Federal Medical Centers

By Elizabeth Franklin-Best, Esq., and Christopher Zoukis, JD, MBA

A Federal Medical Center is an administrative-security Bureau of Prisons institution that functions as a Medical Referral Center (MRC) — the Bureau’s Care Level 4 facilities, for people who “may require extensive medical and nursing care,” including “24-hour nursing care … with activities of daily living such as feeding, toileting, and dressing.” That definition is verbatim from Program Statement 6031.06, Patient Care, at p. 12, effective 22 June 2026.

BOP’s public facility roster carries seven administrative-security medical facilities: six named “Federal Medical Center” — Butner, Carswell, Devens, Fort Worth, Lexington and Rochester — and one named “U.S. Medical Center for Federal Prisoners,” MCFP Springfield. Their combined published population is 8,072. Placement is not made by the staff who designate everyone else; it is made by the Office of Medical Designations and Transportation, under PS 6270.02, Medical Designations and Referral Services for Federal Prisoners, issued 7 May 2026.

Federal Medical Centers at a glance

What an FMC is	An administrative-security BOP institution operating as a Medical Referral Center — a Care Level 4 facility (PS 6031.06 at p. 12)
How many	7 — six FMCs plus MCFP Springfield
Combined published population	8,072
Security classification	Administrative — all security point totals and all custody levels (PS 5100.08 at pp. 14, 16)
Who decides placement	OMDT (Office of Medical Designations and Transportation), not the DSCC, for Medical Care Level 3 and 4 and Mental Health Care Level 4 (PS 6270.02 at p. 5)
The referral form	Re-Designation Referral Request (770), completed in the electronic health record (PS 6270.02 at p. 7)
The form that sends you back	Treatment Complete Referral Request (413) (PS 6270.02 at p. 6)
Urgency tiers	Routine · Routine Urgent · Emergency (processed within 72 hours of receipt) (PS 6270.02 at pp. 6–7)
Female medical center	FMC Carswell only
Governing policy	PS 6270.02 (designation) and PS 6031.06 (patient care), plus PS 5100.08 (security classification)
Governing statute	18 U.S.C. § 4042(a)(2) — the Bureau shall “provide for the safekeeping, care, and subsistence” of all federal prisoners; 18 U.S.C. § 3621(b) — placement
Recent change	Lexington FMC satellite camp announced for closure, 1 July 2026

Facility counts and populations read from the Bureau’s own facility records, retrieved 11 June 2026 and reconciled field-by-field against BOP’s live roster on 5 September 2026.

A Program Statement is the Bureau’s instruction to its own staff — agency policy, not law. What binds is the statute: 18 U.S.C. § 4042 obliges the Bureau to “provide for the safekeeping, care, and subsistence” of everyone in its custody, and 18 U.S.C. § 3621(b) makes “the prisoner’s mental and medical health needs” one of the factors the Bureau must weigh in placing someone. The Program Statements below are how the Bureau tells its staff to carry that out — and, in practice, they are the standard against which delay and inaction can be measured.

What is a Federal Medical Center?

Three things at once.

An FMC is an administrative-security prison

Under PS 5100.08 at p. 16, an administrative institution is one “with a special mission, where inmates are assigned based on factors other than security and/or staff supervision (for example, medical/mental health, pretrial and holdover),” and it is “designed to house all security level inmates.” An FMC therefore takes all point totals and all custody levels (PS 5100.08 at p. 14) — a first-time defendant with a 4-point score and a man who would otherwise be in a penitentiary can be on the same unit, because neither is there on account of the score. See administrative-security prisons.

An FMC is a hospital inside a prison, not a hospital

Acute care requiring hospitalization is normally provided in a community hospital near the institution, and PS 6270.02 at p. 3 sets the expectation that “most institutions will be able to locally manage hospitalizations between seven and 14 days for acute medical care or surgical procedures followed by one to three post-operation appointments.” An FMC is where someone goes when the need is longer, more complex, or beyond what an ordinary institution’s health services can carry.

An FMC is the top of a four-level classification ladder

Every BOP institution carries a medical care level, and every person in BOP custody carries a medical and a mental-health care level. That system — not a diagnosis list — is what actually decides who goes where.

The Care Level system, verbatim

Reproduced word-for-word from PS 6031.06, Patient Care, at p. 12 (effective 22 June 2026), which states: “Medical Classification is the system of assigning a care level to each Bureau institution, and a medical and mental health care level assignment to each inmate. The system has four care levels.”

