In the midst of sweeping healthcare changes, a certain population will continue to receive complete medical care without having to purchase any plan at all – the inmates in our county jails and state prisons.
Covering medical care for inmates means providing for a population who has disproportionately more medical issues, as compared to the general population.
During a recent meeting of the North Carolina Sheriff's Association, a presentation pointed out that 1 in 7 people with HIV pass through a correctional facility every year. Additionally, 39% of inmates have a chronic medical condition and 30% deal with major depression.
As a result, every county Sheriff's Office and ultimately, every tax payer, gets saddled with a hefty bill.
From the moment an inmate enters a county jail, whether awaiting trial or convicted, they gain access to complete medical care including prescriptions, dental and mental health services.
"Anything that they could possibly need, we have to supply," stated Sheriff Ed McMahon of the New Hanover County Sheriff's Office.
Therefore, many counties have outsourced the management of their in-house clinics to private companies in an effort to lower costs. However, if a medical issue goes beyond what the clinic can handle or requires hospitalization, those charges go above and beyond the contracted plan.
New Hanover County's detention facility, which houses the largest area inmate population (550 on average), pays about $2.2 million annually to Correct Care Solutions. That contract routinely goes out to bid, and covers all services delivered in the detention facility's clinic.
While the service provider relieves the detention facility of having to manage medical care, it absorbs almost 6% of the sheriff's total annual budget.
An additional $109,190.98 was needed to fund the cost of care outside the jail (hospitalizations, surgeries, etc), an expense that is almost impossible to predict year to year.
At Brunswick County's jail, $822,232.80 was paid to Transform Health for clinic services; Columbus County spent $211,599; and Bladen County allotted $130,670 to a private provider, but spent $214,212 for their estimated 122 inmate's care.
In Pender County, Southern Health Partners was paid $236,153 for health services. Additionally, Correctional Behavioral Health received $14,400 for mental health services and an additional $98,886 was needed in outside costs to care for their 67 inmates.
Some of the jails charge inmates $5 to $20 per clinic visit for non-emergency care but the collection of those fees can be hit-or-miss. If the inmate has a private healthcare plan, the service provider is billed.
As the nation battles rising healthcare costs, so do the county jails. The topic was addressed specifically, at a March meeting of the North Carolina Sheriffs' Association.
"If you have two or three inmates with a long-term, significant medical issue this could absolutely destroy a county's budget," said Association member, John Aldridge. "I don't think that's underestimating it."
These figures pale in comparison though, to what the state prison system requires for inmate medical care: $165.1 million in medical, $22.3 million in mental health, $9.8 million in dental and $38.7 million in pharmacy. All total, it's an estimated average healthcare cost of $6,226 per inmate.
"Anything they have, we inherit once they are arrested," acknowledged McMahon.
Anecdotally, sheriffs will tell you that for some inmates, that practice is entirely intentional: committing small crimes to gain access to no/low cost care.
"It's not uncommon whatsoever, for an inmate to go through a facility where that inmate is receiving the very best medical care they have received in the last year, two, or even their entire lives," remarked Aldridge.
McMahon acknowledges public sentiment demanding basic care, housing and meals for convicted criminals. He points out that many inmates are awaiting trial and not yet proven guilty.
Moreover, it's the state who dictates healthcare requirements. Deviating from those mandates can result in a jail being shut down.
In other parts of the country, states are putting their inmates on Obamacare, thereby transferring healthcare costs to the Federal Government. However, North Carolina opted out of Medicaid expansion into additional categories, which some inmates fall under.
In some counties, outsourcing the management of their clinic to a private provider has resulted in savings and efficiency.
In the past, staff had to be dedicated to inmate transfer to hospitals and demands of managing billing and paperwork. Under contracted service plans, healthcare is placed back in the hands of medical professionals whose training and equipment has helped to eliminate unnecessary hospital visits and treatment.
In addition, sheriff's offices review cases looking for inmates with heavy medical bills. If awaiting trial and deemed not to be a threat to the community or a flight risk, the sheriff will work with the District Attorney's Office and a judge to change the bond to unsecured or house arrest. The inmate is still heading to court but is now out of the tax-payer funded facility which is covering their medical care.
For every county Office, it's a constant balancing act between protecting their citizens from crime and excessive costs.
Copyright 2014 WECT. All rights reserved.