In many cities and counties, inmate health care comprises as much as a third of the cost of the corrections department. Options are presented on ways to substantially reduce the costs without reducing the quality of the care. We drew on practices of jails and prison across the nation. The approaches for cost reduction include ways to reduce demand or need for health care (e.g., screening need for hospitalization), and ways to reduce the cost per inmate when care is need (e.g. use of telemedicine.)