Level	The Bureau’s own definition
Care Level 1	“Care Level 1 institutions house inmates who are generally healthy but may have limited medical problems easily managed by Health Services staff and supplemented by existing community resources.”
Care Level 2	“Care Level 2 institutions house inmates who have stable chronic conditions managed by Health Services staff and supplemented by existing community resources. Care Level 2 inmates generally self-manage their conditions and need infrequent visits to medical specialists or community facilities.”
Care Level 3	“Care Level 3 institutions house inmates who have more complex medical conditions and are more fragile. They require frequent clinical contacts with Health Services staff and more visits to community medical specialists. They may also periodically require hospitalization to stabilize their conditions.”
Care Level 4	“Care Level 4 institutions are the Bureau’s MRC. Inmates housed at MRCs may require extensive medical and nursing care. Some inmates may require 24-hour nursing care including assistance with activities of daily living such as feeding, toileting, and dressing. These inmates may have frequent visits to medical specialists or hospitalizations for specialized medical care that isn’t available in the MRC.”

Source: PS 6031.06 at pp. 12–13. The Health Services Division assigns institution care levels “based on an analysis of the physical plant, community-based resources, local labor market, and impact on other correctional programs,” and higher-care-level institutions receive increased staffing and ancillary/specialty services as determined by the Assistant Director, HSD.

Four operational points follow from that table, and they are the ones families need.

1. Care levels are assigned twice — to the institution and to the person. A person’s care level has to match the institution’s, or a transfer is indicated.
2. The person’s care level is reassessed continuously. “The CD or designee physician makes a care level assessment upon an inmate’s arrival, and regularly reviews and revises medical care levels at each chronic care clinic visit, and as the inmate’s health needs change. Institutions are required to review and update inmate care levels at every comprehensive medical evaluation encounter” (PS 6031.06 at p. 13).
3. The initial care level is provisional and must be converted. Initial designations are assigned a Screening Care Level (SCRN), assessed and changed to a non-provisional care level during the first comprehensive medical and psychological evaluation at the institution — and “SCRN care levels must be changed to a non-provisional care level … in order for the inmate to be re-designated to another institution” (PS 6270.02 at p. 5). If a transfer request is going nowhere, an unconverted SCRN is one of the first things to check.
4. The detailed criteria are not public. PS 6031.06 points to “clinical guidance on Care Level Classification for Medical Conditions or Disabilities located on the Health Services Division (HSD) page of the Bureau’s intranet site” (PS 6031.06 at p. 12). That document is internal. The four definitions above are the public statement of the framework, and they are what a request or an administrative remedy should quote.

Mental health care levels

A parallel four-level system runs for mental health, defined at PS 5310.16, Treatment and Care of Inmates with Mental Illness, at p. 8:

Level	Definition
CARE1-MH	No significant mental health care. No significant functional impairment associated with mental illness and no need for regular mental health interventions; no history of serious functional impairment, or a history with consistently appropriate help-seeking behavior.
CARE2-MH	Routine outpatient mental health care on an ongoing basis, and/or brief crisis-oriented care of significant intensity — for example placement on suicide watch or behavioral observation status.
CARE3-MH	Enhanced outpatient care (weekly mental health interventions), or residential mental health care in a residential Psychology Treatment Program.
CARE4-MH	Inpatient psychiatric care, where the person “is gravely disabled and cannot function in general population in a CARE3-MH environment.”

Two rules attach. All Mental Health Care Level 4 designations are made by OMDT, and the Bureau Chief Psychiatrist reviews every CARE4-MH transfer request; Care Levels 1, 2 and 3 are handled by DSCC designators (PS 6270.02 at p. 6). And people released from an MRC after treatment for acute mental health problems are ordinarily classified CARE3-MH, “due to the resources required to assist them in adjusting to a mainline institution” (PS 5310.16 at p. 9). See treatment and care of inmates with mental illness, the Psychology Services Manual, and mental health programs for inmates.

Every Federal Medical Center in the U.S.

Seven facilities. Populations are BOP’s published totals from the June 2026 capture; where a facility has an adjacent camp, the breakdown is shown.

Facility	Location	Houses	BOP population	Adjacent camp	Judicial district	Region
FMC Butner	Old N. Carolina Hwy 75, Butner, NC	Male	777	No	Eastern North Carolina	Mid-Atlantic
FMC Carswell	1200 Meandering Road, Fort Worth, TX	Female	1,237 (1,005 FMC, 232 camp)	Yes	Northern Texas	South Central
FMC Devens	42 Patton Road, Ayer, MA	Male	1,205 (1,094 FMC, 111 camp)	Yes	Massachusetts	Northeast
FMC Fort Worth	3150 Horton Road, Fort Worth, TX	Male	1,569	No	Northern Texas	South Central
FMC Lexington	3301 Leestown Road, Lexington, KY	Male and female	1,332 (1,101 FMC, 231 camp)	Yes — camp announced for closure	Eastern Kentucky	Mid-Atlantic
FMC Rochester	2110 East Center Street, Rochester, MN	Male	835	No	Minnesota	North Central
MCFP Springfield	1900 W. Sunshine St, Springfield, MO	Male	1,117	No	Western Missouri	North Central

