Medicaid Helps Ohio Slash Prison Medical Costs

by Christopher Zoukis

A controversial decision by Ohio Governor John Kasich to expand Medicaid under the federal Patient Protection and Affordable Care Act, or Obamacare, has extended health coverage to all Ohio state prisoners, helping the state save $10.3 million in prison medical care costs in 2014 alone. That is on top of savings due to wholesale changes in the state’s prison medical care system, which was under federal court supervision until 2012.

Kasich’s July 1, 2013 decision to expand Medicaid resulted in medical benefits being extended to prisoners under age 21, over age 65, those who are pregnant and prisoners hospitalized for more than 24 hours, according to Joseph Rogers, an analyst for the Ohio Legislative Services Commission. All remaining state prisoners became eligible for benefits in March 2014.

The governor’s directive, which was opposed by state lawmakers, meant that the Wexner Medical Center at Ohio State University, which treats most prisoners who require hospitalization, began billing Medicaid directly for prisoner health care instead of billing the state, which is self-insured.

In an additional money-saving move still being considered, Ohio Department of Rehabilitation and Correction (ODRC) chief Gary C. Mohr asked a House subcommittee to allow the medical release of prisoners who require around-the-clock care or who are otherwise medically incapacitated to nursing homes, which Mohr said are better equipped to provide such care. The state currently pays about $1 million annually for just 58 prisoners who require constant medical treatment or supervision, including two who are brain dead and on life support. Mohr said some of the prisoners suffer from dementia and are no longer even aware they are incarcerated.

Mohr’s proposed change, presented during testimony at a March 5, 2015 legislative budget hearing, would not extend to prisoners who are serving life or who have been sentenced to death. The state prosecutors’ association went on record as opposing the proposal.

Wholesale changes to Ohio’s prison medical care system produced $26.2 million in savings in fiscal year 2012, according to the ODRC. Stuart Hudson, ODRC’s chief of medical services, said the savings resulted from a long process of “looking at every aspect of [its] health care system.” He stressed that the changes do not mean a drop in the quality of medical services: “We did not sacrifice the quality of care ... we feel we are on solid ground.”

Hudson said the key reform was the elimination of private medical contractors in the majority of prisons and a return to having medical personnel on staff. There is now at least one doctor and one nurse at each facility, providing what he called a continuity of care.

He added that on-site staffing could be the most significant reason behind a quantum drop in the cost of prescription medications for prisoners. He said ODRC bought nearly 300,000 fewer prescriptions for prisoners in 2011 than just two years earlier, attributing that substantial decline to the absence of private contractors who weren’t worried about costs but simply “putting in their hours, picking up a paycheck and going home.” The state now has nearly 1,000 prison employees who provide health care.

According to a report released by the Correctional Institution Inspection Committee, a non-partisan legislative agency that reports on Ohio’s prisons, the number of prisoners seen by doctors and nurses has fallen by 25% since 2009. The rate of prisoners seen per health care worker has dropped by nearly a third since 2005.

Ohio’s prison medical care was under federal court supervision as the result of a 2003 lawsuit filed by prisoners who claimed that the abysmal care amounted to cruel and unusual punishment under the Eighth Amendment. A federal district court declared ODRC’s care constitutionally sufficient in 2012.

The state’s medical expenses have remained fairly constant over the past several years. Not including costs for mental health services, Ohio paid $192.9 million in fiscal year 2012, $186.7 million in FY 2013, $192.4 million in FY 2014 and $192.5 million in FY 2015 to provide health care to ODCR’s roughly 50,000 prisoners. In addition to staffing, the prison medical system’s overhaul included a mail-order prescription drug delivery system, a requirement that prisoners purchase more of their own over-the-counter medications and a controversial $2.00 medical co-pay.

CURE-Ohio, a prisoner advocacy organization, called the co-pay a burden to prisoners and their families. The fee is applied each time a prisoner sees a nurse or a doctor.

“When you’ve got someone making $18.00 a month (the average pay rate for Ohio prisoners), spending $2.00 on a doctor is a lot,” said CURE-Ohio president Ellen Kitchens.

The co-pay does not apply to prisoners who are determined to be indigent and receive less than $12.00 per month, or to emergency medical care. Prisoners are not denied care due to inability to pay.

Sources: Associated Press, www.ajc.com, www.dispatch.com, http://thinkprogress.org, www.drc.ohio.gov, www.10tv.com