Only a fraction of Mississippi inmates diagnosed with hepatitis C receive treatment, which has allowed the treatable infection to develop into a life-threatening illness, interviews and documents obtained by Mississippi Today reveal.
As many as 845 people incarcerated in Mississippi Department of Corrections facilities were confirmed to be living with hepatitis C between January and March of this year, records show. During the same period, 48 people – or less than 6% with documented diagnoses – received treatment.
But in private, officials have at times cited a much higher caseload – 5,000 cases out of about 19,000 people incarcerated by the state. This suggests that public records may reveal only a small portion of a widespread hepatitis C problem in Mississippi’s prisons, a state lawmaker with direct oversight over the corrections department told Mississippi Today.
As people in the care of the state suffer and the treatable illness continues to fester, she said, officials aren’t using resources available to them to lower the costs of medications.
This year’s treatment numbers represent an improvement over last year, when 19 people in state prisons – or 2% with diagnoses – received medication for hepatitis C. In 2020, only three people received treatment.
READ THE SERIES: Behind Bars, Beyond Care: A Mississippi Today investigation into suffering, secrecy and the business of prison health care
Department of Corrections spokesperson Kate Head did not answer questions from Mississippi Today about why at least hundreds of people in its custody with the contagious illness are not receiving treatment. But she said the agency’s medical contractor “is responsible for providing appropriate medical treatment to inmates with all medical conditions, including Hep C.”
VitalCore Health Strategies, a company that holds a three-year, $357-million contract to provide medical care to Mississippi prisoners, declined to comment. The company was previously awarded over $315 million in emergency, no-bid state contracts from 2020 to 2024.
Data obtained by Mississippi Today show a clear disparity between the number of people who test positive for the virus and the number of people who receive treatment.
Behind closed doors, state officials and VitalCore executives have been briefed on a much larger volume of cases, House Corrections Chairwoman Rep. Becky Currie told Mississippi Today.
Mississippi has one of the highest incarceration rates per capita in the world. Currie, a Republican from Brookhaven, has oversight of Mississippi’s prison system and those who manage it. During a private meeting at the Central Mississippi Correctional Facility in Rankin County with some of these leaders, Currie said Dr. Raman Singh, VitalCore’s chief medical officer, told her and State Health Officer Dr. Daniel Edney that about 5,000 MDOC prisoners and some prison workers had contracted hepatitis C.
Corrections Commissioner Burl Cain shared the same number with her in a separate meeting, Currie said.
Singh did not respond to requests for comment.
MDOC and VitalCore did not respond to questions about whether such conversations occurred. Department of Health spokesperson Greg Flynn said Dr. Edney did not believe it would be appropriate to comment on a private conversation, but he said it “absolutely could be the case” that as many as 5,000 people incarcerated in Mississippi suffer from hepatitis C.
Mississippi Today identified inconsistencies in testing and diagnosis numbers, such as low numbers of tests that resulted in large increases in new diagnoses, obtained through public-records requests. “Data collection and streamlining of the reception and diagnostic unit” contributed to the discrepancies, Head said.
Rep. Becky Curry, R-Brookhaven Credit: Gil Ford PhotographyDuring a series of tours of Mississippi prisons last year, Currie, who is a registered nurse, said she witnessed prisoners suffering from a wide range of health ailments, including hepatitis C, without treatment. The suffering is preventable, and raises questions about how hundreds of millions of taxpayer dollars have been spent, she said.
Currie called the denial of hepatitis C medication in Mississippi prisons a “public health crisis” that she couldn’t look away from as a nurse and a Christian.
“This is morally wrong,” she said.
A cure to count on
Hepatitis C can be treated with a type of highly effective antiviral medication that cures more than 95% of patients in a matter of weeks. Nonetheless, there are over 10,000 hepatitis C-related deaths in the U.S. each year.
Left untreated, the contagious blood-borne virus can cause serious health problems, including liver disease, liver failure and cancer. It is the leading cause of liver transplants in the U.S.
Hepatitis C proliferates in state prisons across the country, where its prevalence is nine times greater than the general population.
Risk factors for hepatitis C, such as injecting drugs, overlap with those for incarceration, said Dr. Anne Spaulding, an associate professor of epidemiology at Emory University’s Rollins School of Public Health who studies hepatitis C in prisons. She formerly served as medical director for the Rhode Island Department of Corrections.
Spaulding said prisons should make the medication available to every person who wants treatment.
“There should be no reason why a prison can’t treat most of their patients,” Spaulding said.
The first treatment for hepatitis C arrived in the 1980s. But the medication had low success rates and debilitating side effects, including flu-like symptoms, fatigue, depression and suicidal ideation.
A major scientific advance in the early 2010s – direct-acting antiviral drugs – transformed treatment regimens, offering high cure rates, shorter treatment durations and fewer side effects.
“The cure is something that you can really count on,” Spaulding said. “So it’s gone from a difficult-to-treat infection to an infection that is much, much simpler and effective (to treat).”
But the breakthrough in treatment has meant little for most Mississippi prisoners with hepatitis C, who have been fighting for years to receive the medication in prison.
“It is a problem that has been left so long without any answers,” Currie said.
In 2017, Chad Spiers, then incarcerated at South Mississippi Correctional Institution in Leakesville, filed a lawsuit against the Mississippi Department of Corrections and the medical contractor at the time for denying him medication after he tested positive for hepatitis C.
Magistrate Judge Robert H. Walker dismissed Spiers’ complaint, ruling that his care was constitutional because, though he did not receive medication, he was monitored for progression of the illness.
