UNION COUNTY — The Affordable Care Act is fast becoming a tool that can save counties money that would otherwise be spent on healthcare for county jail inmates. Whether New Jersey opts into this plan, though, is still being discussed.
Roughly 10 million people cycle through U.S. jails every year, according to information obtained from Community Oriented Correctional Health Services, a non-profit dedicated to improving connectivity between healthcare in and out of the justice system.
Most are in county jails for a short period before they are either determined to be innocent, post bail or sentenced to probation. Actually, only 4 percent are sent to state prisons to serve longer sentences. In other words, 96 percent return directly to the community from jail, along with their often untreated health conditions.
However, men and women who may have gotten chemical addictions under control or found the right medication to ease mental health symptoms behind bars are released to the community without a backup plan.
While the Affordable Care Act, also known as “Obamacare”, excludes convicts, it does open a loophole for county jail officials who want to avoid using their own money to help sick prisoners awaiting trial.
This loophole expands Medicaid eligibility and can cut costs at the Union County jail by $1.2 million a year, according to officials. But there is a problem: the state has not activated the option.
The first part of this option not only provides states with the ability to expand Medicaid eligibility but changes the traditional partnership between the state and federal government. What does this mean for taxpayers?
Right now, New Jersey, according to its state Medicaid plan, has a 50/50 financial relationship between the federal and state government. Under the ACA, the expansion of the Medicaid program shifts the financial burden to the federal government.
Currently the county jail is required by the federal government to budget annually for the cost of healthcare for inmates to offset any outstanding medical costs that may come up. In order to be prepared for any catastrophic illness an inmate may have at the jail, Union County budgets $5 million annually. This is to cover the cost of regular illnesses but also catastrophic illnesses that may befall inmates while in the county jail.
According to the National Commission on Correctional Health Care, a substantial number of individuals that enter county jail have serious medical and behavioral health needs and would benefit greatly from treatment to address these conditions.
With this ACA option, according to Union County Jail Director Brian Riordan, the county could be looking at saving $1.2 million. It also would allow the county to enroll eligible inmates for Medicaid, thereby saving the county taxpayer dollars in the long run. Riordan explained another important reason why the state should activate this option.
“Say, for example, I owe $150 for traffic fines and there is a bench warrant for my arrest and I’m on Medicaid. Right now, when they bring me in, my Medicaid is terminated and when I get out, which could be the same day, it could take months before I’m back on Medicaid,” explained the jail director.
“There’s a domino effect,” added Frank Guzzo, Union County Director of Human Services, who explained the family of a person arrested like this also suffers because the burden of healthcare is on them financially.
If the state chooses to expand Medicaid eligibility, which New Jersey has but has not yet activated, the federal government will assume 100 percent of the cost for the first few years and after that it goes to 90 percent of the cost and the state is capped at 10 percent for newly enrolled Medicaid recipients.
Primarily, this health care would involve costs for off-site visits that result in an inmate being treated for more than 24-hours outside the jail, which would be eligible under the Medicaid expansion option. Prior to this ACA option, one hundred percent of that cost would be borne by the county and has over the years.
Guzzo said the cost of this care for the county jail population, which currently stands at 769 prisoners, has ranged from $1 to $2 million a year, every year. Riordan estimated a vast majority of inmates at the jail would meet the income eligibility requirements for Medicaid coverage, but there is a problem.
“As of this date the state Division on Medicaid and Health Services has yet to implement the provisions of the ACA as related to incarcerated individuals,” Guzzo said.
Although the ACA does not allow full-time prisoners serving sentences in state prisons to receive Medicaid benefits, an option in the ACA allows those in jail for a short duration, or those awaiting trial, to enroll. What does this mean for taxpayers?
It could add up to more than $1 million or more annually depending on how sick prisoners are in any given year. However, although 25 other states, including New York, Connecticut, Maryland and California, have exercised the option, others, like New Jersey have been hesitant to make the move.
The law allows states to extend coverage to single and childless adults, which is a major part of the prison population, Riordan said.
Experts estimate that up to 35 percent of those eligible for Medicaid under the law are people who have been inmates, those on probation or parole.
Opponents claim the ACA loophole that counties are latching onto will cost taxpayers anyway so there are no real savings. Riordan and Guzzo disagree and believe in the long run, these options have many important implications for the county.
Specifically, counties run and finance local jails which are responsible for providing health care coverage for individuals booked into this system each year. Although some may end up in state prisons, others are often only in jail for a matter of days or weeks, Riordan explained.
Currently Medicaid does not cover standard healthcare for inmates because the law demands it must be terminated when they are arrested.
Riordan believes this is where suspension of Medicaid rather than termination would save the county money but also help a prisoner when they get out of jail.
“Which means someone who is arrested for a minor infraction can end up back in jail because if, for example, they have a drug dependency, they may resort to criminal activity to support it,” the county jail director said.
If the state opts to expand ACA coverage, it also changes the traditional partnership between the federal and state government.
Riordan said, for instance, right now if an inmate gets seriously sick while in jail and requires an operation or heart procedure, the county has to pay the bill, but under the ACA option, when a person is arrested we can just suspend their Medicaid and once they are out “it kicks right back in.”
“Prisoners do get seriously ill, they need organ transplants or other serious operations or treatment for cancer,” the jail director said.
“If the state picks up on this ACA option, we will be able to just suspend their Medicaid when they are arrested and if they get sick while in jail and end up in the hospital for more than 24-hours, right now the county has to pick up the tab, but if the state picks up this AFA option, the federal government would have to pay the bill,” Riordan said.
The problem here is that New Jersey would need to apply to the federal government for a rule change to allow suspension instead of termination.
The Union County Board of Chosen Freeholders was concerned enough about this to pass a resolution recently urging the state to resolve the delay and opting to suspend, rather than terminate, Medicaid coverage for those Medicaid eligible individuals admitted to jail. This resolution was sent to the governor, the commissioner of the state department of human services and the county legislative representatives.
Both Riordan and Guzzo are hoping for a speedy response.
“If the state allows us, we can begin enrolling prisoners in Medicaid and this will save taxpayers money,” said Riordan.