Friday, October 21, 2011

Obamacare provision a boon to budget writers on state prison health costs but complicates UTMB negotiations

Via Sentencing Law and Policy, I was fascinated to see an article from about how "Obamacare" may soon actually provide hospital coverage for state-level prisoners, which is an aspect of federal healthcare reform I was definitely unaware of. Reported
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.

Here’s how it works:

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 a bonus to state corrections agencies, most inmates would be considered new to Medicaid, making them eligible for 100 percent coverage by the federal government between 2014 and 2019. After that, states would be responsible for only 10 percent of their coverage. In addition, state health insurance exchanges—which are required to be functioning by 2014—would make it easier for corrections departments to sign inmates up for the program.
I find this report fascinating in the context of the ongoing negotiations between university health systems in Texas and the state prison system over provision of inmate care. Hospital care is considered the "plum" of Texas inmate healthcare, while the money losing part is the frontline clinics inside prison facilities. So UTMB has been pushing to keep the hospital care and dump in-prison healthcare, while the Department of Criminal Justice has threatened to farm out inmate healthcare to local hospitals if UTMB won't agree to continue operating the prison clinics.

This news, though - while welcome from the perspective of Texas taxpayers who will see state costs for inmate healthcare decline - seemingly throws a monkey wrench into everyone's plans. Presently, UTMB charges more than Medicaid rates for hospital care, so once inmates are covered by Medicaid, that part of the contract would cease to be the "plum" they consider it now. Similarly, local hospitals may be less likely to seek out contracts with the prison system if they must accept Medicaid rates, and it's a virtual certainty that private prison health contractors won't want the job at the low rates Medicaid pays.

At the same time, the state would be foolish NOT to sign inmates up for Medicaid, where the feds would pay 100% of hospital costs between 2014 and 2019 and 90% after that. Given recent cuts to Texas' prison healthcare budgets, the state has virtually no choice but to go that route. Right now, 100% of hospital costs come from the state budget.

I've no idea whether the parties to negotiations are aware of these changes to federal law, but signing up prisoners for Medicaid would alter the incentives for everyone involved, making hospital care less lucrative and attractive for UTMB, local hospitals, and private prison health providers alike. Indeed, finding providers willing to take Medicaid rates is already a challenge in the free world, so it remains to be seen how all this will play out.

In any event, this is good news in the medium term for Texas budget writers, even if it's an especially complicating factor for TDCJ's ability to contract for hospital care, with UTMB or anybody else, in the short run.


Anonymous said...

You've got to be kidding me! God I hope the Supreme Court strikes this socialist welfare program down. It makes no difference if inmate health care is paid for by the state or federal governments. Ultimately, it's the taxpayers who are having to foot the bill. When there are millions of children in this country without healthcare, it just defies common since that we're spending tax dollars for health care for criminals. Call me insensitive, but we have some really screwed up priorities in this country!

gravyrug said...

Umm, anon 11:00, are you suggesting that prisoners should be left to rot? That shows not only a callous disregard for human life, but a serious disregard for public safety. Most prisoners do eventually get out of jail, and if they come out sick, they can spread that sickness to the rest of us. It is in all our best interests to provide basic medical care to incarcerated people.

Gritsforbreakfast said...

11:00, you're not insenstive, just foolish and somewhat ignorant. The question isn't whether or not taxpayers pay for prisoner health care, it's whether the state of Texas pays 100% from its budget or passes some of it along to federal indigent care programs. As long as we have mass incarceration, taxpayers are on the hook.

Besides, requirements by federal courts are what mandate the state pay for prisoner healthcare, why shouldn't the feds help pick up the tab?

Prison Doc said...

`You are all wrong. Nobody wins on this deal. Medicaid is never a good answer, reimbursement of costs is so small as to almost make billing them a waste of time. Granted, this would allow some cost shifting to occur, but medical providers at every level--UTMB and local hospitals too--would get the shaft, making their financial situation even worse. It's not an helpful change.

Furthermore, Texas taxpayers shouldn't get off the hook anyway: it's their public servants, legislators and local criminal justice systems that are keeping all these offenders locked up with their attendant medical expenses.

Anonymous said...

I agree with Prison Doc, if the Federal government has no say in the criminal justice policies in the state, then they should not be the ones paying for the it. Texas is only willing to change policies when budgets get tight. If the state is able to shift the costs to another party that has no say in its policies, what will prevent the state from continuing mass incarceration policies? Feds should pay for healthcare for the Federal inmates and States should pay for the state inmates. I shouldn't have my federal taxes raised because of policies in California I am unable to vote on or change. If we want Feds to pay for it then control of the whole system, policies and everything need to be shifted over to them.

