Jails across Arkansas could soon begin recouping hospital costs for prisoners newly eligible for insurance through the state’s Medicaid expansion. But some county jail officials are still trying to figure out how to use the system.
Jail officials with Benton, Washington, Pulaski and Miller counties have said they need to research the matter further.
“We are trying to make sense of it all, of what we can and can’t do,” said Rob Holly, Benton County chief deputy, about operations at the Benton County jail.
“I am all about saving money. If I knew how to do it today, I would do it.”
A majority of county jail and state prison inmates recently became eligible for insurance in states that expanded Medicaid, said Maeghan Gilmore, program director for the Community Services Division of the National Association of Counties.
Arkansas’ private-option program began Jan. 1; it uses federal Medicaid dollars to pay the premiums for private insurance plans.
The program expanded Medicaid coverage to adults with incomes of up to 138 percent of the poverty level - $16,105 for an individual or $32,913 for a family of four.
While many inmates are eligible for Medicaid, the insurance does not cover health care provided inside a jail, Gilmore said. It covers hospital stays only after the inmate has been treated for more than 24 hours, she added.
Jail officials say recouping hospital costs could affect their bottom lines. Jails pay the bill for almost all healthcare services provided to inmates while they are detained.
Marty Brazell, warden for the Miller County jail, said the lockup’s health-care expenses can fluctuate drastically on just one prisoner’s hospital stay. The Miller County jail averages 300 prisoners, Brazell said.
“You are always one heart attack way from a $200,000 deal,” Brazell said. “If a guy has a heart attack and stays in intensive care for three days, that alone could cost $100,000.”
Brazell said health-care expenditures for the jail last year were nearly $500,000. He said there was one surgery that cost $41,000.
“We want the public to understand that we are doing everything we can to take care of these guys with very little help,” Brazell said.
Brazell said the discussion about Medicaid coverage has been confusing. He said state officials have at times said hospital stays would be covered and then later said they wouldn’t be.
On Wednesday, Brazell said he was under the impression that prisoner hospital stays were not covered by Medicaid.
Ronnie Baldwin, the Arkansas Sheriffs’ Association’s executive director, said that early discussions on the issue were muddled.
However, the association has known for several months that hospital stays are covered by Medicaid.
“We had a series of sitdowns and discussions with everybody involved,” Baldwin said. “Sometimes we were getting conflicting stories from people sitting at the same table.”
Jail administrators and county sheriffs are not in the health-care business, Baldwin said, which can make navigating programs like the Medicaid expansion difficult.
“We provide health care,” Baldwin said. “We are certainly not experts on it. We are correctional officers.”
Benton County officials are discussing the privatization of their jail health-care system, Holly said.
Hiring a company to handle billing and processing of Medicaid claims, for example, could relieve jail officials of those health-care decisions. He said the discussions are not directly related to the Medicaid expansion.
Southern Health Partners is a private company based in Chattanooga, Tenn., that contracts with several counties in the state, including Miller County.
The company provides health care, personal services and medications to prisoners, and also handles health-care billing.
On Tuesday, the company led a discussion on privatizing health care in Benton County during a Quorum Court Committee of the Whole meeting.
Tim Quintana, a company marketing representative, told the committee that billing can be complex for jail officials who often have little medical training, comparing it to a language barrier.
“Law-enforcement officials speak Chinese to each other,” Quintana said. “While medical people speak [a different] Chinese to each other.”
Washington County Sheriff Tim Helder said his office also is considering how to respond to the Medicaid expansion. He said hiring a private company like Southern Health Partners has been discussed. Another option would be creating a new position at the jail to handle Medicaid matters.
Screening inmates for Medicaid eligibility could become cumbersome, Helder said.
“When someone is booked, most of the time they are not real forthcoming with information,” Helder said.
Address or employment information that the prisoner provides could be false, Helder said, which could cause a lot of people to be denied coverage.
Regardless of the obstacles, Helder said, his office will figure out a way to help prisoners sign up for coverage.
“We know that it will be a cost savings to the local economy,” Helder said.
The Washington County jail spent $475,846 on medical expenses in 2013, according to documents provided by the sheriff’s office.
The jail recently has been averaging nearly 600 inmates a day.
Lt. Carl Minden, spokesman for the Pulaski County sheriff’s office, said officials there are also looking at how the Medicaid expansion will affect them but aren’t currently signing up prisoners for Medicaid.
“We are not a health-care center,” Minden said. “We do not have people doing medical billing or coding.”
Minden said it’s uncertain whether the jail will save money by signing up prisoners for Medicaid.
He said the jail could run into many obstacles, such as signing up prisoners who are released soon after.
“We are a county jail,” Minden said. “We are a pretrial facility. The average stay of an inmate is not as long. Is it logical to sign them up, if they may not need it?”
Minden said the jail spends nearly $4 million on medical costs annually. The jail has funding for 1,210 prisoners, but it is running over that amount, he said.
Baxter County Sheriff John Montgomery said he also is questioning whether the Medicaid expansion will help his 100-bed facility.
“We booked over 3,000 people in our jail last year, and we had no one who spent a night in a hospital,” Montgomery said.
The daily expenses of providing medication and short visits to the hospitals are the costs that add up, Montgomery said. He said taking the time to help inmates apply for insurance could be more costly than the savings.
The Arkansas Department of Correction has said virtually all of its inmates will become eligible for Medicaid because of the expansion.
Shea Wilson, spokesman for the department, said inmates will be enrolled in Medicaid after they receive health services.
The department spent $57,192,272 providing health care to inmates last year, Wilson said.
Arkansas, Pages 11 on 03/17/2014