Rising Prison Health Care Costs Increase Burden on State Corrections: Pew

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America’s aging prison population is putting new strains on health care costs for state corrections authorities, according to a study by the Pew Charitable Trusts.

In order to cope with the cost of caring for inmates growing older and sicker behind bars, prison officials are taking advantage of Medicaid subsidies to send more incarcerated individuals to offsite hospitals or, in some cases turning to high-tech approaches like telemedicine, the study found.

“Corrections departments face rising health care costs for the foreseeable future,” said the study, which drew on two 50-state surveys conducted by Pew and the Vera Institute of Justice, as well as interviews with more than 75 state officials.

The main driver of health care in state prisons today is the increasing share of incarcerated individuals 55 or over, said the study authors, noting that in 44 states which responded to questions on this issue, the elderly population increased by a median of 41 percent between 2010 and 2015.

“Most incarcerated individuals experience the effects of age sooner than people outside prison because of such issues as substance use disorder, often inadequate preventive and primary care before incarceration, and stress linked to isolation and the sometimes violent environment in prison,” the study said.

Even when appropriate facilities are available inside a prison, rising costs are driving corrections authorities to send ailing inmates  to hospitals, where they can qualify for Medicaid coverage—which under federal law is otherwise unavailable to the incarcerated. Under the Affordable Care Act, states can expand the number of  low-income people aged 65 or over who can qualify  for Medicaid, and prisoners with little income can be covered by definition under this umbrella.

According to Pew, an increasing number of corrections officials in states that have opted for Medicaid expansion, which allows them to receive federal reimbursement for at least half of the costs, are taking advantage of the opportunity.

Virginia, for instance spent 27 percent of its prison health care budget on offsite hospital care in 2015.

But hospital care for the incarcerated can be a lot pricier than ordinary care, because of the additional costs of providing secure transportation and 24-hour guards. (There have been several cases where prisoners escaped from custody while enroute to hospitals.)

With more than one million adults in state prisons, authorities are “under increasing pressure to contain hospitalization costs while also ensuring the constitutional right to ‘reasonably adequate care,” the study noted.

One alternative approach used by some states to reduce costs involves the use of telemedicine and mobile health services that allow inmates to be diagnosed without ever leaving prison grounds.

Texas, for example, now conducts 11,000 patient-doctor video conferences a month for inmates—second only to the U.S. military. Some states lease a mobile mammography van to administer cancer screening tests inside their prisons for female inmates.

But while the shift to Medicaid has saved states “millions of dollars” in prison health care costs, states’ future ability to use the program may be in doubt as a result of  government efforts to dismantle the Affordable Care Act.

That only increases the burden on state policymaker “to look for ways to trim costs, especially as their prison population ages and requires more intensive and frequent care,” the study said.

The full study can be downloaded here.

This summary was prepared by Stephen Handelman, editor of The Crime Report. Readers’ comments are welcome.

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