Four things that list tells you which no summary will:

• FMC Carswell is the Bureau’s only female medical center. Every woman in federal custody who needs Care Level 4 medical placement is looking at one facility in Fort Worth, Texas. That single fact drives most of what families of women in federal custody find frustrating about distance and visiting.
• FMC Lexington is the only one holding both men and women.
• MCFP Springfield is the Bureau’s oldest and largest-mission medical facility, and PS 6270.02 uses it as its worked example of an MRC destination — describing ground-ambulance transfers “e.g., USP Leavenworth to USMCFP Springfield” (PS 6270.02 at pp. 13–14).
• FMC Butner sits inside the Butner Federal Correctional Complex, alongside a low and two medium-security FCIs, which is why “Butner” on a locator result does not tell you whether someone is at the medical center.

The Lexington camp is closing

The Bureau’s press release of 1 July 2026 announced closure of the Lexington FMC Satellite Camp, along with Beaumont FCI Low, Big Spring FCI and its camp, La Tuna FCI/FSL/camp, Petersburg FCI Low and Taft FCI, and the conversion of Morgantown and Duluth camps to Federal Satellite Lows — citing a deferred-maintenance backlog exceeding $4 billion. Staff at the Lexington camp are being transferred onsite or nearby. The FMC itself was not announced for closure. See major federal prison closures and deactivations.

What each facility actually offers — and where that is written down

BOP does not publish a per-facility list of clinical specialties, and any page that gives you one is guessing. What exists — and what counsel can ask for — is a specific internal document.

Every institution’s Health Services Administrator maintains a Medical Resources Directory (MRD) “listing the availability of specialized medical and mental health services on-site, such as dialysis, blood transfusions, wound care, intravenous antibiotics, Residential Drug Abuse Treatment Program (RDAP), and physical therapy.” Institutions must provide it to OMDT and update it at least quarterly, or sooner when staffing or community-resource availability changes. Each MRC maintains its own version on a specialized template (PS 6270.02 at pp. 3–4).

That is the document that answers “can this institution do dialysis.” It is the document OMDT uses to decide where someone goes. It is not on bop.gov. Naming it by its form number — EMS-A206.060, Medical Resources Directory — in a request or an administrative remedy is more effective than asking a general question about services.

Conditions treated at Federal Medical Centers

The honest framing is that the Bureau designates by care level and reason for referral, not by diagnosis. PS 6270.02 is explicit that stacking up diagnoses does not work: “the mere presence of multiple chronic medical conditions is not sufficient to justify an MRC transfer. When making a referral, the primary diagnosis and reason for referral (e.g. surgery, chemotherapy, comfort care) should be identified” (PS 6270.02 at p. 4).

Read the policy for what it treats as MRC-appropriate and a picture emerges:

• Surgery, chemotherapy and comfort care — the Bureau’s own three examples of a stated reason for referral (PS 6270.02 at p. 4).
• Ongoing inpatient care or intensive follow-up care. Requests for Care 3 and Care 4 transfers “should only be submitted when the inmate is stable for transport,” but people “requiring ongoing inpatient care or intensive follow-up care may be considered for MRC transfer,” weighing prognosis for long-term treatment and rehabilitation, the local institution’s nursing resources, cases requiring long-term skilled nursing care, and overriding case-management or security needs (PS 6270.02 at p. 3).
• Care that the institution can only obtain externally. “If a major medical treatment or procedure can be performed internally at an MRC but would have to be done externally at the referring institution, a re-designation will be considered” (PS 6270.02 at p. 4).
• Conditions the local community cannot handle. OMDT determines whether there are sufficient community resources near the current institution; if not, re-designation may be considered (PS 6270.02 at p. 3).
• 24-hour nursing and activities of daily living — feeding, toileting, dressing (PS 6031.06 at p. 12).
• Inpatient psychiatric care for a CARE4-MH person who is gravely disabled and cannot function in a CARE3-MH general-population setting (PS 5310.16 at p. 8).
• Court-ordered forensic evaluation. See below.

Applied Insight — Christopher Zoukis, JD, MBA, Managing Director: The sentence that changes the most outcomes is the one about co-morbidities. Families and unit teams both tend to build the case by listing everything — diabetes, hypertension, neuropathy, a bad back — and PS 6270.02 says in terms that a pile of chronic conditions is not enough. What OMDT is looking for is a primary diagnosis and a reason for referral, tied to something the current institution cannot do. A referral that says “chemotherapy the institution cannot administer on site” travels further than one that says “he is very sick.”

