Tuesday, July 23, 2013

TOP STORY >> Sheriffs like Medicaid for sick inmates


Leader staff writers

The Pulaski County Detention Center spends about $4 million a year on inmate medical care, but with recent changes in the state law, Medicaid could pay for some of that, according to Lt. Carl Minden, public information officer for the sheriff’s office.

New state and federal laws may lighten the financial burden upon prison and county jail budgets by paying for off-site hospitalization costs. Like the Medicaid expansion/private option implementation in general, details are just being worked out and no one seems certain of much.

As Arkansas Medicaid rules are written now, the care it pays for is available to the state’s most vulnerable residents, the elderly poor, children from low-income households and pregnant women with low incomes. But the rules change on Jan. 1 and an estimated 250,000 more residents will become eligible if their incomes are 138 percent of the federally-set poverty level or below.

The new rules also apply immediately to state prisoners who are treated in hospitals outside the prisons, and eventually to prisoners in county jails, if the counties and state work together on a mechanism to make it happen.

Lonoke County Sheriff John Staley said this week he was surprised he hadn’t been made aware of the changes before. His budget for medical and dental treatment for prisoners and hospitalization of prisoners is only about $50,000, but he said it could go over that amount as it did last year when the amount spent was $30,000 more than budgeted.

Staley said prisoners arrested for minor offenses such as non-payment of fines or pro bation violation, are usually released until their court date if they become ill because the county can’t afford the medical bills.

If information about policies and procedures in his department is what the state needs to make his department eligible for Medicaid for prisoners, he will gladly cooperate. But he’s skeptical and not counting on Medicaid to take part of the burden off his healthcare budget anytime soon.

“We’re probably getting excited for nothing,” he said. “It sounds good on the outside but, when you get down to the meat of it, we don’t know if it might be more burdensome than it’s worth.

“But it sounds really good,” he said.

Currently, the Affordable Care Act (Obamacare) is slated to kick in this January, but Cong. Tim Griffin has introduced a bill that would push the start date back a year.

Some of the state’s roughly 15,000 inmates already receive hospital care paid for by Medicare and Medicaid.

Minden says the sheriff’s office is getting educated about this possibility, largely through the Arkansas Sheriff’s Association, and has sent at least one high-ranking officer to an association meeting on the topic.

The detention center has its own infirmary with “30 plus” nurses and contractual agreements for a physician, a psychiatrist and some others to care for inmates at the 1,210-bed lockup, Minden said.

Currently, those in need of further care are taken to the University of Arkansas for Medical Sciences.

“If we could get some relief, we need to look at this,” Minden said. “We have to foot the bill for everything, unless someone has private insurance, and the vast majority don’t,” he noted.

“We’re in the business of detaining and arresting but not the insurance business,” Minden said. He wondered whether or not the detention center would need its own claims department.

“We’d need to get someone trained in the paperwork, and is it worth our while to do it?” Minden asked.

Capt. Clayton Edwards, administrator for the White County Detention Center, said he pays $15,000 a month to Advance Correctional Healthcare to provide nursing service 12 hours a day, a doctor on call at all times and weekly doctor visits for his inmates. But the company allows only $20,000 for hospitalization. The county has to pay outright for anything above that amount.

Right now, Edwards is not even sure which inmates would be eligible for Medicaid. Since eligibility will be based on income, the question is which income, he said. Would it be from the last year’s W-2 form or the last paycheck stub?

Those questions and many others need to be answered, Edwards said, and then jail workers need to be trained to fill out the forms if it is decided that the job is theirs.

Edwards said he hopes to learn more during the Association of Arkansas Counties conference in Hot Springs on Aug. 22.

“It’s going to be interesting to say the least, but it could be a blessing for counties across the state,” he said.

Mark Whitmore, a lawyer with the Association of Arkansas Counties who worked on legislation to allow sheriffs to sign up prisoners for Medicaid even if they don’t want it, said Tuesday that he hopes many of the details will be worked out within a month.

He said three major state agencies — the Department of Health, the Department of Human Services and the Insurance Department — are working with the Sheriffs Association and Association of Arkansas Counties and that he believes they all agree conceptually on allowing Medicaid to pay for hospitalization. But the issue of pharmaceuticals is unclear and working out the mechanics for enrollment could be problematic.

The National Association of Counties’ website has this to say about the barriers to working out the details of a transient jail population: “There will be enrollment challenges due to the nature and constraints of the jail setting. First, high turnover rates are common in jail populations — a substantial portion of jail detainees are released within 48 hours, although the average length of detention varies from two weeks to two months.

“Since a significant number of individuals are released in a matter of days, for a large portion of the justice-involved population there may not be sufficient time during their stay in custody to conduct eligibility determination and enrollment in Medicaid or an appropriate health plan on the exchange.

“Also, some county jails that currently conduct Medicaid enrollment just prior to an inmate’s release have encountered complications associated with inmates’ scheduled release dates frequently changing, making it difficult to track individuals and connect them to coverage in a timely way.

“Another challenge is that some inmates will not have the appropriate documentation needed for enrollment.”