MEDICAID LAW Inmate health-care policy irks officials

Some arrestees develop ailments, knowing they'll go to a hospital.
By PATRICIA MEADEand BOB JACKSON
VINDICATOR STAFF WRITERS
YOUNGSTOWN -- Medicaid coverage stops if you're jailed, even if you're not convicted, a situation that makes Mahoning County responsible for the health-care costs of jail inmates, nearly $2 million a year.
The situation isn't new, but with the county facing a possible fiscal crisis if a sales tax is not renewed in November, officials are renewing a call for changes in Medicaid law. One area lawmaker says the state has its own money problems, so chances of changing the law are slim.
"We take huge exception to the loss of Medicaid benefits," said Joseph Caruso, assistant county administrator. "People are innocent until proven guilty, and why should we assume payment for their lost benefits?"
At any given time, roughly 70 percent of the jail's inmates -- 767 as of Aug. 30 -- are not serving a sentence but are awaiting court action. Most are in jail because they can't make bond; a few are held without bond.
"If I'm arrested and lose coverage and then have a heart attack in jail, the county is responsible," Caruso said.
Legislature
Caruso said there's a push to have the Legislature change the law that now cuts off Medicaid benefits for inmates who have not been convicted or sentenced. He said there have been brief discussions with state lawmakers, and the goal is to give them "hard-core statistics" to show what the cost means to the average taxpayer.
"It's almost unconstitutional," said Robert Knight, jail health administrator. "The law should be reworded to say 'convicted,' not just incarcerated."
John Leutz of the County Commissioners Association of Ohio said federal Medicaid policy does not prohibit the continuation of Medicaid benefits when a person is incarcerated. The problem, Leutz said, is that states simply don't include it in their Medicaid funding plans.
"This is a major issue for county governments and sheriff's offices all over the state," he said. "It's a very complicated issue to get a handle on."
Dee Crawford, director of the county's Department of Job and Family Services, said she and other county JFS directors across the state have complained for years about the cutoff of Medicaid benefits when people are arrested.
"We have been trying to get the Legislature to revisit that, to no avail," Crawford said. "It's another instance where the state passes down the cost of doing business onto the county."
At the state level
State Rep. John Boccieri of New Middletown, D-61st, agreed and said he understands the county's plight, but doesn't see any help on the horizon. He said the state is looking at a projected $4 billion deficit in the next two to four years.
"I just don't see this being corrected in the near future, as long as the Republicans are in control," Boccieri said.
He said a solution would be for the state to restore local government funds to counties and municipalities. That is revenue from several state taxes that is distributed back to local governments. The state consistently has reduced LFG money over the past several years, leaving local entities to pick up the slack for mandated costs, such as jail medical services.
Once an inmate whose Medicaid service was terminated because of incarceration is released from jail, Crawford said it's up to JFS to jump through hoops of red tape and get him or her reinstated.
County contracts
The county has contracted with Prison Medical Services of Brentwood, Tenn., since 1996 to provide medical care for jail inmates. In 2000, it cost the county $89,000 a month for 424 inmates. The cost has risen steadily since then.
The jail's current contract is $127,507 per month for up to 550 inmates and $2.64 per inmate per day above 550, Caruso said. Because the jail routinely holds about 750 inmates, the added monthly cost has been about $15,000, he said.
At those rates, spending will reach $1.7 million this year, Caruso said. The contract includes up to $150,000 for off-site medical care that can't be provided at the jail. The county is responsible for anything above that amount.
The new contract, to be considered by commissioners in October, would be nearly $1.8 million, which is $149,808 monthly for 750 inmates with no per diem, Caruso said. The contract will include up to $300,000 for off-site medical care, with the county and the health provider splitting 50-50 anything above that amount.
Other problems
Knight said, along with the number of inmates, the cost of medication and staff has increased.
Caruso said some of the money the county earns from housing federal detainees at the jail will be used to help defray the increase in health-care coverage. The jail receives about $70 per day per federal inmate and typically houses 70 inmates.
Jail policy dictates that anyone under arrest who complains of a medical problem be checked out before being booked.
"If they think there's an alternate to jail they'll go to the hospital," Knight said of arrestees who complain of a medical problem.
Sheriff Randall Wellington said that's been a longtime policy at the jail. If a detainee shows any visible sign of injury or illness, they are not accepted into the jail until they are taken to a hospital for treatment.
By sending them for treatment before they are booked into the jail, the county avoids paying for that medical care, the sheriff said. If the person has no medical coverage, the hospital absorbs the cost.
Knight said the jail has a physician and two dentists during the day and nurses around the clock. The costs are covered by the county contract, he said.
Sometimes, even when there's no complaint, a jail nurse will not accept inmates until a hospital clears them for admittance.
Last week, for example, an 18-year-old man who police said struggled during an arrest after he fought with family members was not immediately accepted at the jail. The hospital described the man's wounds as superficial.
On occasion, men and women on their way to jail will complain to the arresting officers of chest pains, stomach cramps, blinding headaches and so forth. As Knight said, they know the complaint -- real or feigned -- will result in a hospital exam, which delays their trip to jail.
meade@vindy.combjackson@vindy.com