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Health care for prison inmates accounts for about a fifth of state correctional budgets, according to a report released by the State Health Care Spending Project, a joint initiative of the Pew Charitable Trusts and MacArthur. The report warns that the “graying of American prisons” — tens of thousands of older men and women behind bars who will need greater medical care — could offset savings even if inmate populations get smaller. Certain policy strategies, including Medicaid enrollment, could help officials contain spending, according to the report.