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Bill aims to restore jail health care partnership
By Paul V. Beddoe
ASSOCIATE LEGISLATIVE DIRECTOR
A new bill, Restoring the Partnership for County Health Care Costs Act (H.R. 5698), would remove the so-called “inmate exception” that prevents Medicare, Medicaid, SSI and SCHIP benefits being paid for people in jail waiting for their day in court.
Introduced April 3 by Rep. Alcee L. Hastings (D-Fla.), Rep. Rush Holt (D-N.J.) and Rep. Michael Burgess (R-Texas), the bipartisan measure addresses a significant flaw in federal benefits rules that leaves counties holding the bag for inmate health care.
Broward County Nudges Florida to Suspend, Not Terminate, Medicaid for Inmates
By Gretchen Harkins
Broward County, Fla. has worked to introduce state legislation that would suspend, rather than terminate Medicaid benefits for incarcerated persons who have been inmates for 12 months or less. Similar legislation was pushed through the New York legislature by the New York Association of Counties and through the Minnesota Legislature by the Association of Minnesota Counties.
Presently in Florida, like many other states that have not yet passed similar legislation, persons brought into the jail system with SSI/SSDI benefits often have those benefits terminated if they remain in jail for 90 days or more.
The U.S. Social Security Administration (SSA) has created a financial incentive to report individuals who are charged with crimes and remain in county jails or state prisons, by offering $200 to $400 to the facility (depending on how quickly the inmate is reported to the SSA).
Florida House Bill 525 and Senate Bill 1456 have been heard in committee and reported out favorably, unanimously. While the bills have several more stops before they will move to the floor for consideration, the state has seen no opposition to the legislation and in fact, has received support from the state Department of Corrections, Agency for Health Care Administration, Department of Children and Families, and many others.
If federal legislation can be passed to repeal or amend the Social Security Act (42 USC §1396d(a)) to remove the “inmate exception” such that it would permit states to receive federal matching funds for health services provided to otherwise-eligible incarcerated persons, states and local governments would be relieved of the burden of caring for an aging inmate population which has higher rates of virtually every chronic physical and mental illness than the general population.
When Estelle v. Gamble was decided by the U.S. Supreme Court in 1976, it created the only protected class of individuals who would be recognized to have a Constitutional right to “adequate” health care — incarcerated persons. This health care was a responsibility of the states (prisons) and local governments (jails), and the decision was not immediately challenged.
In 1976, the national incarceration rate was 350,000, so the costs of providing this health care were minimal. Now, the costs associated with providing health care to inmates are astronomical, with nationwide estimates ranging in multiple billions of dollars annually.
Broward County supports state and federal legislation that will address the inequities and consequences of policies that terminate federal entitlement benefits and create a revolving door to our criminal justice system. The utilization of county jails as the new “asylums” as reported by PBS and CNN, is a societal cost counties can no longer afford.
(Gretchen Harkins is a lobbyist for Broward County, Fla.)
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Under current federal and state laws, local governments, usually counties, are solely responsible for the medical expenses of jailed individuals — even those who have not been convicted of any wrongdoing.
“The federal and local governments are partners in ensuring that all of our residents have medical coverage. Neither partner should be bearing an unfair burden in meeting this mandate,” said Hastings, who represents Florida’s Broward, Palm Beach, Martin, St. Lucie and Hendry counties.
“Stripping people of their federal benefits before they have been convicted of anything is a direct contradiction of the basic presumption of innocence which is the foundation of the American criminal justice system. And for the federal government to stick local governments with the tab for this contradictory policy is just plain wrong,” he said.
Counties have also grown increasingly alarmed at the skyrocketing costs of providing federally mandated health care to jail inmates. Restoring even partial federal funding would provide tremendous relief to cash-strapped counties. “This bill will have a positive financial impact for every county in the U.S.” said Ron Wiborg, a grants manager for Hennepin County, Minn., upon learning of the bill’s introduction.
“This is a simple matter of fairness,” said Holt, whose district includes parts of Hunterdon, Mercer, Middlesex, Monmouth and Somerset counties. “The federal government should not saddle states and counties, who are already facing difficult fiscal challenges, with these costs. Our bill would correct this historic unfairness,” he said.
Added Burgess, “Cost-shifting, whether public or private, undermines efforts to control the growing costs of health care. This bill targets the cost-shifting between different levels of government to keep costs in check and keep people covered.” Burgess’ north Texas congressional district includes most of Denton County, large portions of Tarrant and Cooke counties and a small part of Dallas County.
“Counties cannot continue to be on the hook for the medical costs of inmates on Medicaid, Medicare or Social Security who have lost coverage but have not yet been convicted of a crime,” said Tarrant County, Texas Judge Glen Whitley. “It is an unfair burden to impose on counties and their taxpayers.”
Whitley, whose North Texas county jail has roughly 3,200 inmates, said his concern over what amounts to “another unfunded mandate” prompted him to urge Burgess to cosponsor the bipartisan bill.
“This is one more example of the need to restore the partnership between counties and the federal government and in doing so, raise the awareness of federal officials about the role county governments perform in our communities,” Whitley said.
While fixing this problem has been on NACo’s legislative agenda for some time, NACo’s Large Urban County Caucus (LUCC), which represents the collective interests of the nation’s largest counties, recently made it a top priority.
LUCC Vice Chair and Broward County, Fla., Commissioner Ilene Lieberman, has made the case, both in Washington and in Tallahassee, that the current system disrupts continuity of care for her county’s most vulnerable populations. This is, she argues, not only more expensive in the long run, but also fundamentally unjust.
Lieberman points out that each year in Broward County there are about 800,000 bookings into and releases out of the county’s jails.Between 50 and 80 percent of these people have behavioral, health or substance abuse problems and are charged with nonviolent or minor drug-related offenses. “Unfortunately, they are often held for long periods due to backlogs in the court system. Then, when they are finally released, it is without the health benefits they had when they entered the jail.”
She further points out that during the 90 days or so which it takes to reinstate Medicaid and other health benefits, people who have just left jail are particularly vulnerable to homelessness, relapse and acute medical emergencies.
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