How people are placed in a Federal Medical Center

There are two doors: the initial designation, and the re-designation of someone already in custody.

Initial designation

Most initial designations are made by staff at the Designation and Sentence Computation Center in Grand Prairie, Texas, working from the Judgment, the Marshals Service, the U.S. Attorney’s Office and the Probation Office. But “inmates with major medical/psychiatric problems, or those with chronic care requirements, are referred to OMDT by DSCC for initial review to determine a care level.” OMDT then designates Medical Care Level 3 or 4 and Mental Health Care Level 4 cases, and returns Medical Care Levels 1 and 2 and Mental Health Care Levels 1, 2 and 3 to DSCC for ordinary placement (PS 6270.02 at p. 5).

Five factors must be considered before any initial medical or mental-health designation: the person’s medical and psychiatric needs; their security needs; proximity to their home; transportation requirements; and recommendations made by the sentencing judge (PS 6270.02 at p. 5). That last one is worth saying out loud to anyone still at the sentencing stage: a judicial recommendation about medical placement is a factor the Bureau’s own medical designation policy requires it to consider, alongside the statutory factor at 18 U.S.C. § 3621(b)(4)(B). It is not binding. It is also not nothing, and it costs nothing to ask for.

Medical Screening Care Levels are assigned “using available medical records and information provided in the Pre-Sentence Report” (PS 6270.02 at p. 5). If the Presentence Report is silent about a serious condition, the initial screening care level will likely be wrong. That is a fixable problem, and it is fixed before sentencing, not after.

Re-designation: the 770 and the 413

For someone already in custody, everything runs through two forms in the electronic health record.

The Re-Designation Referral Request (770) is used for “an acute medical, surgical, or psychiatric condition, or for those inmates who have chronic care needs that cannot be addressed at their current institution.” OMDT then decides whether the person needs a Medical Care 3 or 4 institution or a Mental Health Care Level 4 facility — “if appropriate, OMDT can also grant authorization for the inmate to be treated locally” (PS 6270.02 at p. 5). Where the person is in community custody, a paper form is used instead: BP-A0770, Medical/Surgical and Psychiatric Referral Request (PS 6270.02 at p. 7).

The route a 770 travels is fixed:

1. An institution provider or staff member initiates it, with input from other providers involved in the person’s care — advanced practice providers, psychologists, medical officers, nurses, physical therapists, consultant physicians (PS 6270.02 at p. 8).
2. The Clinical Director and Health Services Administrator must review it, authorize transmission, and notify the Warden that a transfer request has been submitted (PS 6270.02 at p. 8).
3. Care Level 3 requests go to the Regional Medical Director for concurrence or disapproval, then to the OMDT Medical Designator for final review; if the two disagree, the request goes to the Chief, Health Programs for final determination (PS 6270.02 at p. 8).
4. Care Level 4 requests are reviewed by the assigned Medical Designator, who may approve — but “all recommendations for disapproval are referred to the CHP for final determination” (PS 6270.02 at p. 8).
5. Mental health Care Level 4 requests go to the Medical Designator and then to the Bureau Chief Psychiatrist for final determination (PS 6270.02 at p. 9).

Two provisions in that section are worth memorizing, because they are the ones staff most often overlook.

An incomplete request gets deferred, not decided

“If a 770 or 413 request does not include the necessary information for OMDT to make a determination, OMDT will defer the request and the institution will be responsible for submitting a new request with the required documentation” (PS 6270.02 at p. 8). A deferral looks a lot like silence from the outside. Ask specifically whether the 770 was deferred.

The institution keeps the duty to treat while the transfer is pending

“Institutions are responsible for scheduling and continuing all medically necessary treatment and ongoing medical care for inmates who have been approved for re-designation by OMDT, but who have not physically transferred to the receiving facility. Failure to provide necessary treatment while awaiting physical transfer after re-designation could result in a delay in care” (PS 6270.02 at p. 8). “We’re waiting on the transfer” is not an answer under the Bureau’s own policy.

Where OMDT sends an approved person is decided on six stated criteria: medical needs; security/custody level; Central Inmate Monitoring considerations such as separatees; custodial concerns; Care Level 3/MRC bed space availability; and proximity — “a facility as close to or, to the extent practicable, within 500 driving miles of the inmate’s primary residence” (PS 6270.02 at p. 9), which tracks the statutory standard in 18 U.S.C. § 3621(b).

