Locked Up Behind Fiscal Bars

December 20, 2007
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In a real sense, Kent County is being held in solitary confinement when it comes to covering medical expenses for inmates at the jail. And right now there doesn't seem to be an easy or apparent pardon on the way from this fiscal detention.

State law holds the Kent County Sheriff's Department financially liable for the physical and mental well-being of those incarcerated in the county jail, even if the initial arrest wasn't made by a Sheriff's deputy.

"Once we get the folks here, we pay for their health care regardless of who pays for their bed," said Richard Vander Molen, county vice chairman.

Last year, the county spent $5.7 million on that care, up from $5.5 million two years ago. This year's spending is expected to reach $6 million. Most of the money will come from property taxes that go into the general fund and from the corrections and detention millage. Those dollars pay for care at the jail, the honor camp and the re-entry program, but not at the juvenile detention center where money from the county's child-care fund is spent on medical expenses for the detained youth.

"We've been paying closer and closer attention to inmate medical costs," said Daryl Delabbio, county administrator and controller.

Delabbio said the county spends an average of $4,000 a year for each prisoner, a figure that includes the cost of an inmate's medication.

State law also gives county commissioners the right to seek reimbursements for those expenses, and the county can try to collect from the person locked up, from his or her insurance company, or from the health care provider.

But according to Capt. Darrell Singleton of the Sheriff's Department, more often than not the person charged isn't insured. Even if an inmate has insurance, though, many plans contain a clause that stops coverage when an individual is injured while committing a crime or is taken ill while awaiting trial. In those cases, the county becomes the primary payer.

What makes the situation worse, Singleton said, is that many of the 30,000 persons processed through the system each year haven't seen a physician in years, and their checkups at admission often reveal undetected conditions such as diabetes that need immediate treatment. Or a prisoner can develop a serious condition, such as kidney failure, while in prison. And expecting a doctor, clinic or hospital to always pay for that care is unreasonable in today's system — a private-sector model built on profit.

"On average, the individuals that come to us are of a lower economic status, typically unemployed, and therefore many of them do not have health care insurance. We find that many of them have not been to a doctor or received any medical treatment in years," said Singleton.

The county has to provide something to almost everyone it takes in, as the law requires it to assess the medical condition of all inmates within 14 days of their arrival at the jail. The only exception to that regulation is when a prisoner's stay is less than 14 days.

But of course the consistently biggest medical expense for the county is for inmates who are admitted to a hospital due to an illness or injury. An injury doesn't necessarily have to result from the commission of a crime; it could also come from an auto accident that results in an arrest, for instance.

"As soon as they are in custody or under arrest, the county becomes responsible for the health care costs," said Singleton.

The county has hired Prison Health Services, a private firm, to manage medical expenses at the jail, and PHS has negotiated a discounted rate for the county with Spectrum Health. So the county pays less than an uninsured inmate would be charged. Mary Swanson, an assistant county administrator, said the county also gets another price break. This one comes from Medicaid — but only if the situation is right.

"If a person is admitted and is Medicaid eligible, the in-patient charges can be charged to Medicaid," she said. "But only if they're admitted. If they're treated and released, it's our responsibility."

Despite having a discounted rate from Spectrum and some in-patient coverage from Medicaid, the county's medical expenses at the jail have risen by $500,000 over the past 24 months. That trend likely will mean the payment will go up again in 2009 as the jail almost always has a full house of 1,300 inmates.

One factor, though, will affect that expenditure more next year than the rates will. The county's corrections and detention millage expires in December 2009, meaning 2010 is the last year the county will receive those dollars if voters don't renew or increase it. The millage was worth $15.3 million to the jail last year and is projected to reach $16.5 million this year.

But there is a legislative light at the end of the medical-expense tunnel. In 2006, state lawmakers passed P.A. 20., which says a health care provider has to make a reasonable effort to determine whether a prisoner has some sort of coverage. Swanson said providers filed 90 claims with private insurers from February to October of 2006 and were able to collect $161,538 for services performed on inmates that the county otherwise would have had to pay.

"We've been working with the hospitals when we have taken someone there to have them determine if the person has coverage they can bill before they bill us," she said.

"It's good that we're working together with Spectrum on this. They're helping us with the identification and the billing."

Swanson said the county met with Spectrum Health officials recently to make sure both sides were on the same page regarding what is needed to determine if an inmate's treatment can be billed to an insurer. Most are treated at Spectrum's Butterworth Campus, but some emergency cases can end up at Saint Mary's Heath Care.

The county is looking to the state again for more help to control and possibly lower that medical expense. Swanson said because the county is a public entity, it would like Lansing lawmakers to say that all medical treatments for inmates can be billed at the same rate Medicaid pays. The county also wants them to let Medicaid coverage apply to every outpatient service.

"Certainly, the in-patient services covered by Medicaid have helped us," she said.

"It would be nice if out-patient Medicaid could help us, as well."     HQX

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