Christine Vestal, writing for Governing’s Stateline blog, discusses the likelihood that Medicaid expansion would ease the cost of providing medical care to inmates.
Typically inmates do not qualify for Medicaid. And, until somewhat recently, simply being incarcerated was a reason for disqualification. (“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.”) The fact of incarceration was eased as a reason for disqualification in 1997, but, in its current form, most inmates don’t qualify for Medicaid anyway. “That’s because all but a few states limit Medicaid to low-income juveniles, pregnant women, adults with disabilities and frail elders.”
That would change with the adoption of a Medicaid expansion. As I understand it, most people making under 133% of the federal poverty level would qualify. (About $15,000 for your average, unmarried inmate.) Why would you, as a law abiding citizen, want to pay for the health care of a good for nothing scofflaw? Doesn’t matter – you already are. Under IC 11-12-5-5.5 county jails are required to reimburse hospitals and medical providers for care given to inmates at 104% of the Medicare rate. State prisons are also required to provide medical care to inmates.
This is a big deal and a big expense for jails. You see a lot of people with big health problems coming into jail. Because they lack health insurance (and, to be honest, a lot of other life skills), a lot of times the only treatment they get is in jail. Or, if they have gotten treatment, it is sporadic and they frequently don’t do a good job managing their illnesses when they’re out of jail. See, e.g., this from the Indiana Law Blog about DuBois County:
June 26, 2012 – Monday afternoon, the Dubois County Council met and heard from Sheriff Donny Lampert on a request for a standard appropriation for medical expenses for inmates at the Security Center.
The $150,000 appropriation is a standard amount, but one inmate has racked up a bill of about $80,000 for medical treatment that could not be disclosed due to privacy laws. The inmate is doing better now, but the result is a high bill from an Evansville area hospital.
Neera Tanden, has noted that this sort of dynamic might put a lot of municipal leaders at odds with state leaders who take a dogmatic stand against the federal Medicaid expansion.
Mayors might recognize a “big windfall” for communities in the Medicaid expansion as currently uncompensated local costs born by municipalities begin to be eased with the new Medicaid funds from the federal government. And they might turn against their governors if they see them getting in the way of easing one strain on tight local budgets, Tanden suggested.
In any case, making jails the medical providers or medical insurers of last resort for marginal elements of our society is a horribly inefficient way to deliver health care. I expect a lot of local officials would like to get out of that part of the health care business to the extent possible. Ideological rejection of the Medicaid expansion by state officials might make that impossible.