The Treatment Complete Referral Request (413) is the other direction. It is initiated for people “who have completed the necessary clinical procedures or treatments as determined by NURAB and are ready to return to an appropriate Medical Care Level 1–2 institution, or Mental Health Care Level 1–3 institution,” and it also requires Unit Team or Case Management recommendations for placement (PS 6270.02 at p. 6). Bed pressure drives this: the Chief, Utilization Review Section compiles a list of people whose treatment is complete and communicates it to OMDT and to MRC providers, who are then required to complete the 413 — “this will vacate the bed space for other designated inmates, expediting inmate movement and management of the MRC pipeline” (PS 6270.02 at p. 12).

The three urgency tiers

Tier	What it means	Transport	Source
Routine	Treatment “that is not urgent or emergent and time en route is not a major factor”	Any means, including Bureau bus and JPATS airlift	PS 6270.02 at p. 6
Routine Urgent	Not an emergency, but must go directly to an MRC because of the acuity of the condition or because MRC services must start within a specific time frame. Holdover status at a county jail or Bureau general population institution is not permissible	Air ambulance, air charter, ground ambulance; sometimes institution vehicles	PS 6270.02 at p. 7
Emergency	A condition determined by medical/mental health staff “to require immediate, direct transportation,” including anyone not medically or psychiatrically capable of routine Bureau air/surface transport. OMDT processes these within 72 hours of receipt	Air ambulance, air charter, or emergency ground transportation	PS 6270.02 at p. 7

A fourth category sits alongside them: Care Level 3 re-designation with direct transfer, for people whose condition puts them at risk during holdover. That decision is made by the Chief, Health Programs (PS 6270.02 at p. 7).

One line polices the boundary: “Any case that can be moved via regular Bureau transit (e.g. Bureau bus, Bureau/USMS airlift) cannot be declared an emergency transfer” (PS 6270.02 at p. 7). And emergency transfers take priority over Routine and Routine Urgent, with OMDT, the Chief of Health Programs, the Mental Health Treatment Coordinator and the Bureau Chief Psychiatrist reviewing everyone pending MRC transfer each week (PS 6270.02 at p. 11).

Getting there: transport, and who cannot fly

This is the least-published and most consequential part of the process, because a person can be approved for an MRC and still not move.

Nobody moves without an Exit Summary

Generated through the electronic health record, it “must accompany all inmates in transit regardless of physical or mental condition or reason for transfer,” and no federal prisoner in transit leaves a Bureau institution without one. Tuberculosis screening must be completed before transfer, and “transporting officials will not accept any inmate for transfer unless the TB clearance section” of the Exit Summary or form BP-A0659 is completed (PS 6270.02 at p. 12). All medications must be listed with dosage, frequency, expiration date and route (PS 6270.02 at p. 12).

A flight nurse can pull anyone off the plane

A USMS-employed flight nurse accompanies all Bureau/USMS airlift flights and “has the authority to exclude any inmate, including a medically re-designated, routine level inmate, from the flight,” based on the transfer packet, an evaluation before boarding, the Exit Summary, whether the person was medicated before transfer, or the absence of a seven-day supply of medication (PS 6270.02 at p. 14).

These conditions generally will not be considered for airlift transport at all (PS 6270.02 at p. 15):

• type I diabetes — “must be direct transfer”
• unstable cardiac conditions
• severe chronic obstructive pulmonary disease
• pregnancy in the third trimester, and a history of spontaneous abortion — with an exception where an obstetrician authorizes air travel within 72 hours of departure, by direct transport without holdover stops
• acute psychosis
• symptomatic sickle cell disease, or a previous history of attacks with air transportation
• anyone requiring respiratory equipment, including oxygen
• a history of myocardial infarction with restricted ambulation, or angina on slight or moderate exertion
• anyone unable to walk
• any dental appliance or device that prevents the mouth from opening
• hemoglobin that is not at least 8 mg/dL or above — and “if no current laboratory information is available, travel will be approved for ground transportation only”

Modes of transport (PS 6270.02 at pp. 13–14): air ambulance, normally staffed by a flight nurse or physician, for people who are bed-bound, cannot maintain a seated position, or need in-flight care; air charter, referred to as Specialized Operation Air Program (SOAP) flights, “typically utilized for emergent/Routine Urgent travel over 400 miles”; ground ambulance and institution vehicle, for people near an MRC; commercial air, which the Warden may authorize for Routine and Routine Urgent transfers, but which may not be used for anyone designated to an MRC for mental health treatment; Bureau/USMS airlift (JPATS), routine transfers only; and Bureau bus, routine only. In every case the Clinical Director must certify the person is stable before transfer, and “under no circumstances will inmates be transported who are not in stable condition” (PS 6270.02 at p. 15).

The practical lesson: if a transfer keeps not happening, ask whether the obstacle is the designation or the transport. Those are two different problems with two different fixes, and the Exit Summary, the medication supply, the TB clearance and a current hemoglobin result are where the second one usually lives.

