David Levine is a GOVERNING contributor.E-mail: firstname.lastname@example.org
Prison, it’s been said, is a microcosm of society. In the case of health care, that is certainly true. Just like the rest of us, the prison population is getting older and, as a result, sicker. They need more -- and more expensive -- health care, which they have a right to receive under the 8th Amendment’s ban on cruel and unusual punishment. That’s putting a tight squeeze on corrections budgets across the country.
According to the Bureau of Justice Statistics, the number of federal prisoners 55 and older nearly doubled over the last decade, from 8,221 in 2000 to 15,323 in 2009. That’s due in large part to the more draconian drug sentencing laws of the 1970s and 1980s, which sent baby boomers away for longer stretches.
Today, those prisoners are in their 50s and 60s, and are developing age-related health conditions like heart disease, cancer and complications from diabetes. With years of hard living behind most of them, they have higher odds of carrying hepatitis C or HIV, of having AIDS, liver or kidney disease, substance abuse damage and mental illnesses.
Correctional health-care costs reached $9.9 billion in 2009, according to Prison Health Services, a private company that provides health care to inmates. When HIV treatments alone cost $2,000 a month, you can see why costs are so high. They fall entirely on states, too, since prisoners aren’t eligible for Medicaid or Medicare. “When I started in this field in 1978, health care was on average about 10 percent of the correctional budget,” says Jacqueline Moore, a Colorado-based correctional health-care consultant. “Now, it’s about 20 percent.”
Given the current budget conditions, states are looking for ways to cut costs. The Kansas Department of Corrections (KDOC) has found one with a managed-care contractor called Correct Care Solutions. Among that company’s care solutions was establishing clinics to treat chronic illnesses within prison walls. Inmates with kidney disease are housed at sites that have dialysis machines, while inmates with other medical problems are moved to facilities that specialize in those diseases. The solution saves on the cost of hospital visits and related high fees, such as security guards and transportation.
Since inmates are closer to care, they now receive better preventive care, which lowers the risk of more serious and costly health problems. These and other changes have been a success, according to Viola Riggin, director of health-care services for KDOC. The state expects 2012 costs to actually go down to $45.5 million from $46.1 million in 2010, even though the prison population has grown. When the contract is renewed in 2013, Riggin expects an increased cost of less than 4 percent, compared to the industry average of 6.9 percent.
Within the next year or so, the corrections department plans to open an Activities of Daily Living unit for the 474 inmates who are considered significantly disabled and/or frail due to age or disability. “Geriatric inmates are usually our highest users of services such as offsite dialysis, oncology and hospice,” Riggin says, noting that this category of patient costs $22.55 per day to treat, compared to just $9.18 per day for inmates in the lowest level of care.
Moore, the corrections health-care consultant, recommends that states partner with local universities to stay on top of research (KDOC is affiliated with the University of Kansas), have access to nonprofit administrative oversight and obtain better pharmacy prices under the 340B Drug Pricing Program, which provides outpatient drugs to eligible safety-net health organizations at a reduced price. Those states that self-administer their correctional care should negotiate better prices with providers and create a preferred provider network, just as outside managed-care companies do.
Of course, these inmates are only going to get older, and health-care costs are only going to rise. The problem isn’t going away. States like Kansas, which has been aggressively attacking the issue for a decade or more, stand the best chance of keeping their heads above water. “We don’t know what the future holds,” Riggin says, “but we won’t be waiting to find out.”