Bernalillo County commissioners voted 4-1 on Tuesday to put the county itself in charge of healthcare inside the Metropolitan Detention Center, a shift that will end the jail's reliance on an outside hospital system and hand oversight to county government starting next summer. More than 1,700 people live inside MDC on an average day, and the vote sets in motion a new structure for how they get medical, mental health and addiction care behind bars.
The new model was adopted at the Bernalillo County Board of County Commissioners' Oct. 27 meeting, according to abq.news. Under the plan, the county will oversee the healthcare system as a whole while hiring a lead contractor and specialized subcontractors to handle services such as pharmacy, radiology and addiction treatment, the outlet reported. The transition is scheduled for July 1, 2027, when the county takes over from UNM Hospital, whose current contract runs out on June 30 of that year.
That handoff follows a four-year agreement UNM Hospital and the county signed in 2023, according to KOAT. UNM Health System stepped in to run MDC healthcare that year after MDC used five different private vendors over 17 years, the Albuquerque Journal notes in its own coverage. The jail has cycled through plenty of hands over the years — MDC used five different private vendors over 17 years before UNM took over in 2023, per the same KOAT report.
What the Takeover Will Actually Cost
Exactly how much the new arrangement will cost taxpayers depends on which document you read. The station's report states that county leaders are asking the New Mexico Legislature for $36.1 million in one-time funding to cover startup costs. abq.news separately reported about $37 million in one-time fiscal year 2027 startup costs covering electronic health records, medical equipment, facility repairs and initial staff onboarding, while KOAT reported that MDC estimates it will need about $63 million in fiscal year 2027 for medical operations, staffing and facility improvements.
Whatever the final number, those startup costs come on top of the county's existing $34.5 million annual contract with UNM Hospital, per the same abq.news account. To help bridge the gap, commissioners also voted Tuesday to ask the state for permission to withdraw up to $30 million from county reserves — a move that still requires state approval, the outlet reported. County officials are also exploring gross receipts tax funds, federal grants and opioid settlement dollars as additional funding sources, though none of that money has been secured.
Accountability Measures and Next Steps
Commissioner Eric Olivas pushed for an amendment requiring staff to deliver quarterly updates on the transition's progress and finances, covering operational, clinical and infrastructure milestones, according to abq.news. The county has already issued a request for proposals for pharmacy service providers and expects to pick one by mid-November, the outlet reported. A separate option that would have handed the entire system to one outside provider was estimated to cost $44.1 million annually during its first two years, per abq.news, while county staff had recommended a cheaper option estimated at $35.7 million a year for its first two years, according to City Desk ABQ.
The push to overhaul MDC healthcare isn't happening in a vacuum. The county has already had to patch the current system's budget this year — commissioners approved $4,012,583 in reconciliation funding for MDC medical costs back in May, an increase the Albuquerque Journal attributed primarily to higher staffing costs, including reliance on travel nurses amid a nurse hiring shortage. County officials have framed the broader overhaul as part of a wider push to expand treatment access for detainees, support recovery and re-entry, and improve accountability for results, according to a separate KOAT report on the county's review of healthcare models.
KOB 4 reported that the county has described the new structure as positioning itself as the healthcare system's leader and accountable authority at MDC, stating that the plan is meant to ensure people in custody can access quality care while maintaining transparency, fiscal responsibility and public trust. Under the new plan, the county will retain a lead healthcare contractor and use specialized subcontractors for clinical, behavioral health, substance use, pharmacy, peer support and re-entry functions. Whether lawmakers approve the requested $36.1 million, or the state signs off on the reserve withdrawal, remains to be seen as the July 2027 deadline approaches.