What life is like inside a Federal Medical Center

It is still a prison. The Bureau’s medical policy runs alongside, not instead of, everything else: visiting, telephone, mail, TRULINCS email, commissary, property and discipline all operate on national policy with local implementation. Where a national rule leaves room, the institution supplement — the local written policy issued by the warden — governs, and an FMC’s supplement will differ from a general-population institution’s because the physical plant does.

What is different is the medical rhythm, and it is written down.

Intake screening within 24 hours. “Qualified health care providers will conduct an intake screening assessment of each inmate within 24 hours of arrival to the facility … ideally while the inmate is still in Receiving and Discharge.” It covers urgent medical, oral-health and mental-health needs; signs of intoxication or withdrawal; housing and work restrictions; transmissible infections; pregnancy; disabilities requiring accommodation; any new problem since the last comprehensive evaluation; medication reconciliation; medication for opioid use disorder; and any recent PREA history. “This intake screen is mandatory and cannot be waived” (PS 6031.06 at pp. 18–19). See intake process.

A comprehensive medical evaluation within 14 or 30 days. “If no history or active medical or mental health diagnosis are identified on intake screening — complete within 30 days. For inmates with history or active chronic or new health concerns/conditions — complete within 14 days” (PS 6031.06 at p. 20). It must document a comprehensive list of all medical problems, resolved and current, and the full treatment plan.

Chronic Care Clinic follow-up on a fixed cadence (PS 6031.06 at p. 23):

Care level	Minimum follow-up with an APP or physician
Medical Care Level 4	Every three months, or more often as clinically indicated
Medical Care Level 3	Every six months, or more often as clinically indicated
All CCC enrollees	A physician evaluates every enrolled inmate at least once every 12 months

“Inpatient inmates at MRCs are not excluded from CCC enrollment. Inmates residing on an inpatient unit will be enrolled as stated above and maintain CCC encounters at the frequency established by this program statement.”

The $2 copay still applies — with a long list of exceptions

The fee is $2.00 per health care visit for a visit the person requested (PS 6032.01 at p. 2, quoting 28 C.F.R. § 549.71–.72). No fee is charged for: health care services based on staff referrals; staff-approved follow-up treatment for a chronic condition; preventive health care; emergency services; prenatal care; diagnosis or treatment of chronic infectious diseases; mental health care; or substance abuse treatment — with blood-pressure monitoring, glucose monitoring, insulin injections, Chronic Care Clinics, TB testing, vaccinations, wound care and patient education given as examples (PS 6032.01 at p. 3). At an MRC specifically: people “assigned medical or psychiatric out-patient status[] will be charged a copay fee for inmate requested visits not directly related to their primary diagnoses” (PS 6032.01 at p. 2). Fee disputes are reviewable through the Administrative Remedy Program (28 C.F.R. § 549.73, quoted at PS 6032.01 p. 3). See the inmate copayment program.

Camps are attached to three of them

Devens, Carswell and Lexington each have an adjacent minimum-security satellite camp — although the Lexington camp is closing. Camp populations are ordinary minimum-security placements, not medical ones.

Federal Medical Centers versus standard federal prisons

	Standard FCI / USP / camp	Federal Medical Center
Security classification	Minimum, Low, Medium or High, by security point score	Administrative — all point totals, all custody levels (PS 5100.08 at pp. 14, 16)
Who designates	DSCC, Grand Prairie	OMDT for Medical Care Level 3 and 4 and Mental Health Care Level 4 (PS 6270.02 at p. 5)
Institution care level	1, 2 or 3	4 (PS 6031.06 at p. 12)
Bed management	Local	OMDT and the National Utilization Review Advisory Board hold “full authority over all Care Level 4 (inpatient) medical bed management decisions including admission and discharge” (PS 6270.02 at p. 2)
Hospitalization	Community hospital, typically 7–14 days managed locally	Inpatient units on site, plus community hospitalization for what the MRC cannot do
Chronic care follow-up	Care Level 1–2: as clinically indicated	Care Level 4: every three months with an APP or physician (PS 6031.06 at p. 23)
How you leave	Ordinary transfer codes	413 Treatment Complete referral, requiring NURAB determination that treatment is complete plus Unit Team placement input (PS 6270.02 at p. 6)
Who overrides whom	Warden and local staff	“OMDT clinical and DSCC custody/security authority supersedes local clinical and executive decision making” (PS 6270.02 at p. 2)

That last row is the one to remember. When a Warden or a local Clinical Director says no, PS 6270.02 says central authority supersedes local decision-making on Care Level 4 bed management. That is a policy statement, not a right — but it tells you where the decision actually sits.