Anonymous said...

What exactly are "mass incarceration policies?" When exactly was this policy implemented? I just thought we were locking up convicted criminals who were deemed by juries or judges to be unfit to remain in a free society. Ya'll make it sound like these criminals are some kind of political prisoners or something. That's pretty absurd.

Anonymous said...

Grits are you on twitter? I love your blogs and would love to follow you! (I am one of the many stressed out utmb cmc employees)

Gritsforbreakfast said...

"When exactly was this policy implemented?"

4:29, see the chart in this post and you can pretty much tell when they began to be implemented.

4:34, I don't use Twitter, sorry. You can sign up in the right sidebar to receive a daily email each morning with the previous day's posts.

Nurseypooh said...

I don't see how this will work due to security reasons. Most of the hospitals are leary of the inmates being in their care anyway they don't have the security staff and they send 2 TDCJ officers with each inmate. TDCJ doesn't have enough officers to send with every inmate who needs hospital care either. This would create a great danger to the public!
Policy changes would help with the cost of the unit based clinics and I don't mean the lay off's or the great KOP experiment which failed recently but thats another soap box.
Nerves are frayed at the units it is stressful to not know who you will be working for next month, year or what kind of benefits you will have. The last 2 yrs have been rough! Time will tell.

Anonymous said...

Just my opinion but I don't really believe this will be a factor after 2012 because I think Obamacare will go away when he does. The way things are going, he will not be re-elected and a Republican controlled house and Senate is probable and they will do away with Obamacare.

Deborah said...

I have got news for all of you, if UTMB quits as TDCJ Healthcare provider, we are going to have alot of dead prisoners, who have been left to rot! If UTMB quits TDCJ, then TDCJ has no one to monitor whether they are providing care to the inmates or not; I know this first hand, as my husband is one of those inmates! The money that will be paid into the healthcare for the inmates, will be taken by TDCJ and not used for healthcare! Think about that one! There will be no accountability by TDCJ to anyone about how they are caring/not caring for our loved ones! I agree with 1100, we have some really screwed up priorities in this STATE! I agree with what Gravyrug said too about spreading illness to all of us. And I agree with Prisondoc-- they just lock up anyone and then scream about taking care of them-- let the non-violent offenders out!
It seems that the people of Texas have their heads in their posteriors, when it comes to TDCJ and the inmates-- the ONLY ones who care are the loved ones, who are outside taking care of the inmates, because the system does not! We are having to pick up the $100.00 tab per year on the inmates care, which most of us are living hand-to-mouth and cannot afford it, as we are also paying court costs and such! I feel if TDCJ is going to lock up the breadwinners of the families on a tech violation, then they should have to 'foot the bill' for their meals, medical care and supplies too, which the inmate would do if they were home with their families!

Anonymous said...

It is way past time for families of inmates come together and force changes. We have the numbers. It is time for reckoning of tdcj, the bpp and our legislators.

Anonymous said...

I agree with you Cathy and this is one time that I agree with Prison Doc. As usual Grits you are right and thanks for staying on top of it.

A Mom said...

It is time for the families of offenders to come together. In addition to God only knows how many innocent people, we have low level, non-violent offenders in prison on technical violations of probation involving money. Most were given deferred adjudication with outrageous conditions of probation and astronomical costs for evals, assessments, treatment, probation fees and court costs and fines. Once the probationer or their family couldn't keep up with the costs, the probationer was revoked and the "criminal" was sent to "pay their debt to society" at the cost to taxpayers. And, most of the sentences are for a minimum of 5 years in some counties. The cost to incarcerate the delinquent probationer is costing far more than what the probationer owed.

Providing basic healthcare and food for inmates is called civilized, not socialist.

Anonymous said...

@Deborah: Offenders are already dying due to decreased healthcare staff and hours.

@A Mom: People in this country in general need to come together against corporate corruption. That's the root of this issue.

Perry's camp has tried and tried to have prison health care private. If Perry's pockets were being lined by a private company, the money would be there to pay the companies to come in and take over. However, none of them can do it at the $9/hr rate that UTMB does it at. So no profit for Perry=no money for healthcare.

This is essentially what Occupy Wall Street is all about. Corporate interests are running our country into the ground in every single sector. Their money in politics is the root of the problem. Eliminate profit from serving in a public office, serving your country, which should be a privilege, not a career.

Anonymous said...

Ok Mom I am so ready to rock the worlds of our lawmakers. When, where and how can we get the families together? I am ready, and willing to do whatever it takes. I live in north Texas. My email is Lets come up with a plan and implement it. I am sure there has to be more family members fed up with tdcj and how it is run. Cathy