When the signature reforms of the Affordable Care Act go into effect on January 1st, millions of Californians will have expanded access to government subsidized health-care benefits. Counties, some of which saw their jail populations and health-care costs swell since prison reforms took effect in 2011, want to make sure that jail inmates will be among the newly insured.
Inmates tend to be younger and sicker than the general population, and the poor health care offered in prisons was the reason that courts ordered California to reduce their prison populations. The prison population was reduced by making county jail or probation — rather than state prison –the only sentencing option for certain felony offenses.
That change in turn increased jail populations in several counties, prompting some critics to wonder if reform simply shifted the health care problems in prison to jail.
According to a report from Community Oriented Correctional Health Services, jail inmates are disproportionally young, male, people of color with low incomes. They also have a high rate of health problems, including substance abuse and mental health disorders. Additionally, they say, eighty percent of detainees with a chronic medical condition did not receive treatment in the community before their arrest.
This same report indicated that most detainees – 90 percent – have no health insurance when they leave jail.
Marcus Dawal, Division Director of the Alameda County Probation Department, said that enrolling inmates and educating them about available resources helps with the bigger picture.
“If somebody is stabilized and their basic needs are met, they are more inclined to have stability and that helps them as far as having the tools that they need to live a law-abiding life and be productive and secure employment,” he said.
Many California counties offer a Low Income Health Program, or LIHP, an optional, local program in place until 2014, when the reforms that will expand greatly expand access to health insurance begin. On Jan. 1, the majority of its enrollees will become eligible for Medi-Cal under national health care reform.
Those not eligible for Medi-Cal will be eligible for participation in Covered California, the insurance marketplace that will open for enrollment on Oct. 1. Lower income people will be eligible for subsidies to defray the costs of monthly insurance premiums.
The federal government offers limited assistance for inmates in the form of Medi-Cal. For the government to kick in some funding, the inmate must be receiving acute in-patient care, and it must be off the grounds of the facility where they are incarcerated.
“They have to be really sick,” says Cathy Senderling-McDonald, the Deputy Executive Director of the County Welfare Directors Association of California. Run-of-the-mill illnesses and injuries are typically taken care of within the jail’s own health system (some jails have clinics, while others rely on county clinics to provide routine services).
“So 100 percent of them could be found Medi-Cal eligible but unless they are going off-site, nobody can actually claim funding from the government for health services,” she said.
Senderling-McDonald spoke to county jail representatives in April at an event that discussed how county criminal justice systems could be involved with health-care reform. She warned them not to be too optimistic about how much money health-care reform might save. “One of the things I said to them was, ‘I’m sorry if I’m making you sad by telling you that you’re not going to be able to refinance your jail health system through this,’” she said.
She pointed out that participation is voluntary – you cannot force an inmate to enroll – and the enrollment process can be long and complicated.
Though the benefits that can be claimed are fairly limited while the inmate is incarcerated, counties already enrolling inmates in the LIHP say it’s worth the trouble.
“The kinds of costs that can incur out there can get fairly expensive real quick,” said Lieutenant Scott Peterson, the Detention and Corrections Contracts Manager for Alameda County Sheriff’s Department. Alameda County was one of the first to enroll inmates into the LIHP. Peterson said the cost savings for hospitalized inmates have been substantial.
“Recently we had someone here who had leukemia, so obviously that’s a case where we won’t be treating that inside the jail – we’re not equipped for that,” he said. Peterson said enrolling an inmate who is seriously ill has the benefit of recouping some of those costs for the county, and in turn, its taxpayers.
Another important reason to enroll inmates, Senderling-McDonald said, is so that when the inmate is released, they have health care services available to them without having to repeat the lengthy and often-complicated process of enrolling in the program.
If, for example, a qualified inmate is released and they need substance abuse or behavioral health services, they have access to those services right away. Studies have shown that access to health care, particularly substance abuse and mental health services, reduce an inmate’s chances for recidivism.
Improved health care for inmates will have an affect on the community too. If an inmate is released with a chronic condition, such as diabetes, it can be very expensive to treat them as uncompensated care at their local clinic or hospital, which contributes to a less healthy community overall, said Senderling-McDonald.
Many counties are at varying stages of incorporating the LIHP into their criminal justice system. While Alameda County has been enrolling inmates since fall 2011, some counties are just getting started, and others are waiting for clearer information about how the ACA will affect their procedures down the line.
Lee Kemper is the Director of Policy and Planning for the County Medical Services Program, or CMSP, a program that helps small, rural counties meet the needs of providing health-care services to indigent adults. He says their program – for the counties who opt to participate – will take effect on July 1st of this year, with only six months left with the CMSP LIHP program.
Their focus will be primarily on enrolling current inmates on a case-by-case basis, as needed, but they plan to focus on the outgoing, probationary inmates.
Kemper said their goal is to help counties be prepared. Approximately 35 LIHP programs will operate in the state with their own rules until 2014. The ACA will operate under one set of rules. “If people can get their feet wet a little bit by working with us for six months, so that when [the ACA] really kicks in,” Kemper said, “people will be able to adapt and be better positioned to [take advantage of it].”