Inmate health care in community facilities not likely to net savings

12/11/2015 11:17 AM

FRANKFORT – As the cost of prison health care increases, Kentucky officials are considering ways to provide acute hospital and long-term care in community medical facilities so that Medicaid funds may assist with the cost, but questions over Medicaid eligibility for inmates may negate any savings gained.

That’s the findings of a report looking at ways medical care could be provided for prison inmates in community medical facilities, which was presented on Thursday to members of the Program Review and Investigations Committee.

Jean Ann Myatt, a member of the Legislative Research Committee who worked on the report, told legislators that there are some cases where care for inmates in a community hospital makes sense.

“Prisons can provide some health care services efficiently, but hospital care requires specialized equipment, facilities, and personnel, that are not cost effective for prisons,”
Myatt said.

According to the report, several states, including Kentucky, have found additional savings by working with hospitals to build secured units within the hospitals. Each inmate placed in a regular hospital bed required one or two officers around the clock.

Myatt pointed out that one of the struggles is having hospitals which would welcome such an arrangement.

“Some states reported that hospitals were reluctant to dedicate beds to inmates without additional compensation,” Myatt said. “It seems likely that Kentucky’s arrangement ended because the hospitals did not think that it was worthwhile.”

Shane Stevens, an LRC researcher who worked on the report told committee members that the cost differential providing long-term care inside of a prison, and providing long-term care in a nursing facility is the difference between the costs saved by corrections and the percentage of the nursing facilities costs not covered by Medicaid funds.

“In order for the strategy of placing inmates in nursing facilities to be cost effective, the variable cost savings must be greater than Kentucky’s portion of the Medicaid costs,” Stevens said.

Medicaid eligibility, as it relates to long-term care for medical parolees, is another sticking point.

LRC research analyst Van Knowles says in many cases, Medicaid long-term care eligibility requirements keeps many inmates from qualifying because of the Department of Corrections obligation to pay for inmate health care.

“If a Medicaid applicant has assets, Medicaid requires the applicant to spend those assets until becoming eligible for the long-term care benefit,” Knowles said. “However, current state law requires the Department of Corrections to pay for inmate health care. So, it cannot require inmates to spend their personal assets to become eligible for Medicaid.”

Stephanie Johnson, of the Kentucky Association of Health Care Facilities, says that even if inmates are Medicaid eligible for long-term health care, many community nursing facilities do not want inmates in their facilities because of public safety.

“Our concern is that our member facilities have very little protection with regard to the litigation environment in Kentucky, and with the survey environment,” Johnson said. “Until we can fix those two issues in Kentucky, our members are not likely to take inmates into their facility.”

Kentucky Department of Corrections officials reported that the department approached existing nursing homes and other facilities asking to have dedicated use of a wing or portion of the facility, but all facilities turned down the request. The possibility of developing a facility in Kentucky has been raised.


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