Forensic designations: court-ordered evaluations at Bureau medical facilities

A separate stream of people arrives at Bureau medical facilities not for treatment but because a court ordered an evaluation. OMDT designates all forensic cases, in collaboration with the Chief Psychiatrist and the Chief, Psychological Evaluations Section. Forensic designations are “court ordered psychological/psychiatric evaluations pursuant to Title 18 U.S.C. 3552, 4241 – 4247, and 4248, which are conducted at identified Bureau facilities” (PS 6270.02 at p. 6).

Four points from the policy:

• The study order has to be in the system. “Study orders must be received in the applicable federal law enforcement agency centralized database for designation” (PS 6270.02 at p. 6). An order the Bureau has not received is an order that produces nothing.
• OMDT will try to clarify an ambiguous order. “All forensic designations are managed through OMDT who will attempt to clarify the statutory intent of the court order prior to designating the individual” (PS 6270.02 at p. 6). Precision in the order is worth real time.
• Outpatient and inpatient sites are different. Evaluations “permitted to be completed in an outpatient setting” go to a Bureau outpatient forensic site; those requiring inpatient evaluation go to an inpatient forensic site (PS 6270.02 at p. 6).
• § 4248 cases involve a separate branch. OMDT consults the Sex Offender Certification Review Branch on 18 U.S.C. § 4248 designations (PS 6270.02 at p. 6).

The statutes themselves matter to families because two of them can extend confinement. 18 U.S.C. § 4241 governs competency determinations. 18 U.S.C. § 4245 governs hospitalization of a person already serving a sentence who objects to being transferred for care or treatment: the government may move for a hearing, and “a motion filed under this subsection shall stay the transfer of the person pending completion of procedures contained in this section.” 18 U.S.C. § 4246 governs hospitalization of a person due for release who suffers from a mental disease or defect. See our explainers on forensic and other mental health evaluations and civil commitment of sexually dangerous persons.

How many federal medical prisons are there?

Seven. Six carry the name “Federal Medical Center” — Butner, Carswell, Devens, Fort Worth, Lexington, Rochester — and one is the “U.S. Medical Center for Federal Prisoners” at Springfield, Missouri. All seven are classified administrative security on BOP’s roster, and their combined published population is 8,072.

Those seven are the Bureau’s Care Level 4 institutions, which is what “Medical Referral Center” means in policy (PS 6031.06 at p. 12). Separately, a larger set of ordinary institutions carries a Care Level 3 designation — the Bureau’s term for institutions housing people who “have more complex medical conditions and are more fragile,” who need frequent clinical contact and more visits to community specialists. BOP does not publish a roster of which institutions are Care Level 3; that assignment is made by the Health Services Division and is visible internally. If someone’s care level is 3 rather than 4, they are not going to an FMC — they are going to a Care Level 3 institution, and the request that gets them there is still a 770.

Where families get stuck with medical transfers

“We asked for a transfer and nothing happened.”

Ask three questions in this order. Was a 770 actually submitted, and on what date? Was it deferred for missing documentation (PS 6270.02 at p. 8)? And is the care level still a provisional SCRN, which blocks re-designation until it is converted (PS 6270.02 at p. 5)? Those three answers explain most stalled requests.

“He’s approved but he hasn’t moved.”

Two possibilities. Bed space — OMDT prepares a Transportation Authorization memorandum only “once an appropriate bed is available and a transfer date identified by the receiving MRC” (PS 6270.02 at p. 9) — or transport, which has its own set of medical bars. Meanwhile the sending institution’s duty to treat continues (PS 6270.02 at p. 8).

“The institution says they can’t do it.”

Ask whether the institution’s Medical Resources Directory (EMS-A206.060) shows the service as available on site, and when it was last updated — the policy requires quarterly updates (PS 6270.02 at p. 3). Ask whether OMDT authorized local treatment instead of transfer, which it is expressly permitted to do (PS 6270.02 at p. 5).

“Nobody will tell us anything.”

Medical information is released to a family member only with the person’s written authorization, on BP-A0621, Authorization for Release of Medical Information — see the form and medical records access. Get it signed early; it is far harder to get signed during a crisis.

“We think this is bad enough for release.”

That is a different question with a different route: a motion for a reduction in sentence under 18 U.S.C. § 3582(c)(1)(A), for which the Bureau’s own criteria are in its compassionate release policy. The medical record built at an FMC is frequently the evidentiary core of that motion. See federal compassionate release and what judges consider.

“Everything is a formal fight.”

Use the routes the Bureau publishes, in order: an Inmate Request to Staff (the BP-A0148 “cop-out”), then the Administrative Remedy Program at BP-8 through BP-11. Both create the paper record that any later legal filing depends on.

