Oregon Workgroup Recommends Strategies to Deal with Prison Medical Care Costs

by Mark Wilson

State officials in Oregon continue to grapple with the rising cost of prisoner health care, which largely stems from a rapidly-expanding population of elderly prisoners who have costly physical and mental health care needs.

Over the past decade, the share of the Oregon Department of Corrections’ (ODOC) budget devoted to medical care has ballooned to $203.9 million, part of a whopping 39% jump in overall prison spending according to ODOC spokeswoman Liz Craig. Nearly all of the prison system’s biennial budget is paid from the state’s tax-supported general fund.

“It is not diminishing; it is growing,” said state Senator Jackie Winters, who co-chairs the Oregon legislature’s budget subcommittee on public safety. Just 10 years ago, Oregon spent $50.4 million on prisoner health care. [See: PLN, Sept. 2012, p.16].

“It was one thing when we had only a couple of institutions and everyone was housed here in Salem,” said Winters. “It’s another thing to have 14 ‘cities’ with 14,000 inmates.”

In response to the increase in medical expenses, the legislature created a Workgroup on Corrections Health Care Costs to examine prison and jail spending on medical care. “My intent in putting a workgroup together is to bend that cost curve and reduce costs through efficiencies,” Winters said.

The workgroup’s interim report, issued on February 5, 2014, revealed that between 2006 and 2012, the ODOC experienced a 129% increase in the number of prisoners suffering from cardiovascular conditions, the single greatest statistical increase. The report also noted a 91% increase in the number of prisoners with respiratory illnesses, a 48% increase in diabetic prisoners, a 19% increase in Hepatitis C cases and a 17% increase in the number of prisoners with HIV/AIDS. By contrast, the overall prison population grew just 7.2%.

“Combine the length of stay in prisons with the aging population, and individuals who come into the system are already sick, you have people in their 70s with acute illnesses,” Winters said.

The workgroup also determined that as of October 21, 2013, nearly 16% of the state’s 14,600 prisoners suffered from severe mental illness. That number jumped ten percent in the previous seven years, according to ODOC statistics. Additionally, 74% of prisoners suffered from severe or moderate drug or alcohol addiction.

Culminating a series of five meetings around the state, the workgroup’s final report, published on December 31, 2014, listed a number of recommendations designed to help curtail the increase in prison health care spending. The report noted that some of the recommendations had already been adopted while others were under consideration. A few were abandoned as impractical or unwieldy.

The report identified two areas where the ODOC faced the greatest challenge: providing medical care in prisons in remote regions of the state, and implementing procedures that would require private health insurers to continue providing benefits to offenders after they are incarcerated.

“The Workgroup heard testimony that recruiting, especially in rural areas, is a serious challenge for [ODOC],” the report noted. Therefore, the state was urged to explore “incentives to include, but not limited to, loan forgiveness and repayment, as well as the review of salaries for individuals willing to work in rural areas.”

The workgroup also recommended delaying the implementation of state legislation that would prevent health insurance companies from dropping coverage for people after they are incarcerated. “This concept would require the department to create a new unit assigned with the task of providing billing services – something with which DOC has no experience,” the report said.

“It would also require an Electronic Health Records system in order to ‘code’ medical interactions properly. Finally, the staffing and apparatus required to track individual insurance plans, track family premium payments, and assess billing in the context of pharmaceutical formularies would be substantial.”

The report also addressed the ODOC’s decision to move forward with a plan to implement a “prison-to-community connection for all aspects of health care.”

“Discussion in this area focused primarily on the importance of uninterrupted public assistance for adults in custody transitioning into the community,” the workgroup said. “The department is currently applying for Medicaid on behalf of the adults in custody that are preparing for release.” In addition, the report recommended hiring a full-time ODOC Offender Management and Rehabilitation Division employee “to accommodate the volume of activity required to make this program a continued success.”

Other recommendations included converting the prison system’s medical database to an Electronic Health Records system, a process that is ongoing; conducting a nutritional review of food and associated costs; investigating the benefits and issues of allowing tattooing for state prisoners; and investigating issues related to mandatory hepatitis C testing for all adult prisoners when they enter the prison system. Such tests are currently voluntary.

The workgroup abandoned recommendations to analyze an expansion of a Board of Parole program that allows prisoners to request early medical release, plus a plan that would have required state-mandated prison exercise programs. The workgroup suggested moving ahead, however, with a Chronic Disease Self-Management Program that provides training to prisoners who suffer from chronic health issues.

“Participation [in the self-management program] is a major incentive as it allows for a greater level of autonomy, creativity, and self-actualization within a prison setting for those involved,” the report noted.

The Workgroup on Corrections Health Care Costs was comprised of two state senators, two representatives and officials with the ODOC, the Oregon Youth Authority and the Oregon Health Authority. Six other members were appointed by then-Governor John Kitzhaber, himself a former physician; Kitzhaber resigned from office in February 2015 amid a scandal involving his fiancée that resulted in state and federal criminal investigations.

Sources: Statesman Journal; www.oregon.gov; www.foxnews.com; Workgroup on Corrections Health Care Costs, Report to the Interim Committee of the Legislative Assembly (Feb. 5, 2014 and Dec. 31, 2014)

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