Inmate Care Holds County Captive


    GRAND RAPIDS — Kent County has budgeted nearly $10.6 million for employee health insurance coverage this year, a figure that is up by almost $2 million from just two years ago, and one that could jump by a projected $6 million in four more years.

    But health insurance costs for employees isn’t the only rising medical expense the county is facing. The price tag to provide medical care for inmates at the Kent County Jail and JuvenileDetentionCenter has quadrupled in just the past few years.

    Kent County Administrator and Controller Daryl Delabbio pointed out that in 2001, the county’s medical bill for inmates was $1.3 million. Last year that tab reached $5.3 million, a 400 percent increase in four years and half of what the county will spend on health insurance for its workers this year.

    Rising medical costs account for some of that higher payout. But riders attached to public and private insurance policies also play a role in forcing county taxpayers to pick up the higher expense and make it difficult for the county to contain the rising outlay for inmate care.

    A state statute strips a person covered by Medicaid of most medical coverage once he or she is incarcerated, leaving the county financially responsible for everything except a hospital stay. So if an inmate who is normally covered by Medicaid needs to visit an emergency room, the county gets billed for any procedures performed.

    The federal government doesn’t reimburse the state for inmate coverage, so the state doesn’t provide that coverage under its Medicaid program.

    “It goes from the state’s responsibility to the county’s responsibility,” said Mary Swanson, assistant county administrator.

    “It’s a significant hit to the jail’s budget,” added County Commissioner Harold Mast. “It’s growing, and more Medicaid patients are being incarcerated.”

    And the situation isn’t healthy for local providers, either.

    Kent County Sheriff Larry Stelma said when an inmate is released, his or her Medicaid coverage doesn’t resume immediately. Stelma said it usually takes from 60 to 90 days for an ex-inmate to get back into the Medicaid program. If that person gets ill or injured during that time, he or she would be without insurance, and a local provider would likely have to swallow the treatment expense.

    Some privately funded insurance policies also have a provision that ends coverage if a policy holder gets injured while violating a law. For instance, if a policy holder has too much to drink and then drives a car into a telephone pole and is injured, the county can get billed for whatever medical attention is needed if that person’s policy voids coverage at the time the individual got behind the wheel in an intoxicated condition.

    Swanson said she has talked with hospital executives and asked them to bill the insurance company before they bill the county in situations such as this one. And a bill recently made into law in Lansing requires providers to seek reimbursement for treatment given to an inmate from an insurance company or other source, such as a health corporation, before billing a county.

    KentCounty is hoping to get more legislative relief from the state that would limit its liability for inmates’ medical expenses. The county would like to see lawmakers extend a person’s Medicaid coverage to include incarceration, and also be billed for treatments of Medicaid-covered inmates at Medicaid rates.

    “It’s incarceration that takes their Medicaid away,” said County Commissioner Nadine Klein.

    “They should have some of their rights until they’re adjudicated,” said Paul Mayhue, also a county commissioner, of inmates who had Medicaid coverage before being arrested.

    KentCounty signed a five-year agreement nearly two years ago with Correctional Medical Services to provide multiple services for inmates. The contract will cost the county about $3.4 million this year and that expense will rise by 5 percent each year of its duration.

    “We’re trying to get some cost containment,” said Commission Chairman Roger Morgan when the board approved the CMS contract. “But it’s going to be a challenge.”    

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