Wednesday, October 03, 2012

Expanded medical parole would save tens of millions

At the Austin Statesman, Mike Ward provides the latest data and arguments for expanding use of medical parole for elderly and infirm inmates ("Old, infirm inmates costly to state; officials looking at alternatives," Oct. 3):
With the Legislature certain to face a tight state budget when it convenes next January, state officials confirmed Tuesday they are exploring a plan that could parole many of the most infirm, bed-ridden offenders into secure nursing homes where the offenders could be kept track of by ankle monitoring bracelets.

State records reveal that the 10 sickest convicts alone cost taxpayers more than $1.9 million during 2011, a figure that prison doctors say is growing every year as Texas’ prison population gets older and more infirm.
In all, records show that convicts over age 55 now make up 8 percent of Texas’ prison population, but account for 30 percent of its medical costs. ...
An internal prison report shows health care for the 10 costliest offenders ranged from $331,651 a year for a 48-year-old Houston robber to $131,294 for a drunk driver who died in prison.
At least three others are mostly bedridden with various ailments: A 40-year-old Dallas drug dealer’s health care cost $226,806 a year, a 57-year-old Corpus Christi armed burglar cost $181,779 a year, and a 34-year-old El Paso murderer cost $181,779.
Some prisoners have had open heart surgery, leg and arm amputations, kidney failure, while others have terminal cancer, paralysis and other maladies that have limited their mobility, officials said.
Taking into account the cost of security, [Texas Civil Rights Project attorney Brian] McGiverin estimated that if the state released on parole its terminally ill and infirm convicts, the savings could reach $76 million over two years.
See related coverage from the Texas Tribune, where the Texas Public Policy Foundation's Marc Levin provided more conservative savings estimate than McGivern:
Marc Levin, director of the Center for Effective Justice at the Texas Public Policy Foundation, agreed that the process is creating needless costs. In a recent report, he noted that granting parole to “infirm” inmates would save the state $42.6 million in 2013, while only adding $1.57 million in parole costs.

Levin said his organization is planning to propose legislation to simplify the process for medical parole. Levin said time and money are wasted when doctors spend write recommendations for inmates who won’t be considered eligible for medical parole anyway. And, he said, the parole board members don’t likely have the medical knowledge to understand the language in the recommendations.

A single commission with doctors and parole officials “in the same room” discussing cases “would really streamline the process,” Levin said.
Most of these high-expense prisoners/patients would be eligible for SSI or SSDI if they were paroled, meaning the feds would pick up their medical tab instead of it coming 100% from the state general fund. If the state is going to do this, though, it would behoove them to assist with eligibility determination for benefits as part of the reentry process so that local hospital districts aren't stuck with the tab for indigent services. 


ckikerintulia said...

Again, I will voice my repulsion of medical parole just to save the state money.

Gritsforbreakfast said...

Would you prefer they keep more severely disabled people locked up, Rev?

Sometimes folks do the right thing for the wrong reason, just as the system often does the wrong things for "good" reasons. At this point, I'd rather them do the right thing for whatever reason as opposed to waiting until everyone agrees with my own motives before ever taking a step.

ckikerintulia said...

Scott, I don't necessarily prefer they keep them locked up. I will ask, "Who's gonna foot the medical bills when they let them out?" It's almost certain that they can't. And a very good chance the family can't. So in many cases it's going to be shifting the bill to another branch of government.

I'm probably with you that it's better to let them out, even for the wrong reason. But it is the wrong reason!

Anonymous said...

Not to worry, Obamacare is free for everyone. It's not going to cost us a penny! Let them out!

ckikerintulia said...

When they do these medical paroles, they are making room for somebody else who maybe maybe not should be there. And saving that money not for the taxpayer but to spend on questionable CJ matters.

Richard Boland said...

This is an obviously complicated topic.

I have little sympathy for the criminals simply because they have medical issues. There are plenty of severely disabled criminals who deserve to be in prison for what they have done, just as there are plenty of severely disabled people who choose never to commit any crimes. A disability is not a free pass to commit crime with impunity.

On the other hand, I'm sure that there are convicts who's disabilities would effectively prevent them from committing more crimes, if they were to be released. If they are candidates for regular parole, perhaps this is an argument in favor of granting them parole.

