**SAN DIEGO, CA** – The San Diego County Sheriff's Office is proposing a major overhaul of its inmate healthcare administration, seeking to replace its current contractor, Navicare, with United Healthcare's AmeriChoice. The proposal, discussed at the Board of Supervisors meeting on March 24, 2026, aims to control escalating medical costs and capture new state reimbursement funds, sparking a debate over fiscal responsibility and contractor accountability.
The move comes as the Sheriff's Office faces a severe budget crisis. Off-site medical claims for the incarcerated population are projected to hit $26.9 million this fiscal year, creating a multi-million dollar shortfall. Commander Jesse Johns attributed the rising expenses to a 7.2% growth in the inmate population and an increase in chronic health issues requiring specialized hospital care. The current vendor, Navicare, has been unable to control these costs or implement a critical state program.
A key driver for the proposed switch is the California Advancing and Innovating Medi-Cal (CalAIM) initiative. This program allows for Medi-Cal reimbursement for services provided to inmates in the 90 days before their release. Sheriff Kelly Martinez emphasized the financial imperative of this change, stating, "We are not seeking CalAIM reimbursement where we believe that we can. So we're hoping to generate some money back through the CalAIM process." The department claims AmeriChoice is equipped to handle the complex billing, which must be live by October 1, 2026, while Navicare is not.
The proposal includes a request for an immediate $13.8 million from a reserve account to cover existing cost overages. However, it met with skepticism from some supervisors and public speakers, who raised concerns about United Healthcare's reputation and the lack of a competitive bidding process. Supervisors demanded that any new contract include stringent "guardrails," such as making AmeriChoice financially responsible for cost overruns to prevent a repeat of past fiscal mismanagement.
As the county faces its duty to provide care for an increasingly medically complex population, the board must now weigh the promise of fiscal stability against the risks of a new sole-source agreement. The decision will test the county's ability to balance its budget while ensuring accountability from its private-sector partners in providing essential services.

