TDCJ 'Going California'?: Prison health under-funded by nine figures

The big news in the corrections field recently has been the US Supreme Court's order for California to de-incarcerate its overstuffed prisons because of a failure to provide adequate healthcare. But Texas is setting itself up for the same type of situation with recently announced cuts to the prison health budget. Universities providing prison healthcare said prior to the 82nd Legislature that they weren't compensated for $57 million in healthcare services in the last biennium. The Legislature covered last year's shortfall in House Bill 4, but then they slashed another $71.5 million from prison healthcare over the next two years.

So if the last biennial budget was $57 million short and budget writers cut another $71.5 million without reducing the number of prisoners, the shortfall in the next two years - assuming the same levels of care - would run to $126.5 million, or around $800 per prisoner - a smaller reduction than earlier drafts of the budget but still around a 14% cut. In response, Grits commenters who work at TDCJ say thousands of clinic visits have already been canceled and operating room schedules have been reduced. While some of these services may not have been medically necessary, it's hard to imagine those levels of reductions without impacting actually needed services. As one commenter declared, "The system is clearly going California."

Even taking into account allegations by the state auditor that UTMB overcharged the state $37 million in the last biennium for services not covered under their contract, that's still nearly $90 million short of the amount needed to provide services that state officials already considered barely constitutional. (And notably, the state reimbursed universities for all the alleged overcharges, siding with UTMB over the state auditor.) A new $100 annual fee will replace $3 copays for inmates, but if there's no money in their commissary account they don't have to pay and nobody thinks it will remotely cover the shortfall. (UPDATE/CORRECTION: The bill to revamp inmate copays died unexpectedly on the last day but has been revived in the special session, reports the Statesman's Mike Ward.)

As far back as 2005, UTMB officials said the system was near the brink of failing to provide constitutional levels of care: "'We can't go any farther,' said [Dr. Ben] Raimer, a physician and former chairman of the state's Correctional Managed Health Care Committee. 'I'm certainly not going to be involved with a system that is not constitutional. . . . We're at that line now. One step across it and we're there.'" Unfortunately, the state since then has taken several more steps across that line, culminating in this year's outright draconian cuts.

Regarding future shortfalls, the Galveston Daily News claimed that HB 4, "if it becomes law, will make the Texas Department of Criminal Justice — rather than the health care institutions — responsible for the bills for treating prisoners. When the prison system runs out of money, it will have to find new sources of money or stop sending prisoners for care." However I see no such provision in the bill, which definitely covered last year's shortfall but as far as I can tell did not transfer future obligations to TDCJ. (Perhaps it's in other legislation that passed, but I can't find/haven't seen it.) And as California's example demonstrates, it's simply not an option to "stop sending prisoners for care." Whoever wrote that (the story was attributed to "staff reports") has a slim understanding of the dynamics of prison health finance.

In any event, whoever must pay, the demographics of Texas' aging prison population mean costs will likely go up, not down, since the Lege failed to enact most proposed de-incarceration initiatives this year (with a few exceptions Grits will discuss soon). The Houston Chronicle reported recently that "Elderly inmates in Texas make up 8 percent of the state's prison population, yet they account for more than 30 percent of prison hospitalization costs." In FY 2010, the state "paid $4,853 per elderly offender for care compared with $795 for inmates under 55." In that environment, it's hard to imagine the prison health budget won't enter the next biennial budget cycle somewhere in the range of $100+ million short. Or else the state simply won't provide needed care, potentially leading to California-style litigation.

OTOH, since the California litigation took 20 years to reach the point where the feds imposed a solution, perhaps this move represents an accurate political calculation that legislators can kick this can down the road for now without risking federal intervention. The day of reckoning, however, is fast approaching.