I am also highly suspicious of the "savings" touted in the article. Even if the TDCJ actually reduces their budget by the amount saved, and the savings are passed along to the taxpayers in lower sales and property tax rates, shifting the burden to the Medicare system will in the long run, raise our Federal tax rate, and we taxpayers will not see any savings. Worse yet, what will really happen is that TDCJ will continue to request the same (or greater) level of funding, in spite of shifting the cost of inmate care to other taxing agencies, which is the very opposite of tax savings.

Ideally, we would grant parole to reformed criminals, they would leave prison, and get jobs and pay for their own healthcare. That's the way it is supposed to happen, but it seldom does, especially with those described as "severely disabled." Shifting the cost of their medical care to Medicare, or even the local emergency room, is only a tax-shifting, not tax-saving move. You might be able to argue that convicts who are too disabled to threaten society can be dumped on the street with no entitlement to healthcare at all, and your arguments would indeed have some merit, but this would hardly be described as anything like "compassionate."

Anonymous said...

"A disability is not a free pass to commit crime with impunity."

Typically they're not disabled when they commit a crime, but many, many years later after serving decades on a sentence. The issue comes up because sentences are so long we now have a lot of elderly people in prison who don't need to be there anymore.

Prison Doc said...

10 rilyischIt is a complicated issue indeed. Prison is either a place for punishment, for rehabilitation and restoration, or for permanently warehousing those who have lost the right to mingle in civil society--depending upon one's viewpoint. But prison is definitely NOT a healthcare facility. It is not intended as such, and it is a function that prison does not do very well.

"They're too disabled to commit another crime." 'taint necessarily so. There are career criminals who view prison as just another occupational hazard with which to deal. One of the last big cases I participated in in Federal Court was a human trafficking case where the main perp would easily qualify as "totally disabled" by Social Security standards.

I guess I look at it as a matter of whose ox gets gored, and on this score I am interested in saving money for the State of Texas.

Anonymous said...

The fat cows at TCOOMMI-Austin have been assigned to help with this task for years and years. They are too busy trying to prove that their advanced degrees make them smarter than the people they are supposed to help. They truly are worthless.

Anonymous said...

"If the state is going to do this, though, it would behoove them to assist with eligibility determination for SSDI as part of the reentry process so that local hospital districts aren't stuck with the tab for indigent services."
It would behoove you to learn the difference between SSDI and SSI. In order to qualify for SSDI, a parolee or any person for that matter, would have had to work long enough to earn enough credits to qualify. I know the numbers/studies don't exist, but there are very few parolees coming out of prison that have worked long enough to qualify for SSDI, thus making your "expert" comment irrelevant and pure hearsay on this subject.

Gritsforbreakfast said...

12:13, excuse me, SSI, not SSDI. Either way, parolees would be eligible for the feds to pay their healthcare, which is indeed relevant, despite your pointless snark.

That said, I'll correct the mistaken reference in the post.

Anonymous said...

"Either way, parolees would be eligible for the feds to pay their healthcare, which is indeed relevant, despite your pointless snark."

There's no guarantee they would be eligible, it can take years to get approved for SSI, most folks that apply are denied and that can take over 120 days just to get an answer back, then they have to appeal that decision. After that they have to hire an attorney who generally takes 25% of their back pay. So you thinking the "feds" will pay for their healthcare is completely wrong. The "feds" are the taxpayers. So either way, the people who actually work are getting the short end of the stick having to pay for criminals to get better healthcare than most law abiding citizens get.

Anonymous said...


You really have a lot of learning to do. The state has been providing pre release services for TDCJ-ID inmates for numerous years (SSI applications included). Look at the link provided and learn more about the topics you copy and paste from time to time.

Gritsforbreakfast said...

12:49, the link you provided mentions nothing about SSI eligibility, so I suppose we'll have to take your anonymous word for it that that's true. It's also interesting to me that on the one hand you say SSI takes too much time to apply for then turn around and claim they already do it. Which is it? You're contradicting yourself.

In any event, if it can take 120 days to hear back or even years to successfully apply, etc., that's not a great problem since most folks we're talking about have been in prison for many years, often decades. There's plenty of time. And since we're talking about severely disabled people - the parole board's definition requires far greater disability than SSI standards - I strongly suspect most of those eligible for medical parole would indeed be eligible for SSI.

Either way, there's no doubt I have a lot of learning to do, but I also recently sat through a Senate Criminal Justice Committee hearing in which they discussed how inmates receiving antipsychotics and other mental health drugs left TDCJ, including those leaving directly from solitary confinement, without the agency having arranged continuity of care, despite what you or TDCJ's website may say. (They do successfully connect HIV positive inmates with drugs upon departure, but not those with behavioral health problems.) From that discussion, I think it's highly disputable to claim, as the link you provided stated, that TDCJ is presently "Securing resources in the community for all offenders referred with special needs," which is the closest that page to addressing the issue.

