Few Granted Release Under North Carolina’s Expanded Medical Release Law for Sick and Aging Inmates

RALEIGH, N.C. — In 2023, North Carolina lawmakers expanded the criteria for medical release from prison, hoping to give more seriously ill and aging incarcerated people the chance to spend their final days at home. However, nearly two years later, data shows the expected surge in approvals hasn’t materialized, according to North Carolina Health News.

Expanded Criteria, Minimal Impact

Prior to the change, medical release was limited to inmates expected to die within six months, those “permanently and totally disabled,” or individuals aged 65 and older with a debilitating illness. The 2023 reforms lowered the “geriatric” threshold to age 55, extended the terminal illness timeframe to nine months, and reduced the public safety requirement from “no risk” to “no or low risk.”

Advocates believed the reforms would be a win-win: allowing families to be together in the final months while reducing the Department of Adult Correction’s mounting medical costs. But in 2024 — the first full year under the new rules — only four people were granted early medical release out of roughly 32,000 inmates. So far in 2025, just five releases have been approved.

Why So Few Are Approved

Officials say the reforms didn’t change the core medical eligibility requirements, which remain strict. Most denials stem from:

• Conviction exclusions — People convicted of certain violent crimes or on the sex offender registry are automatically ineligible.
• Medical criteria disputes — North Carolina does not define incapacitation by daily living activity limitations like other states, leaving room for subjective interpretation.
• Aftercare challenges — Some eligible inmates have been denied release simply because there was no available long-term care placement.

Of the 465 referrals for medical release since 2019, nearly 40% failed conviction eligibility, and about a third were denied for not meeting medical criteria.

Advocates Push for Change

Groups like Disability Rights NC, FAMM, and the Wilson Center for Science and Justice at Duke Law argue that the law is underutilized and overly restrictive. They point to research showing older inmates pose a lower public safety risk but are far more costly to care for.

Kristie Puckett of Forward Justice emphasized the humane benefit of releasing people who are “dying in custody” while also relieving overcrowded and understaffed facilities.

In May, a new pilot program began pairing critically ill inmates with legal and medical experts to improve release applications and ensure viable care plans. The team is currently working on several cases, but advocates remain cautious about raising expectations.

Aging Prison Population Drives Costs

The state’s prison system is facing a demographic shift: 26.6% of inmates are now aged 50 or older. Research shows incarceration accelerates aging, meaning inmates often face serious health issues far earlier than the general population.

Prison healthcare costs hit $429.1 million in fiscal year 2023–24 — a 36% increase over five years — driven largely by this aging population. Despite these pressures, officials say most long-term care inmates will remain in custody because their convictions disqualify them from medical release.

Do you think North Carolina should further loosen restrictions on medical release for sick and aging inmates? Share your opinion in the comments at SaludaStandard-Sentinel.com.