/Mississippi lawmakers attempt to save money on prisoner health care with Medicaid

Mississippi lawmakers attempt to save money on prisoner health care with Medicaid

Overcrowding in state prisons is a problem. Hundreds of elderly and sick prisoners are a result of strict mandatory sentencing laws. This has led to large numbers of Americans living in prison for the very first time in American history. Many of these prisoners are eligible for Medicaid coverage due to their age or disability. However, Medicaid won’t cover health care in prisons and jails. Mississippi is left with expensive health care costs. In 2020, the state spent $77 million on health services for prisoners in custody. This includes $24 million on hospital offsite care. Research shows that the cost of imprisoning an elderly person is three times more than for a younger person, as they have higher health care costs. Both chambers approved House Bill 936 this week. It is now on its way to Governor for his signature. The bill aims to reduce prison health care costs and create “special care facilities” to provide housing for 600 Mississippians currently in Department of Corrections custody. The bill would allow for medical parole to be extended for “medically fragile” prisoners. This would enable them to move to private facilities where Medicaid would pay for their care. Mississippi could be the first state to experiment with nursing homes for elderly and sick prisoners. There’s one problem: According to federal guidance, Medicaid will not pay for nursing care if residents are restricted in movement or if the criminal justice systems continues to have a role in their care. Some provisions in HB 936 seem to be against these rules. This raises the possibility that Medicaid might refuse to pay at least some parolees’ care at the facilities. The state would then have to continue paying. The bill defines “medically fragile” as someone who is so sick that they are unable to perform daily living activities. They are not expected recover. Parolees must agree to submit their medical records to the county prosecutor each quarter, if requested by the prosecutor. The final conference report also includes a provision which was added to the bill after it passed the House. It states that the State Parole Board can revoke parole for persons who are able to recover. “The department shall ensure that the inmate is returned to incarceration.” Gov. Tate Reeves office didn’t respond to a request to comment on the legislation. Dan Mistak is the acting president and director for Health Care Initiatives for Justice-Involved Populations at Community Oriented Correctional Health Services. He said that sending someone back in prison if they are healthier seems to be a violation of Medicaid’s guidelines. Mistak stated that a revocation such as this indicates that you are still under the control of state. Parolees being required to give their medical records to prosecutors could compromise the “personal privacy or confidentiality” of patients’ records. This is an important right that facilities must uphold if Medicaid is going to pay for them. Mistak said, “They’re trying out to figure out how to keep people under control while trying to cost-shift towards the federal government.” Otis Anthony (D-Indianola), is a member the Corrections Committee. He worked on the bill. He said that in order to pass it, the other house might add language to appease voters who don’t want paroled for any reason. “So that’s probably one those provisions that the Senate kept in there to make sure that they will serve time… But for most part, I don’t believe that that provision will be ever used. “Very few terminally ill persons who will require either long-term or hospice care will ever recuperate,” said Rep. Kevin Horan (R-Grenada). He stated that if CMS doesn’t approve reimbursement for parolees’ care at facilities, lawmakers can amend the law accordingly. He said that while he doesn’t believe the law is in a state of flux, it was a work-in-progress. However, he stated that CMS must be able to approve reimbursement for parolees’ care at these facilities. “We must do something.” The existing state conditional medical release policy is rarely used. According to the Department of Corrections, only three people were granted release in 2021. This follows seven in 2020 and ten in 2019. Horan stressed that the revocation provision does not apply to Mississippians who are currently in MDOC custody but have been paroled. Horan stated that their parole would not depend on their health. Sen. Daniel Sparks (R-Belmont), focused his attention on these people as he presented the conference report to the Senate floor on Tuesday afternoon. Sparks stated, “They have no place to go.” Their family might have died. They’re still in MDOC. This is a problem for the state. “We are paying their medical, and we are paying their housing,” Sparks stated on the Senate floor. Even though Medicaid won’t pay for the cost of special care facilities, Mississippi will still benefit from the bill. It is cheaper than paying for multiple hospital visits and separate services. Sparks was questioned by Sen. Angela Burks Hill (R-Picayune) about the cost of the legislation. Sparks stated that it would save money but couldn’t give a precise figure. Hill stated that she would like to see an estimate before we commit to Medicaid expansion. Hill and 15 other senators voted no to the conference bill. Many Republicans opposed to expanding Medicaid for the working-poor Mississippians voted for HB 936. Senator Brice Wiggins (R-Pascagoula) sponsored SB 2448 which would have created “special care facilities” for the medically frail. He declined to answer Mississippi Today’s questions about why he didn’t support Medicaid expansion. The Senate passed his bill with wide support, and it died in the House Medicaid committee. Wiggins was also present at the conference on HB936. This legislation makes Mississippi part a growing wave states that are trying to find ways to use Medicaid to reduce the cost of health care for inmates. Mistak stated that Mississippi’s pursuit of this goal is unique because other states have expanded Medicaid eligibility based upon income. This allows for greater savings as almost all incarcerated people are eligible. The program will then pay for any care that takes at least 24 hours in a hospital. Mississippi’s program is not yet in place. A nursing home called 60 West in Connecticut houses parolees released from prison. It was established by a 2013 law. Medicaid refused to pay Connecticut for parolees’ care, citing security measures that were not medically justified. Medicaid eventually agreed to pay after the facility made some changes. 60 West is now a nursing home. David Skoczulek (Vice President of Business Development at iCare Health Network), who runs 60 West, said that only a few 60 West residents have been sent back to prison for violating a term or parole. No one who lives at 60 West can be sent back to prison if their health has improved. He stated that it would be extremely difficult to ensure resident rights are protected in accordance with CMS rules and requirements, if residents still need the custody precautions required of current prisoners. He added that the facility does not share medical information with any other members of the corrections system or justice system. The regulations for special care facilities would be established by HB 936. They are limited to three per Supreme Court district. MDOC would contract with these facilities and regulate them alongside the Department of Health.