“The Constitution guarantee (sic) prisoners ‘only adequate, not optimal medical care,’” reads the ruling.
The Department of Corrections’ hepatitis management policy obtained by Mississippi Today says it will provide treatment for people with hepatitis C diagnoses “when indicated.” Spokesperson Head did not respond to questions about which cases warrant treatment.
But a person with direct knowledge of medical care inside Mississippi’s prisons, who was granted anonymity to speak candidly about how inmates are treated, said prisons are financially incentivized to wait to treat inmates until they get sick enough for prison officials to justify purchasing the expensive medication.
“(Prison staff) were told he’s not sick enough yet,” the person said.
The medication can cost the Mississippi system almost $30,000 for a six-week course, the person said.
However, many state prison systems have negotiated cheaper prices for the medication and are able to treat more patients.
Delaying treatment runs counter to recommendations from the Centers for Disease Control and Prevention and the Federal Bureau of Prisons, which say clinicians should treat people and not wait for the illness to resolve spontaneously.
The CDC’s guidance should be applied to people who are incarcerated, said Dr. Kate LeMasters, as assistant professor at the University of Colorado who studies the public health implications of the prison system.
Most people with hepatitis C do not have symptoms, and about 25% will spontaneously clear the infection without treatment. The disease is slow moving and can take years for symptoms to show. But left untreated, it can wreak havoc on a person’s immune system, turning their skin yellow from jaundice and causing joint pain that leaves them immobile. Its longer-term health consequences, such as liver failure and cancer, are life-threatening.
“What we do now is that we let them get sick and die, or we let them get so sick that they get a liver disease, cirrhosis or cancer, and they die,” Currie said.
Disincentives and unused discounts
Even as the price of costly medication has fallen and treatment has become more effective, some state prison systems argue that treating hepatitis C is prohibitively expensive.
Several states have negotiated innovative payment models to treat people and prevent the spread of the disease inside and outside of prison walls.
Some use what is called the “Netflix” model – a subscription-based program that gives a state unlimited treatment doses during a fixed period. Other states have negotiated lower costs with pharmaceutical companies or obtained the medication through health care organizations enrolled in the federal 340B program, which requires pharmaceutical companies to sell outpatient drugs at discounted prices. The program can offer discounts on drugs in the range of 20% to 50%.
In its February 2024 contract proposal, VitalCore wrote it was “confident” it would be able to access discounted prices for hepatitis C medications using the 340B program.
“We have had tremendous success in accessing 340B purchasing and pricing in other similar contracts for the purpose of purchasing more expensive medications such as those for the treatment of HIV and Hepatitis C,” the proposal reads.
In the 2025 legislative session, a bill proposed by Currie would have required the Mississippi Departments of Health and Corrections to establish a hepatitis C program for inmates and work to obtain the medication at a discounted price through the 340B program.
The legislation passed the House with a large bipartisan majority, but didn’t survive negotiations with the Senate, in part because of a disagreement over the bill’s proposed audit of prison health care.
MDOC and VitalCore did not respond to questions about whether they receive 340B pricing for hepatitis C drugs. University of Mississippi Medical Center, the state’s largest hospital system, did not respond to a request for comment about whether the hospital partners with VitalCore to obtain discounted hepatitis C medication.
The Department of Health provided MDOC information about how to access 340B pricing several months ago, but the agency has not yet taken steps to obtain the reduced prices, Health Department spokesperson Flynn told Mississippi Today.
“The Department of Health has given information about how to go about getting 340B pricing and joining the program to the Department of Corrections,” Flynn said. “But to our knowledge, they are not utilizing the 340B, at least not that we know of right now.”
This means the Corrections Department isn’t making use of the tools it has to purchase hepatitis C medications at a cheaper price, Currie said.
“They’ve been able to get it all along,” she said.
A fate no one deserves
One study suggests it is most cost-effective to test and treat hepatitis C widely and provide linkage to care when people are released from prison because it prevents expensive complications and limits the spread of the infection.
“It’s going to cost the taxpayers more because we don’t initially treat it,” Currie said.
Currie told Mississippi Today she has personally asked the corrections department to treat several people she met while touring the prison system last year. One was “literally about on his deathbed” before receiving treatment, but has shown significant improvement since receiving medication, she said.
Despite evidence that suggests broad testing and treatment save money in the long run, Mississippi does not test widely for hepatitis C. Testing is performed “when deemed clinically indicated by the healthcare providers,” who take into consideration risk factors and the probability a patient has hepatitis C, Head said.
Incarceration itself is a risk factor for hepatitis C, given its high prevalence in prisons, LeMasters said.
“Everyone should be screened when entering prison because people who have a history of incarceration are considered at risk,” she said.
Opt-out testing, where patients are tested unless they specifically decline it, is the most effective way to identify hepatitis C, Spaulding said.
Incarcerated people are one of the few groups in the U.S. with a constitutional right to health care. MDOC has told Mississippi Today that it provides health care to prisoners that meets constitutional standards.
But a former top corrections official, after reading Mississippi Today’s coverage of prison health care issues, turned over internal communications to the news outlet that revealed top prison officials bemoaning the poor medical care provided to prisoners.
Inside prison facilities, hepatitis C patients are denied lifesaving medication – a fate no one, not even people convicted of crimes, deserves, Currie said.
“Our whole ‘because you’re in jail, we don’t care if you die’ program really doesn’t work for me,” she said.
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