October 30, 2013

Maine curbing per-prisoner health care costs

A study also shows huge increases elsewhere, including a 300 percent rise in New Hampshire.

By David Hench dhench@pressherald.com
Staff Writer

The Maine Department of Corrections had the highest per-prisoner health care costs in the nation in 2001 but was able to reduce costs significantly in the following seven years, according to a Pew Charitable Trust study released Tuesday.

Interactive map: Inmate health care expenses by state
 
Click below to compare how much money states spend on inmate health care.
 

Maine was one of only a handful of states that saw its per-prisoner health care costs go down in the 2001-2008 study period. The state’s annualized spending per prisoner dropped 13 percent over that time, from $7,762 to $6,740, the study said.

Meanwhile, some other states saw huge increases, including New Hampshire, where the per-prisoner costs rose 300 percent to $9,055, according to the study.

The costs of health care generally and the overall costs of corrections have both been increasing rapidly in recent years across the country, the study’s authors said. One of the significant drivers is the cost of mandated health care.

Key factors in prison health care spending are the high rates of mental health and substance abuse among inmates, a generally low quality of health among the people who are sentenced to prison, and an aging prison population.

The Pew study examined changes in correctional health care spending over the eight years and analyzed what some states did to effectively control those costs.

The cost-saving measures include compassionate release, which is a furlough for elderly prisoners with serious health problems, so their health care costs can be covered by other programs, such as Medicaid.

Another strategy is enrollment of prisoners in Medicaid whenever care is to be provided outside the prison. Federal rules prohibit Medicaid from covering medical services inside prisons or jails.

Some states, including California, saw their overall spending on prison health care surge over the study period.

Maine’s overall state prison spending for health care increased 6 percent, from $12.9 million in 2001 to $13.8 million in 2008. Meanwhile, the number of state prisoners climbed by 30 percent, from 1,735 in 2001 to 2,257 in 2008.

State officials said they could not vouch for the validity of the Pew figures, which were taken from U.S. Bureau of Justice Statistics reports. Scott Fish, spokesman for the Department of Corrections, said the state currently spends $18.8 million annually on health care for 2,194 prisoners. Those numbers average out to $8,204 per prisoner.

A spokesman for the Pew Charitable Trust said it is likely that the federal government included different spending categories than the state’s current figures.

Maine has experienced the aging of its prison population, which adds to health care costs.

Last year, Maine had 169 prisoners older than 55 – 8 percent of the total of 2,022 state prisoners at the time. Ninety-six inmates were older than 60, double the number in 2005.

Steve Lewicki, coordinator for the Maine Prisoner Advocacy Coalition, said prison advocates support an expansion of compassionate release, which has historically been underutilized, and see possibilities in improved health care by better utilizing Medicaid.

Lewicki said that under the prison system’s new health care provider, Correct Care Solutions, complaints have gone down and the quality of care has increased.

“That said, there still remains problems with health care services in Maine prisons,” he said.

Lewicki said the aging prison population reflects the demographics in the “free world” – where Maine has the oldest population in the country – as well as mandatory sentencing as part of a “get tough on crime” approach.

The result is an older and sicker prison population.

Lewicki said prisons should look at strategies for keeping prisoners healthy. He said he was told once that one in three prisoners at the Maine State Prison had some type of diabetes. The state should focus on health changes like improved diet that would reduce such chronic conditions, he said.

Health care spending is only one component of prison costs.

A separate report by the Vera Institute of Justice found that Maine spent $46,400 per prisoner annually on overall incarceration in 2012.

California estimates it could save $70 million a year by making greater use of Medicaid funding for health care of inmates outside prison walls, according to the Pew study’s authors.

California saved $20 million over three years granting medical furloughs to a total of 47 old and infirm prisoners, they said.

Maria Schiff, author of the Pew study, said increased use of Medicaid can save states money on prisoner health care even if the state, as is the case with Maine, has not enrolled in the expanded Medicaid program through the Affordable Care Act.

“Regardless of a state’s Medicaid expansion plans, enrolling eligible inmates in Medicaid is a strategy that can reduce prison health care costs, as Mississippi, New York and other states have shown,” she said. “Medicaid expansion creates an even greater opportunity for states using this strategy, and that is one of several factors worth considering as policymakers weigh this decision.”

Fish was unable to say how much Maine uses Medicaid funding for prisoner health care savings. State prisons are only one facet of the state’s incarceration expense.

Mark Westrum, administrator for Two Bridges Regional Jail in Wiscasset, also is chairman of the state Board of Corrections, which establishes the budgets for county jails. He said counties have piggy-backed on the state’s bidding process and joined together to share resources like health care administration and medical services as a way to save money.

“We get them fresh off the street when they’re at their worst,” Westrum said of inmates. “By the time the state gets them, we at the county level have been able to stabilize them.”

“Our pharmaceutical costs are very high and it’s very hard to manage because of the people we get in here,” he said.

Penobscot County Sheriff Glenn Ross said the county jails are like the emergency room, where the most acutely ill inmates arrive and need specialized care. By the time inmates are sentenced to prison, they have been stabilized and the prison health care is more like a long-term care facility.

To view the complete report, go to: www.pewstates.org

David Hench can be contacted at 791-6327 or at:dhench@pressherald.com

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