Compassionate release Hawaii approvals are stranding seriously ill prisoners in custody for months or longer when no long-term care facility will accept them, according to state parole officials and advocates.
ʻAiea, Hawaiʻi — At Halawa Correctional Facility’s medical unit, 52-year-old Christian Alameda struggles to stand after a January stroke left his right side mostly paralyzed. He received compassionate release in February so he could seek specialized care, but has remained in the infirmary because no nursing home or care center will take him.
As of June, at least three other people approved for medical parole were also stuck at Halawa’s six-cell infirmary, largely because facilities declined to accept them due to criminal histories, the state paroling authority said.
“This is a challenge across the country,” said Molly Crane, an attorney with FAMM, which advocates for fairness in prison policies.
Every state permits some form of medical parole, but Hawaiʻi is the only one without a statute, relying on an internal policy. Typical candidates cannot care for themselves or have terminal illnesses and often need assisted living, skilled nursing, or hospice. Yet facilities nationwide frequently refuse such placements, leaving people incarcerated long after release is granted.
Research reflects similar barriers elsewhere. In Rhode Island, nursing home rejections spiked when facilities learned a patient came from prison. In Colorado, medically complex parolees waited an average of 200 days post-approval for placement. In New York, prisoners who were granted parole sued the state after nursing homes declined them.
Compassionate release Hawaii faces safety and funding hurdles
Financing also complicates placements. People in prison are ineligible for Medicaid, so newly paroled patients often must apply after approval. A federal law enacted last summer shortened how far back facilities can claim retroactive Medicaid reimbursement from three months to as little as 30 days before application, increasing the risk of nonpayment for late submissions. The Centers for Medicare and Medicaid Services said providers and beneficiaries should prioritize timely applications to maximize coverage.
Demand for beds adds pressure. Most nursing homes already have waitlists, according to a 2024 report by the American Health Care Association and the National Center for Assisted Living. That intensifies hurdles for parolees, said longtime compassionate release advocate and former attorney Bob Merce, who noted many candidates cannot walk, dress, or reliably answer questions.
Sean Sanada, Oʻahu Region CEO for Hawaiʻi Health Systems Corp., which runs Leahi Hospital and Maluhia, said the system has reviewed dozens of compassionate release referrals but has not accepted any. He said they do not discriminate based on where a person comes from, but cited staff safety and resource limits. “The risk is just too high in most of those instances,” he said. Studies have documented resident-on-resident aggression in long-term care, including a 2024 analysis in 14 assisted living facilities where 15% of residents experienced aggression in a single month.
Keeping medically complex people inside is costly. FAMM estimates the annual cost to incarcerate someone with extensive needs in Hawaiʻi can be up to eight times the statewide average of $112,505 for a typical prisoner. By comparison, the average Medicaid reimbursement for a long-term care patient at a Hawaiʻi Health Systems Corp. facility is about $135,000 per year.
Some states have created dedicated pathways. Connecticut, Georgia, Massachusetts, and Vermont contract with nursing facilities to take eligible parolees, according to FAMM. MissionCare Health, part of the iCare Health Network, operates such programs in three of those states and estimates rates that are $100 to $350 per patient per day above average nursing home costs.
In Hawaiʻi, the Department of Corrections and Rehabilitation recommends cases to the paroling authority, which then decides on release. Approved individuals can go to family caregivers or a care facility. Hawaiʻi Paroling Authority head Corey Reincke said that in 24 years he cannot recall a successful facility placement without family stepping in. “Parole has to find a facility that can meet their medical needs and is also willing to take them. That’s where we’re hitting the roadblocks,” he said. For one case, he called more than 100 care homes, all of which declined over safety concerns. A 2024 state report shows Hawaiʻi’s long-term care facilities use about 80% of their licensed beds, but staffing shortfalls make even that hard to sustain.
Hawaiʻi Prisoners’ Refuge: Family
Family remains the primary exit for those approved. Last year, 69-year-old Paul Kupihea died at a hospital five days after his compassionate release to relatives. He passed before he could fly to his home island. In July 2025, after his condition became dire and he was diagnosed with an incurable cancer, his daughter in Hilo agreed to take him in despite limited contact over the years. The release came, but it was too late to move him home.
Crane said expanding and clarifying state laws is critical to speed decisions and broaden eligibility. Hawaiʻi lawmakers have attempted for years to pass compassionate release legislation without success. Without a statute that defines the process and qualifications, she said, even strong family support may not prevent life-threatening delays. “The absence of a compassionate release statute means that people who need compassionate release languish and even die in prison,” Crane said.
Back at Halawa, Alameda shares a small cell with a seatless metal toilet and a narrow window to a concrete wall. He hopes to see his 5-year-old daughter soon. “I made some mistakes in my life,” said Alameda, who has been incarcerated since 2024 for drug possession, driving a stolen vehicle, and bail jumping. Merce continues searching for a placement for Alameda, who was not convicted of a violent crime. He has helped about 15 people secure medical treatment outside prison, but said some have waited years. “The ones that stick with me, though, are the ones that I never found placements for,” he said.
Year-end giving helps sustain independent Hawaii news that covers stories like compassionate release, prison policy, and access to care across the islands.
