Study: Obamacare's Medicaid expansion may lower prison costs
Report examined four ways that states respond to increasing costs
By Rebecca Boone
BOISE, Idaho — States can combat rising prison health care costs by expanding Medicaid under the federal Affordable Care Act, outsourcing and taking other measures, a report released Tuesday states.
Correctional health care spending in 42 states grew by an average of 52 percent between 2001 and 2008, according to the report by Pew Charitable Trusts that relied on figures from federal Bureau of Justice Statistics, with 2008 the most recent year available.
The researchers listed four ways states could reduce those costs, including Medicaid expansion. Critics of that expansion say states shouldn't transfer the responsibility for prisoner care onto the federal government.
Pew's researchers analyzed cost data from 44 states to find that 42 saw correctional health care spending increase, partly because the nation's prisoner population is aging along with the rest of America.
Other contributing factors included an increase in the number of state inmates during the time period examined, the rising prevalence of infectious and chronic diseases among the inmate population, and increasing costs of health care devices and medicines.
The amount of money spent on each inmate per year rose in 35 of the 44 states examined, according to the report. In Idaho, the per-inmate annual tab grew about 24 percent from $3,388 to $4,188. North Carolina saw a 203 percent increase, with costs jumping from $1,938 to $5,866 per inmate.
The report examined four ways that states respond to increasing costs. The methods include telehealth, which uses video conferencing between an off-site doctor and a prisoner; outsourcing care; granting elderly or infirm inmates early parole; and expanding Medicaid coverage.
Maria Schiff, director of the Pew project, said most inmates don't qualify for Medicaid in states that opt not to expand the program. The states that do expand will still have to pay for prisoner health care provided inside prison walls, said Schiff, but if an inmate requires surgery at a nearby hospital or other off-site treatment, Medicaid could cover those expenses.
Such an approach would save Ohio an estimated $273 million between 2014 and 2022, Schiff said, and California as much as $70 million a year.
A study by New Hampshire's Department of Health and Human Services estimated that state's corrections department would save nearly $22 million between 2014 and 2020 as a result of Medicaid expansion. Michigan's Center for Healthcare Research & Transformation at the University of Michigan estimates that state will save roughly $250 million on inpatient hospital services for inmates during the first 10 years.
Putting inmates on Medicaid amounts to using a loophole to foist their responsibility onto the federal government, said Dennis Smith, former director of the Center for Medicaid under President George W. Bush.
"By definition, those state prisoners in state facilities are the obligation of the state and that obligation should not be transferred to the federal government ... I think most people would come down on the side that Medicaid was never intended to pay for the medical care of people in state custody," Smith said. "It's a very significant issue for the federal budget and Congress better close that loophole quickly."
So far, 25 states and the District of Columbia have said they are moving forward with Medicaid expansion.