Preparing for the budget process requires establishing a mission for the correctional medical department. The mission provides direction for all the medical professionals who practice in the department and sets guidelines for the material and human resources needed. A key decision in the budget process is whether to provide medical services with medical professional employees or contract with medical staff or vendors to provide medical services to inmates. If medical staff are employees of the correctional system, sharing medical and dental staff among facilities is a necessity. In a small correctional system, it is necessary for one medical professional to be skilled and efficient in providing a number of services; for example, a facility's director of nursing could serve as the infectious disease nurse, health care administrator, accreditation authority for health care, and clinical laboratory coordinator. Further, the use of telemedicine is an efficient use of medical personnel, and electronic medical records and teleconferencing combined with a centralized pharmacy allow a small system to provide both specialty patient care and primary care to multiple sites efficiently. Also, using guidelines from managed care models will be helpful when managing and meeting the medically necessary constitutional standard of health care services. In addition, this article provides guidance for pharmacy management, professional development and links to professional organizations, and items that must be calculated for the budget. The latter include new programs or services, human resources, contracts, available Federal grants and other income, capital expenditures, expendable supply costs, outside medical cost projections, and pharmacy costs.