Editor’s note: This story was updated Aug. 29 to address all references to an erroneous article from the Pew Charitable Trust, which indicated Vermont was not billing Medicaid for inmates’ health services, when they were eligible. It has also been updated to clarify that state cannot bill Medicaid for emergency room visits or specialty appointments.
The Affordable Care Act could defray some health care costs for Vermont’s correctional system.
The Corrections Oversight Committee caught wind of this Aug. 12 when Legislative Council member, Jennifer Carbee, handed them an article from the Pew Charitable Trust with the headline, “States Missing out on Millions in Medicaid for Prisoners.”
That article turned out to be inaccurate. It stated that, for the past 16 years, only 12 states — Vermont not among them — have been taking advantage of a policy clarification that allows them to draw down federal Medicaid dollars for inmates.
VTDigger cited the Pew article in an earlier version of this story, which listed Vermont as one of the states that doesn’t bill Medicaid for eligible inmates. State Auditor Doug Hoffer informed VTDigger of the error, and VTDigger has since confirmed with Corrections Commissioner Andy Pallito, Corrections Health Services Director, Dr. Dee Burroughs-Biron, and Vermont Health Access officials that the department does, in fact, bill Medicaid during eligible situations.
The communications officer for the Pew Charitable Trusts, Matt Mulkey, said the mistake was an editing error.
“Typically, when using such a source she’d [Christine Vestal, senior writer for the Pew Center on States] say ‘at least 12 states,’ but in this case ‘only 12’ slipped through the editing process.”
VTDigger also contacted the Pew Center’s primary source, Donna Strugar-Fritsch, a principal with Health Management Associates in Oakland, Calif. In an email, Strugar-Fritsch explained, “I have researched quite a few states (maybe 15-20) in the past, but actual practice is very fluid… I have seen several articles that name states that are definitely claiming. They should say (but tend not to) that the list should not be construed as a complete one.”
The ACA does still offer possibilities to states, like Vermont, that already capitalize on this policy.
States foot the medical bills for their inmates — the U.S. Constitution requires it. In Vermont, the money for this comes from the General Fund.
Medicaid can be used to pay for services for inmates who qualify, when they are cared for outside the correctional facility.
The law that created Medicaid, passed in 1965, deemed inmates ineligible for the program, but in 1997, the federal government made a clarification. Medicaid can be used to pay for services for inmates who qualify, when they are cared for outside the correctional facility.
States cannot bill Medicaid for emergency room visits or specialty appointments. Medicaid funds can be used, however, for in-patient hospitalizations lasting at least 25 hours. If, for instance, an eligible inmate was hospitalized after an emergency room visit, the state could bill for the hospitalization but not for the emergency room visit.
Starting in 2014, Medicaid eligibility will be based on income, whereas currently it’s only available to people who fall in certain categories — being pregnant, disabled or elderly, for instance. The Congressional Budget Office estimates 16 million to 17 million additional people will enroll as a result.
The Affordable Care Act, in addition to expanding eligibility for Medicaid, also allows detainees to enroll the in the health insurance exchange. This will allow the Department of Corrections to bill their plan for medical services they receive while detained.
But the Medicaid billing system can be labyrinthine, and the Pew article suggests this is one of the reasons only a handful of states have been using Medicaid to pay for inmates’ out-of-prison medical costs.
Medical costs are a concern among DOC officials — Pallito has said he’s worried that they will climb as Vermont’s prison population ages. In 2011, 13.7 percent of inmates were 50 years or older, up about 4 percent from 2008.
The department’s Health Services Division oversees medical services for in-state prisoners, but it contracts with a private provider, Correct Care Solutions, to actually provide those services.
In FY 2012, the DOC spent $3.9 million on its mental health contract and $17.6 on its general health contract. In FY 2013, it spent $4.2 million and $20.6 million, respectively, on those contracts, and in its FY 2014 request, it asked for an additional $1.2 million for the general health contract.
Medicaid covers 100 percent of costs for patients initially; after several years, states assume a percentage of the cost.
The Affordable Care Act could defray some health care costs for Vermont’s correctional system.
The Corrections Oversight Committee caught wind of this last Monday when legislative counsel member, Jennifer Carbee, handed them an article from the Pew Charitable Trust with the headline, “States Missing out on Millions in Medicaid for Prisoners.”
Vermont is one of 38 states that, according to the article, has been losing out on a chance to draw down federal Medicaid dollars for inmates for the past 16 years.
States foot the medical bills for their inmates — the U.S. Constitution requires it. In Vermont, the money for this comes from the General Fund.
Medicaid can be used to pay for services for inmates who qualify, when they are cared for outside the correctional facility.
The law that created Medicaid, passed in 1965, deemed inmates ineligible for the program. But in 1997, the federal government made a clarification. Medicaid can be used to pay for services for inmates who qualify, when they are cared for outside the correctional facility.
In Vermont in FY 2012, this happened 1,623 times, including 268 emergency room visits and 842 specialty appointments. The inmate has to be in the outside facility for at least 24 hours, but it also applies to people who are on furlough or parole.
When the ACA takes effect in January, the opportunity cost of passing up Medicaid dollars will increase.
Starting in 2014, Medicaid eligibility will be based on income, whereas currently it’s only available to people who fall in certain categories — being pregnant, disabled or elderly, for instance. The Congressional Budget Office estimates 16 million to 17 million additional people will enroll as a result.
Vermont has yet to become one of what the U.S. Department of Justice describes as “pockets of excellence” — places that are already making plans to pull down additional Medicaid dollars as a result of the eligibility expansions under the ACA.
But the Medicaid billing system can be labyrinthine, and the Pew article suggests this is one of the reasons only 12 states have been using Medicaid to pay for inmates’ out-of-prison medical costs.
California, one of the states already pulling down Medicaid dollars for inmates, anticipates savings to reach $70 million a year once the ACA expansion is fully underway. But with $130,000 inmates, California’s prison population dwarfs Vermont’s, and for correctional systems operating on a smaller scale, the financial savings might not outweigh the administrative hassle.
Still, medical costs are a concern among DOC officials — Commissioner Andy Pallito has said he’s worried that they will climb as Vermont’s prison population ages. In 2011, 13.7 percent of inmates were 50 years or older, up about 4 percent from 2008.
The department’s Health Services Division oversees medical services for in-state prisoners, but it contracts with a private provider, Correct Care Solutions, to actually provide those services.
In FY2012, the DOC spent $3.9 million on its mental health contract and $17.6 on its general health contract. In FY2013, it spent $4.2 million and $20.6 million, respectively, on those contracts, and in its FY2014 request, it asked for an additional $1.2 million for the general health contract.
Medicaid covers 100 percent of costs for patients initially; after several years, states assume a percentage of the cost.
