Sunday, July 7, 2013

The Vindicator: Expand Medicaid to prisoners

Matthew T. Mangino
The Youngstown Vindicator
July 7, 2013

An inmate in county jail costs local taxpayers about $65 a day or about $24,000 a year. That price tag doesn’t include the additional costs associated with getting into more legal trouble behind bars — that happens more often than you might think — drug smuggling, assault, even scams and fraud.

The cost also does not include catastrophic medical expenses. An inmate who is injured, or becomes ill, and needs hospitalization usually receives that treatment at local taxpayers’ expense.

A significant majority of counties across the country bear those medical costs out of their general budget even though a 1997 federal ruling permitted state prisons and local jails to pass off a portion of those costs to the federal government.


The Urban Institute did a study earlier this year on expanding Medicaid in Ohio and found that the state could save $15 million in inmate medical costs in 2014 alone through Medicaid expansion. However, the Republican-led Legislature cut Gov. John Kasich’s proposal to extend Medicaid eligibility from his budget. Kasich used a line-up veto to restore it, but he will have to negotiate with the General Assembly to win the necessary funding.

The Centers for Medicare and Medicaid Services issued a guidance letter 16 years ago directing that Medicaid benefits are available to eligible individuals who are incarcerated and have been admitted as an inpatient in a hospital that is not part of the state or local correctional system.

Medicaid can be billed to cover the costs of medical services for an inmate transported out of a correctional facility for inpatient services. The federal government pays 50 to 84 percent of medical costs, according to Stateline Magazine’s Christine Vestal.

States and local government bodies have a constitutional obligation to provide adequate health care to prisoners, and they must find a way to pay for it. These rights have been confirmed nationwide by countless lawsuits seeking not only adequate medical coverage as a constitutional right, but also access to such things as exercise areas, libraries and even cable TV.

There are about three quarters of a million inmates in local jails, another 1.6 million in state prisons, according to the U.S. Justice Department. The United States has the highest incarceration rate in the world, with the local jail population growing at a faster pace than the prison population. Most are in jail awaiting trial and incarcerated for relatively short periods of time.

Beyond treatment for inmates who are transferred from a correctional facility to a hospital for inpatient care, the Patient Protection and Affordable Care Act, better known as Obamacare, allows incarcerated individuals in pretrial detention to be classified as qualified to enroll in and receive services from health plans participating in state health insurance exchanges if they qualify for coverage. The act also makes changes to the enrollment criteria for Medicaid.


Obamacare provides yet another opportunity for savvy state and local governments to pursue recoupment of prisoner medical costs.

Only 12 states — Arkansas, California, Colorado, Delaware, Louisiana, Michigan, Mississippi, Nebraska, North Carolina, Oklahoma, Pennsylvania, Washington — and some local governments are pursuing Medicaid to pay for inpatient medical care for prisoners.

In Pennsylvania, Act 22 went into effect July 1, 2011. The law caps inpatient hospital care for most county and state inmates at Medicaid rates and outpatient care at Medicare rates.

In Wisconsin, the state stands to save almost $17 million in hospital costs for inmates, as a result of changes in enrollment criteria for Medicaid under Obamacare. Although taking full advantage of the cost savings for prisoners, Gov. Scott Walker has been unwilling to expand Medicaid for law-abiding adults who would also qualify under new income guidelines.

Ohio is doing neither. Although policy makers have made an ill-fated attempt to save money by selling a state prison to a private company, Ohio has failed to seek federal reimbursement for prisoner medical treatment and the Legislature continues to resist the governor’s effort to access potential cost savings created by Obamacare.

Matthew T. Mangino is of counsel with Luxenberg, Garbett, Kelly and George and the former district attorney for Lawrence County, PA. You can read his blog at and follow him on twitter @MatthewTMangino.

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