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October 18, 2011

"Medicaid expansion seen covering nearly all state prisoners"

The title of this post is the headline of this interesting report from Stateline.org, which gets started this way:

The federal health law’s controversial Medicaid expansion is expected to add billions to states’ already overburdened Medicaid budgets. But it also offers a rarely discussed cost-cutting opportunity for state corrections agencies. Starting in 2014, virtually all state prison inmates could be eligible for Medicaid coverage of hospital stays—at the expense of the federal government.

In most states, Medicaid is not an option for prison inmates. But a little known federal rule allows coverage for Medicaid-eligible inmates who leave a prison and check into a private or community hospital. Technically, those who stay in the hospital for 24 hours or more are no longer considered prison inmates for the duration of their stay.

Under the 1965 law that created Medicaid, anyone entering a state prison lost Medicaid eligibility. The same went for people who entered local jails, juvenile lock-ups and state mental institutions. The reasoning was that states and local governments had historically taken responsibility for inmate health care so the federal-state Medicaid plan was not needed.

But an exception to that general rule opened up in 1997 when the U.S. Department of Health and Human Services wrote to state Medicaid directors saying inmates who leave state or local facilities for treatment in local hospitals can get their bills paid by Medicaid, if they are otherwise eligible. In addition to the incarcerated, those on probation or parole or under house arrest were among those who could participate.

Still, most state prisoners do not qualify for Medicaid. That's because all but a few states limit Medicaid to low-income juveniles, pregnant women, adults with disabilities and frail elders. The majority of people in lock-ups are able-bodied adults who do not qualify, even on the outside. In 2014, however, when Medicaid is slated to cover some 16 million more Americans, anyone with an income below 133 percent of the federal poverty line will become eligible. Since most people have little or no income once they are incarcerated, virtually all of the nation’s 1.4 million state inmates would qualify for Medicaid.

As the article goes on to explain, this could end up being very be good news for states struggling with prisoner health-care costs (and presumably bad news for anyone hoping federal spending will be reduced in the years ahead):

The 1997 ruling meant that even though a limited number of inmates would qualify, state corrections agencies could save millions in hospitalization costs because most hospital fees are lower for Medicaid patients and the federal government pays from 50 to 84 percent of the bill.

The problem was, few corrections agencies heard about the ruling. As a result, it took more than a decade for any state to take Washington up on its offer.... Even among corrections officials who did find out about the opportunity, many were reluctant to talk to Medicaid officials about the complex law, she says. Another barrier has been that many hospitals oppose the idea because it means lower fees for patients they are already serving.

So far, only Louisiana, Mississippi, Nebraska, North Carolina, Oklahoma and Washington State have taken advantage of the ruling. California is preparing to launch a statewide reimbursement program this year. Alabama, Michigan, New Jersey and Utah are studying the idea.

Mississippi was among the first to make the change. Launched in 2009, its program has already saved the state $10 million in inmate health care costs, says corrections commissioner Christopher Epps. The cost reduction comes partly from lower hospital fees and partly because 84 percent of the state’s Medicaid bills are paid by the federal government.... Out of 21,000 inmates in Mississippi, 242 have been approved for the program, and Medicaid reimbursements have paid for 2,088 days in the hospital. Perry says the most common reasons for hospitalization are childbirth, and treatment of cancer, liver and heart disease.

North Carolina launched a reimbursement program this year that includes all of the state’s 40,000 Medicaid-eligible prison inmates. According to a 2010 auditor’s report, the state corrections agency is likely to shave about $12 million from its $160 million annual health care bill by requiring hospitals and skilled nursing facilities to seek payment directly from Medicaid.

California, with about 160,000 inmates, is likely to be the next state to launch a Medicaid inmate reimbursement program. Corrections officials say they expect to have an enrollment system up and running by the end of the year. The state also plans to use Medicaid to fund hospital stays for some 6,000 inmates of state mental institutions. In 2014, of course, virtually all of the state's incarcerated will qualify for Medicaid-covered hospital stays.

October 18, 2011 at 12:04 PM | Permalink


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This might provide at least some balance to prison medical decisions -- which currently overwhelmingly involve ignoring complaints and refusing referrals to outside doctors/hospitals until the prisoner goes into some kind of acute distress (loss of consciousness, Myocardial infarction, etc.). Maybe if someone else pays for out-of-prison care, nurses and doctors will have a counter-incentive to send people to hospitals.

Now, it would be nice if they just made the decisions on a solely medical basis in the first place, but as long as there are non-medical motivations (budgetary, etc.) pushing them to undertreat prisoners, maybe some other non-medical motivations pushing them to overtreat would at least have some balancing effect and, on the aggregate, result in more appropriate treatment for the overall population.

Posted by: Anon | Oct 21, 2011 3:18:52 PM

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