And yes, the feds are the taxpayers. So what? So are county hospital districts, but it makes a lot more sense to get people whose healthcare costs that much on SSI than it does to have folks cycling through the emergency rooms.

Anonymous said...

Didn't say SSI takes too much time to apply, i said it takes at least 120 days to get a response from the social security administration for an initial SSI application. Since it's not a great problem as you claim, how do you suppose parolees take care of themselves in the meantime? Food, shelter and clothing aren't free like they are in prison. You cannot receive SSI benefits while incarcerated but you probably already knew that from your extensive work with parolees applying for SSI benefits, or as you say , SSDI, because you don't know the difference.
You can sit thru any committee hearing you want, the fact of the matter is the TCOOMMI continuity of care program has been linking mentally ill parolees/safpf referrals with community mental health services for numerous years. Maybe if the lawmakers actually visited an MHMR and saw how things actually worked, then and only then would they know what they are talking about.

Anonymous said...

Check the info on this link. It specifically says what is done for (COC) continuity of care. And just so you don't get confused, benefits means SSI.

Msybe you can take this with you to the next committee meeting you attend?

Gritsforbreakfast said...

1:51, you're all over the map at this point - take a breath. It's not just that I sat through a hearing, it's what Brad Livingston and TDCJ officials SAID at that hearing that contradicts what you're saying, and since they were willing to say so accountably under their own names and you're hiding behind anonymity and providing links that don't back up your statements, for now I'll believe them.

As for getting folks onto SSI, TDCJ should do all they can to facilitate signing up folks getting medical parole before they ever leave (you've spoken out of both sides of your mouth on this, claiming both that they do that now and that they don't). All I said was that, for just the reason you stated, it would behoove the agency to enable as quick a transition as possible to SSI as part of the reentry process. I'm not sure why you've got a burr under your saddle about this, but you seem to be saying the same thing, at least when you're not contradicting yourself.

Richard Boland said...

I'm still trying to figure out how it's better that my Federal taxes pay for something than for my State taxes to pay for it. Either way, it's still my taxes.`

Prison Doc said...

I think we are all pooling our ignorance here. All I know about SSI (and I used to be a medical examiner for Social Security) is that it is not a slam-dunk to get. And as other commenters have noted, it takes a long time in the application process.

But the name of the game here I think is to get the medical parolees out of the state prison system; it should not be the obligation of the prison system to insure seamless health coverage just because they are felons. Most are more interested in getting out of prison than they are in maintaining health care coverage.

Gritsforbreakfast said...

RB says, "I'm still trying to figure out how it's better that my Federal taxes pay for something than for my State taxes to pay for it. Either way, it's still my taxes."

Several reasons, Richard. For starters, state taxes are regressive, federal income taxes are progressive. Also, as Prison Doc pointed out, prisons serve many functions but healthcare provider isn't the one they're best at. Finally, since the state can't afford to build more prisons, removing severely disabled prisoners and elderly folks with low risk of recidivism frees up space and resources to house actually dangerous offenders.

There are probably other reasons but those are the main ones that make me prefer expansion of medical parole.

And to Prison Doc, I disagree that "it should not be the obligation of the prison system to insure [sic] seamless health coverage." These are very high-cost patients and IMO it makes little sense to dump them on counties without any provision to pay for their care. That said, if Texas were to participate in the Medicaid expansion under the Affordable Care Act, for most offenders it would resolve that issue.

sunray's wench said...

This really is shutting the stable door after the horse has bolted though.

Not all inmates would be released to no family support if they were actively rehabilitated and paroled earlier - before they become so ill that medical parole needs to be considered. So in those cases the family would be picking up the tab with their own insurance cover. Did you know that there are many families who are willing to contribute to medical insurance cover for their inmate, but that the insurance companies and TDCJ wont allow it? I totally understand why they wont allow it, but just the fact that the families want to contribute should tell you that the will and ability is there.

Put whatever money is available into real rehabilitation and training programmes, get these (mostly) men paroled a lot earlier and back into employment, and you will have enough people paying taxes to cover the other things that you want, like better roads, schools and other projects.

Richard ~ you don't get a say on what your taxes get spent on, no one does. You also don't get a say about whether you pay them or not. Try not paying and see how you then feel about prisons.