What changed in 2026

PS 6270.02 replaced a twenty-one-year-old policy

Issued 7 May 2026, it rescinded PS 6270.01 (15 January 2005). Its own summary of changes (PS 6270.02 at pp. 1–2) lists, among others: the local-management standard for hospitalization moved from five-to-ten days to seven-to-14 days; Follow-up Care added; a new section for the Treatment Complete Referral Request (413); a new section for forensic designations; a new section for Mental Health Care Level 4 designations; a new requirement that a Screening Care Level be converted to a non-provisional care level at the first comprehensive health assessment; a new section on OMDT prioritization of MRC re-designations; an explanation of the deferral procedure for incomplete requests; an express statement of the duty to treat until physical transfer occurs; the hemoglobin requirement set at 8 mg/dL; removal of the two-to-three-week time requirement for Routine Urgent designations; and removal of the section on procedures for long-term detainees.

PS 6031.06, Patient Care, took effect 22 June 2026, as part of a mass reissue of Bureau program statements, carrying the four-level medical classification quoted above (PS 6031.06 at p. 12) and the intake, comprehensive-evaluation and chronic-care timelines. See our explainer on patient care.

PS 6032.01, the inmate copayment policy, is dated 7 May 2026 and carries the $2.00 fee and the § 549.72 exemptions (PS 6032.01 at pp. 2–3).

The Lexington FMC satellite camp was announced for closure on 1 July 2026 (BOP press release). The FMC was not.

Four facilities came off BOP’s roster entirely in the 5 September 2026 reconciliation — MCC New York, FCI Dublin, FPC Pensacola and FCI Terminal Island. None is a medical facility, but any older list of BOP institutions you are working from is now wrong in at least four places.

Working with our team on a medical designation

Elizabeth Franklin-Best, P.C. is a nationwide federal practice with more than 20 years of federal and appellate criminal defense experience, run on an intentionally small caseload from offices in Columbia and Mount Pleasant, South Carolina. Medical designation work is the most document-driven part of our prison practice: confirming whether a 770 exists and whether it was deferred; converting a stale screening care level; getting the primary diagnosis and reason for referral stated the way the policy requires rather than as a list of conditions; identifying whether the obstacle is designation, bed space or a medical bar to transport; and building the administrative record through a cop-out and the BP-8 through BP-11 sequence so that a later filing has something to stand on. Where the destination is a court — a compassionate release motion, a habeas petition, or litigation about care — the legal work is handled by Elizabeth Franklin-Best and the firm’s attorneys.

We do not promise medical transfers, care-level changes, or release; those are discretionary decisions of the Bureau and of the courts. What we can do is make sure the request in front of the decision-maker is the one the policy actually contemplates. To talk it through, contact our office at (843) 620-1100. If the underlying question is release rather than care, start with federal compassionate release or federal prison early release.

For the rest of the system, see administrative-security prisons, minimum security, low security, medium security and high security, or the overview at federal prison security levels. For care in an ordinary institution, see medical care in federal prison, medical and dental care and dental care in prison.

Frequently Asked Questions About Federal Medical Centers

Authorities Cited

Every source relied on above, cited in full and linked once. Page references in the text are to the editions listed here.

• BOP Program Statement 5100.08 — U.S. Dep’t of Justice, Federal Bureau of Prisons, Inmate Security Designation and Custody Classification (Sept. 12, 2006), as amended by Change Notice CN-3 (May 6, 2026)
• BOP Program Statement 5310.16 — U.S. Dep’t of Justice, Federal Bureau of Prisons, Treatment and Care of Inmates with Mental Illness (May 1, 2014), as amended by Change Notice CN-1 (Feb. 18, 2025)
• BOP Program Statement 6031.06 — U.S. Dep’t of Justice, Federal Bureau of Prisons, Patient Care (June 22, 2026)
• BOP Program Statement 6032.01 — U.S. Dep’t of Justice, Federal Bureau of Prisons, Inmate Copayment Program (May 7, 2026)
• BOP Program Statement 6270.02 — U.S. Dep’t of Justice, Federal Bureau of Prisons, Medical Designations and Referral Services for Federal Prisoners (May 7, 2026)
• 18 U.S.C. § 3621 — Imprisonment of a convicted person
• 18 U.S.C. § 4042 — Duties of Bureau of Prisons
• 18 U.S.C. § 4241 — Determination of mental competency to stand trial to undergo postrelease proceedings
• 18 U.S.C. § 4245 — Hospitalization of an imprisoned person suffering from mental disease or defect
• BOP press release, July 1, 2026 — Federal Bureau of Prisons, Facility Closures and Conversions

Reviewed for legal accuracy by Elizabeth Franklin-Best, Esq., Principal Attorney·September 2026