The Bureau of Prisons classifies every federal prison by security level, medical care level, and mental health care level. The Bureau also assigns each federal inmate security, medical care, and mental health care level. As a general rule, an inmate will be housed in an institution with classifications that correspond with his or her designation.
The federal prison experience can differ significantly from institution to institution. The biggest difference-maker is the security level assigned to an individual prison facility. High-security federal prisons tend to be extremely dangerous environments where abject violence at the hands of inmates and staff alike is relatively common. Minimum-security facilities, on the other hand, are usually quite safe and sane.
Medical and mental health care level classifications also impact life in federal prison, though to a lesser degree than security level classifications. In general, the higher the level, the better the care provided to inmates. For a federal inmate with a medical or mental health condition, the quality of care available at an institution can make a tremendous difference in the prison experience and quality of life. Sometimes the difference quite literally amounts to life or death.
Note: Private federal prisons have their own medical care levels. Please refer to the individual private prison or review the private prison websites for more information.
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Medical Care Levels
In an effort to better address and manage the health care needs of federal prisoners, the Bureau of Prisons assigns one of four medical care levels to each federal prison. The Bureau also designates every inmate with a medical care level classification. In most circumstances, an inmate will be housed in an institution with a medical care level classification that corresponds with or is higher than his or her medical care level.
Medical Care Level 1
Bureau institutions classified as Care Level 1 are located one hour or more from a community medical center. Care Level 1 facilities provide on-site medical treatment for prisoners and contract with local hospitals for inpatient care needs. As of March 2017, 21 Bureau institutions were classified as Care Level 1 prisons.
Inmates designated Care Level 1 are less than 70 years of age and are generally healthy. Care Level 1 inmates may have some limited medical needs requiring clinical evaluation and treatment every six months. Such medical needs may include asthma or diet-controlled diabetes, among other mild conditions. As of February 2019, about 71 percent of all federal inmates were classified as Medical Care Level 1.
Medical Care Level 2
Institutions classified as Care Level 2 provide the same on-site medical services as Care Level 1 facilities but are located less than one hour from a major regional treatment center. The closer proximity of these prisons to major treatment centers permits more immediate attention to serious and life-threatening medical situations. As of March 2017, 96 Bureau facilities were classified as Medical Care Level 2.
Care Level 2 inmates are medically stable but require at least quarterly clinical evaluations. Inmates with this designation can be managed in chronic care clinics and do not regularly require enhanced medical resources. Inmates designated Care Level 2 may suffer from medication-controlled diabetes, epilepsy, or emphysema. As of February 2019, 26 percent of all federal inmates were classified as Medical Care Level 2.
Medical Care Level 3
A Medical Care Level 3 facility is generally located near, or adjacent to, a Medical Care Level 4 facility. In rare instances, an institution that has greater on-site medical capabilities than typical Bureau institutions is classified as Care Level 3. As of March 2017, fewer than 20 Bureau institutions were classified as Medical Care Level 3.
Federal inmates designated as Care Level 3 have chronic conditions and are fragile outpatients who require frequent clinical contact and treatment. Care Level 3 inmates may require assistance with what the Bureau refers to as “activities of daily living” (bathing, dressing, etc.). Federal inmates suffering from advanced HIV, congestive heart failure, and cancer in remission less than a year may be designated Care Level 3. As of February 2019, about 2 percent of the Bureau’s population was designated as Medical Care Level 3.
Medical Care Level 4
The Bureau classifies seven institutions as Medical Care Level 4. All of these prisons are Federal Medical Centers, which provide enhanced medical services, including inpatient care. FMC Butner, North Carolina, is affiliated with Duke’s medical school and provides advanced oncology services. FMC Devens, Massachusetts, provides dialysis services to the federal prison population. FMC Rochester, Minnesota, is affiliated with the Mayo Clinic and provides complex, inpatient medical care. FMC Carswell, Texas, is the Bureau’s female-only Care Level 4 facility. FMC Lexington, Kentucky, provides complex medical services to lower -federal prisoners. MCFP Springfield, Missouri, provides Care Level 4 services to higher-security level inmates. FMC Fort Worth, Texas, is the Bureau’s newest Care Level 4 facility, officially designated an FMC in December 2016.
