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[I]n Vermont, health care for prisoners is a $20.5 million business.
Now, a legislatively commissioned study will determine whether the state can bring that number down at least a little.
The Joint Fiscal Office is accepting bids for a study that will examine the way Vermont handles its prison health care services and compare that to at least eight other states “to assess whether current costs are excessive.”
The Department of Corrections didn’t initiate the study but welcomes a closer look at prison expenses, said Matt D’Agostino, the department’s financial director.
“We do have a sizable budget as it relates to the overall state budget,” D’Agostino said. “We want to do our best job to control the costs where we can.”
The state study comes after the Pew Charitable Trusts issued a comprehensive, state-by-state look at prison health care costs last year. Among the 49 states that participated in the study, Vermont came in with the second-highest per-inmate health care cost in fiscal year 2015 – $13,747.
Only California was higher, spending $19,796 per inmate. The national median cost was $5,720.
There’s a lot of nuance in those numbers, however. Because of variations in how states deliver care, the Pew study noted that “higher spending is not necessarily an indication of either waste or good quality care” and, “likewise, lower spending is not necessarily a sign of efficiency or poor quality.”
D’Agostino said the Pew study wasn’t “an apples-to-apples comparison between the states.” For example, he said Vermont is one of the few states that provides medication-assisted treatment for inmate addiction.
Also, Vermont is one of just six states that operates what Pew calls a “unified” correctional system, meaning there is no separate system of jails operated by other, smaller governmental entities.
Regardless of such variations, prison health care is a thorny issue. As Vermont and other states deal with budget shortfalls, officials are caught between the steadily rising costs of health care and a constitutional mandate to provide adequate health care to those who are incarcerated.
Vermont’s current approach is to outsource most prison health care functions to Centurion Managed Care. That has helped keep costs relatively consistent, D’Agostino said.
“With the current provider, we are in the fourth contract year, and the overall price hasn’t really changed (substantially),” he said. “There’s been a lot of work with the current contract, too, in terms of creating efficiencies where we could and finding savings where possible.”
At the same time, however, inmate health care costs are expected to rise. The state has allocated money for a legislatively mandated expansion of inmate addiction treatment, and officials also are seeking funds for a new program of hepatitis C treatment.
The Joint Fiscal Office study might come up with ways to alleviate some of those cost pressures.
The study is included in the fiscal year 2019 budget bill, Act 11. The statute says the fiscal office, in conjunction with the Office of Legislative Council, “shall review and evaluate the policies, contracts and processes the Department of Corrections uses to deliver health care services to assess whether current costs are excessive.”
That study “shall include a review of whether there is potential for the state to achieve savings in providing health care services to inmates and whether the state is contracting for appropriate services,” the law says.
The Joint Fiscal Office’s solicitation for a contractor to conduct the study says the review must include a comparison to at least eight other states. That includes the five other states with unified correctional systems – Alaska, Connecticut, Delaware, Hawaii and Rhode Island – as well as the other New England states of Massachusetts, Maine and New Hampshire.
The study also is supposed to include assessment of “current and past processes” for providing inmate health care in Vermont. And it should “identify possible policy levers that could reduce corrections’ health care costs,” the Joint Fiscal Office says.
According to state documents, the study will begin sometime next month. A final report is due to the Legislature Jan. 15.
At a recent meeting of the Legislature’s Joint Fiscal Committee, lawmakers complimented the Corrections Department’s ability to stay on budget last fiscal year.
But Sen. Dick Sears, D-Bennington and chair of the Judiciary Committee, noted that the prison population is getting older – a driver of higher health care costs. The Pew study said the portion of Vermont inmates age 55 and up rose from 8 percent in fiscal year 2010 to 11 percent in fiscal 2015.
“We’re paying 100 percent of (medical treatment for inmates), so I’m happy to see that the JFO will work on that study of health care,” Sears said.
State Human Services Secretary Al Gobeille echoed that sentiment. “I think that’s going to be a really good thing to take a look at that,” Gobeille told legislators.
