MBA | Last Updated by Christopher Zoukis, JD, MBA on Apr 13, 2025 at 3:22 pm