Care Level 4 inmates are severely impaired and may require daily nursing care. Such inmates may be suffering from cancer (in active treatment), quadriplegia, require dialysis, or may be undergoing or recovering from major surgery. Less than one percent of the Bureau’s population is designated Medical Care Level 4.
Mental Health Care Levels
In recent years, the Bureau of Prisons has operationalized a Mental Health Care Level system. This system augments the Medical Care Level system. Similar to Medical Care Levels, each federal institution is assigned one of four Mental Health Care Levels. The Bureau also designates every inmate with a Mental Health Care Level and attempts to house inmates in corresponding institutions according to their designation.
Mental Health Care Level 1
Federal prisons classified as Mental Health Care Level 1 are also classified as Medical Care Level 1. As such, an institution with this designation has no specialized services available to inmates with mental health care needs. As of February 2013, 17 Bureau institutions were classified as Mental Health Care Level 1.
Only inmates who show no significant level of functional impairment associated with mental illness will be designated Mental Health Care Level 1. An inmate with a history of serious functional impairment due to mental illness will only be designated at this level if the inmate consistently demonstrates appropriate help-seeking behavior in response to the reemergence of symptoms. If an inmate demonstrates the need for regular mental health interventions, he or she will not be designated Mental Health Care Level 1. As of February 2019, 96 percent of the federal prison population was designated Mental Health Care Level 1.
Mental Health Care Level 2
A Bureau institution classified as Mental Health Care Level 2 has a fully-staffed Psychology Services department. Such institutions also utilize dedicated Care Coordination and Reentry (CCARE) Teams. According to the Bureau, an institutional CCARE Team “identifies potential concerns affecting inmates with mental illness in a correctional environment” and develops “strategies and supports to mitigate potentially negative interactions between inmates with mental illness and the correctional environment.” As of February 2013, there were 61 Bureau institutions classified as Mental Health Care Level 2.
Inmates assigned Mental Health Care Level 2 require moderate levels of intervention. Such inmates have a mental illness requiring routine outpatient mental health care on an ongoing basis. Mental Health Care Level 2 inmates may also require brief, crisis-oriented mental health care of significant intensity. This type of periodic crisis care is generally limited to placement on suicide watch. As of February 2019, about 4 percent of the Bureau’s population was designated Mental Health Care Level 2.
Mental Health Care Level 3
The Mental Health Care Level 3 classification is different in that the Bureau does not classify entire institutions with this level. Rather, specific programs and psychologists are designated to provide this level of mental health care. However, if an institution provides such programs and psychologists, it is for all intents and purposes a Mental Health Care Level 3 facility. Mental Health Care Level 3 institutions also use CCARE Teams and are able to provide at least weekly interventions and more intensive outpatient care. As of 2013, 19 federal prisons were classified as Mental Health Care Level 3.
Inmates assigned Mental Health Care Level 3 require significant mental health interventions but not inpatient treatment. An inmate may also be designated as Mental Health Care Level 3 if he or she requires care in a residential treatment program, such as the STAGES program. As of February 2019, less than one percent of the Bureau’s population was designated Mental Health Care Level 3.
Mental Health Care Level 4
Federal prisons classified as Mental Health Care Level 4 are also classified as Medical Care Level 4, meaning that all Mental Health Care Level 4 prisons are Federal Medical Centers. Mental Health Care Level 4 institutions are essentially inpatient psychiatric hospitals that provide a broad range of services for the most severely mentally impaired inmates. As of February 2013, five federal prisons were classified as Mental Health Care Level 4.
Inmates assigned Mental Health Care Level 4 have acute needs that require intense, inpatient care. Such inmates are gravely disabled and cannot function in general population in a Mental Health Care Level 3 institution. Very few inmates in the Bureau’s custody are assigned Mental Health Care Level 4.