Senate Bill 2448 passed the Senate without opposition. It is now with House Medicaid Committee. This bill would allow “medically fragile” inmates to be released to “special care facilities.” These are specially licensed nursing homes that Medicaid could pay for. Senator Brice Wiggins (R-Pascagoula), sponsors the bill. His bill would lower costs for Mississippi Department of Corrections. The department spends approximately $77 million annually to provide healthcare for those in its care. Medicaid will not pay for healthcare in prisons or jails. The state is responsible for the entire cost of the care of the very sick and elderly people incarcerated. According to the Department of Corrections, only three Mississippians were granted medical parole in 2021. Mississippi Today asked Wiggins for an estimate of the savings. He said that he did not have the numbers but would get them later. Wiggins did not return subsequent texts and phone calls. Wiggins stated that he still opposes Medicaid expansion. This would have saved Mississippi approximately $200 million in 2027. He declined to elaborate. He said, “I answered your question about the legislation, which was fair.” “And then, you jumped into Medicaid. “I’m not talking about that.” Last year, a comparable bill passed the Senate but died in the House. Rep. Joey Hood (R-Ackerman), is the Chair of the House Medicaid Committee. He did not respond to our request for comment. The bill is being criticized by some prominent supporters of Medicaid expansion in Mississippi. Richard Roberson, vice-president of state policy at the Mississippi Hospital Association, said, “If we’re offloading and giving parole inmates so that they can then get off state’s dime and put them on Medicaid, when it’s not allowing Mississippians who are working and have paid taxes to have the same benefit as these inmates who committed crimes against society, or haven’t been taxed in years, that is just wrong.” Roberson finds the politics surrounding SB 2448 puzzling. He said, “Anytime you see something out of the ordinary from the Capitol, such as this one, where Republicans pass a bill to extend Medicaid to inmates,” he explained. “That usually tells me there’s something underneath the surface.” Senate Bill 2448 defines “medically fragile” inmates as people who are “a minimal risk to society” due to their medical condition. They can’t do daily living activities independently and may have limited mobility. People on death row and sexual offenders would not be eligible. MDOC doesn’t currently use the term “medically frail” to classify incarcerated persons. Therefore, the Department cannot immediately tell how many people would be eligible for parole if SB2448 becomes law. People could be sent to “special care facilities,” which offer similar services to other nursing homes. They can also provide spiritual and recreational activities. Wiggins stated that the bill reduces state costs. It places these inmates in a location where they can receive medical treatment. It’s a win for everyone. They could be licensed as “special-care facilities” and welcome new patients. Wiggins stated that there are many facilities in the state interested in being licensed for this purpose. However, he didn’t say which. Connecticut was the first state to sign a contract for a nursing facility in order to house parolees from prisons who had serious medical needs. 60 West now houses approximately 40 parolees from prison. There are 85 total residents. Others are difficult to place due to their criminal histories or registration as sex offenders. David Skoczulek is vice president of business development for iCare Health Network. 60 West is a profitable operation. Skoczulek stated that he was only vaguely familiar with the Mississippi proposal. He was contacted in Mississippi a year ago by someone who was interested in pursuing a similar project. Skoczulek didn’t recall the details, but said that the Mississippian had an idea for a property and needed advice from iCare to make it a facility that could house paroled prisoners or to create a joint venture. Skoczulek stated that they were keen to see it move through the legislature. Connecticut’s lead in expanding medical parole to allow inmates to be sent to nursing homes has been followed by other states. This is the model Wiggins would follow. Skoczulek stated that iCare often provides advice and information to those in other states looking to duplicate the success of 60 West. A similar facility is also owned by the company in Massachusetts. The bill has not been supported by the Mississippi Health Care Association. This is the largest state-based organization of nursing homes. The organization declined to comment on the story. The Mississippi State Department of Health would be responsible for licensing special care facilities. However, it said that no interested facilities had contacted it. Also, the agency said that it hadn’t seen an analysis of costs and savings for the bill. The 1970s saw an increase in the number of Americans incarcerated due to tough-on-crime policies, as well as mandatory minimum sentencing laws. These policies have led to more people being incarcerated over time. A 2012 ACLU report found that the number of Americans incarcerated over 55 years old quadrupled between 1995 and 2010. They could make up a third of all prison inmates by 2030 according to a 2012 ACLU report. Healthcare for older and sicker prisoners is costly: North Carolina officials estimate that the average cost to care for someone over 55 was four times higher than for someone younger. According to MDOC, Mississippi currently holds 507 people over 65. Some states have adopted compassionate release policies in order to save money and send people home where Medicaid or Medicare can pay all their care. Mississippi has its own compassionate release policy. Early release is available for those who are 60 or older and have a serious medical condition that has no chance of recovery. This condition can be described as “incapacitating or totally disabling” or “terminal in nature”. As in many other states, Mississippi’s policy has not been widely used. MDOC reports that 10 people were granted parole in 2019 under this policy, followed by seven in 2020 and three in 2019. Experts believe that expanding Medicaid eligibility for all Mississippians would be a more cost-effective way to save money on the state’s prison system. Because of their low income, many incarcerated persons are eligible for Medicaid in states that have expanded coverage. Medicaid will not pay for healthcare that is provided in prisons or jails. However, it can reimburse states for any care that takes places off-site and involves at least 24 hours in a hospital/nursing facility. Medicaid may be able to pay for the care of a 35-year-old male in Kentucky who has appendicitis. According to the Pew Charitable Trust, this saved the state $16.4million in 2014 and 2015. The entire bill is paid by Mississippi. MDOC spent $24 Million on off-site healthcare in fiscal 2020. Acting president and director of Health Care Initiatives for Justice-Involved Populations at Community Oriented Correctional Health Services, Dan Mistak, stated that SB 2448 will likely only affect a few incarcerated persons, limiting Mississippi’s potential savings. Mistak stated that MDOC would be able to receive reimbursements for a larger share of medical expenses through a wider Medicaid expansion. This could help decrease the number of criminal justice cases. Access to mental and behavioral healthcare and substance abuse treatment programs can be expanded, which could result in fewer people being sent to prisons. Mistak stated that the legislator appears to be trying to patch up the mess at the end, on the most costly side, rather than going upstream to say how can we improve people’s lives and keep them out prisons. Paroling people in prison to nursing homes isn’t as easy as passing a bill. Because of the criminal records of Colorado’s parolees, it has been difficult for officials to find nursing homes that will accept them. Medicaid initially refused to pay Connecticut for parolees’ care at the 60 West because some residents were in a secure unit without medical justification. The federal government eventually approved reimbursement for 60 West. Medicaid will not pay for care if a facility looks like a prison. Skoczulek stated, “If I had you visit both nursing homes and didn’t tell what the mission was to you, you wouldn’t know that you were in any other type of nursing home.” “There are no guards or gates, no shackles or lights out, there is no security… We must protect resident rights.” Wiggins, an ex-prosecutor, said that paroling “convicted felons” to medical facilities was better than sending them home to their families. He said, “They gotta do their time.” “And they would considered an inmate.”