A report released this week shows that Vermont has the second-highest health care spending per inmate in the U.S., and state data show those costs continue to grow.
States are legally obligated to cover the health care costs for inmates and, according to the report, the median cost per inmate nationwide rose 13 percent from 2011 to 2007, but peaked in most states prior to 2011.
That was not the case in Vermont where per-inmate health spending grew 17 percent during that period from $10,092 to $11,761. Only California spent more per inmate at $14,945 in 2011, according to the report, which was sponsored by the Pew Charitable Trusts.
The report cautions against reading too much into state-to-state comparisons because they don’t capture health outcomes for prisoners. That means higher costs don’t necessarily indicate waste and that lower costs may not be a sign of efficiency.
But how states manage prison health services can impact public health and safety as well as overall corrections spending, according to the report.
Vermont paid its inmate health services contractor $18.7 million in fiscal year 2013, or $1.2 million more than FY 2011, according to state figures. The Pew report covers 2007-2011.
Aging prison populations, the prevalence of chronic conditions – including mental illness – and transportation and staffing for health services are among the primary factors the report identifies for the growth in spending.
Those are all problems that challenge Vermont’s Department of Corrections, said Dee Burroughs-Biron, the department’s director of health services, but keeping inmates healthy in prison can have a positive effect when they’re released.
Vermont has the second-highest number of inmates over age 55, according to the Pew report, and the state’s inmate population continues to age, state data shows. Prisoners age 55 and older with chronic and terminal illnesses are on average two to three times more expensive to care for than other inmates.
The Department of Corrections looks to move older inmates with high medical needs out of prisons into long-term care facilities or even hospice care, but it isn’t easy, Biron said.
That’s because long-term care facilities are reluctant to admit inmates, even those who are feeble or incapacitated, she said, because of the stigma that follows a stint in prison and fear of public reaction.
Mental health and other chronic conditions make up the bulk of prisoner health services, the most recent figures from corrections show.
Mental health and other chronic conditions make up the bulk of prisoner health services, the most recent figures from corrections show. Thirty-two percent of inmate sick-call requests were related to a chronic physical illness and 18 percent were related to mental illness in FY 2013.
Forty-four percent of male inmates and 73 percent of female inmates in Vermont required mental health services, according to a point-in-time census from June 2013.
The Pew report states that nationally 65 percent of inmates had substance abuse issues in 2010, and Biron said the co-occurrence of substance abuse and mental health problems strain corrections’ health services.
Vermont’s five-year contract with Tennessee-based Correct Care Solutions LLC ends this year, and a new request for proposals calls for potential vendors to include greater substance abuse services in their bids. A contract is expected to be awarded at the end of the month.
The $18.7 million Vermont paid CCS in FY 2013 comes from the general fund and does not receive a federal match. Corrections can only use Medicaid money — which is federally matched — when an inmate spends more than 24 hours at a hospital or when they receive a medical furlough for long-term treatment, Biron said.
Getting prisoners to off-site medical services is also costly in Vermont, Biron said, mostly because medical transports require 2-3 corrections officers, some of whom are called in specifically for the transport or are working overtime.
The state also pays “an additional premium” to find doctors and nurses willing to work in corrections, Biron said.
Overall, health services in Vermont’s corrections system are more expensive because as a small state it can’t take advantage of economies of scale, Biron said.
Vermont’s eight prisons must all be able to provide basic health services, whereas a larger state might consolidate its infirmary or psychiatric services at one corrections facility, she said.
But that system is intentional and not necessarily a bad thing, she said, because it allows inmates to be closer to family and support systems, and ultimately the health services they receive are achieving good results.
Biron said that inmates with chronic conditions, such as hypertension or diabetes, often fare better than people with those conditions on the outside.
Inmates see their physicians regularly because they are required to, whereas people in the community with chronic conditions may miss appointments or balk at their cost.
It’s a struggle to make sure inmates continue treatment upon release, and the state is working to enroll them in Medicaid or subsidized commercial health coverage.
Vermont is also pursuing many of the cost-reduction strategies identified in the Pew report, Biron said, such as using telemedicine to avoid off-site medical or psychiatric visits and tracking health outcomes to see where services can be improved.
