County to get a break on inmate medical bills

By ED HOWELL, Daily Mountain Eagle
Posted 9/29/17

The Walker County Commission said Tuesday it had reached a local agreement that will reduce inmate medical bills almost immediately, while inmates that had been on Medicaid before going to a county jail can be reinstated in …

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County to get a break on inmate medical bills


The Walker County Commission said Tuesday it had reached a local agreement that will reduce inmate medical bills almost immediately, while inmates that had been on Medicaid before going to a county jail can be reinstated in the federal program for inpatient hospital visits statewide starting Jan. 1.

The commission, which has been trying to cut expenses due to its tough finances, welcomed the news and voted for the new agreement with Walker Baptist Medical Center.

“This is a big win for Walker County. This is a big win for the State of Alabama,” District 4 Commissioner Steven Aderholt said. He later said the statewide Medicaid program alone will be “unbelievable” for county commissions across Alabama dealing with their budgets.

Walker County Sheriff Jim Underwood said recently the jail normally has to pay about $400,000 to $450,000 a year for inmate medical care. About $158,000 of overall budget overspending in the Sheriff’s Office and the county jail was recently documented to medical care, Underwood said.

For Fiscal 2017, a total of $458,000 had been spent as of Sept. 1 on inmate care, with one month to go in the year.

At Tuesday’s commission meeting, County Attorney Richard Fikes complimented Aderholt, who was in discussions with Walker Baptist about medical bills for inmates at the county jail.

He said Aderholt had reached an agreement.

Officials said the hospital will charge 120 percent of the current year Medicare rate for inpatient and outpatient care. A Sept. 19 email from Aderholt to County Administrator Cheryl Ganey said, “Outpatient is important because that would cover any acute illnesses that do not require hospitalization for inmates beyond 24 hours, whereby we could have still been liable for very large single day bills even after the new Medicaid rate takes effect on Jan. 1.” He went on to say the agreement was “an extraordinary win for the taxpayers of Walker County.”

The county also released a June 13 letter from Zachary Abercrombie, the chief financial officer of Walker Baptist, confirming the deal, saying that the new fee schedule supersedes any other arrangement between the commission, its claims payer or affiliated entities. The agreement can be ended on 30 days notice by either party, and it can also be amended.

Ganey said at Tuesday’s meeting she had sent paperwork for Underwood to sign for the Medicaid coverage that would take effect Jan. 1. Then the paperwork will be forwarded to the Association of County Commissions of Alabama (ACCA) to notify that group the county wants to participate in that coverage.

The association referred on its website to the Medicaid for County Inmate Program, whose implementation the association said was a top priority. The first round of documentation is due on Oct. 16.

In May, the website noted “ACCA’s priority legislation (the Medicaid for Inmates bill) to allow Medicaid-eligible inmates to have their Medicaid benefits reinstated for inpatient hospital visits exceeding 24 hours was signed into law” that month. “The provisions of the law (now known as Act 2017-298) will go into effect on January 1, 2018.” 

The website carried the new act, showing that county inmates and county juvenile inmate will have their Medicaid benefits suspended when put in county jails — but they can be reinstated when they become an inpatient at a medical facility. County officials will reimburse the Medicaid Agency the full amount of any federally required state match. The ACCA will participate as a centralized source on behalf of counties to provide information to the Medicaid agency on the qualifications of prisoners each county case.

Medical bills in county jails has become a nationwide problem due to rising healthcare costs. In May 2015, U.S. News and World Report noted counties nationwide were looking for similar breaks through Obamacare.

“Jails and prisons across the country are aggressively enrolling inmates in government-funded Medicaid under President Barack Obama's health care law, hopeful that their efforts will reduce the crippling costs for cities, states and counties responsible for inmate health care and that it will help prisoners gain better access to services upon their release,” the magazine said.

The report went on to say, “Meanwhile, prisons and jails are constitutionally obligated to provide health care to inmates under the Eighth Amendment, which prohibits cruel and unusual punishment. But the costs of following the law have been burdening state budgets. A July 2014 report from The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation found that in 2011, the country spent $7.7 billion on correctional health care. Across the country, the share of corrections costs going toward inmate health care can range from 9 to 30 percent, according to the Urban Institute.”

Local officials are still unclear about some details about the new changes. Fikes wants to make sure if the inmate already had other insurance coverage, including Medicaid or Medicare, whether or not the hospital will accept that coverage as opposed to the county paying 120 percent.

Aderholt noted the most recent discussions about the medical bills for inmates in the county started a couple of years ago when a county inmate was shot, resulting in a $220,000 bill that Aderholt eventually negotiated down to about $22,000. Another case several years ago almost led to a bill totalling about $500,000 before some Medicaid/Medicare coverage was discovered.

“If you don’t have insurance walking into a hospital, the emergency room especially, and you can go into surgery and other major complications, the bills rack up quick. You can bankrupt the household quick if you don’t have any medical coverage,” said Aderholt, who is the president of Central Alabama Urgent Care in East Walker.

Aderholt said Thursday the case led him to ask Senate Majority Leader Greg Reed, R-Jasper, why counties were “on the hook” for such bills and suggested all county inmates be charged no more than the state Medicaid rate. He said that he questioned that if an inmate can’t afford insurance outside of the jail, then they might be Medicaid eligible while an inmate. He said Reed proposed a bill to implement the suggestions, but it died in the House. Aderholt pointed out the new act that did pass will only deal with those who have already been on Medicaid.

While the Reed bill died, Aderholt said it created much discussion that apparently led to the new program.

He noted on Tuesday that under the new plan about to start, the taxpayers will still be paying for the hospital bills, “but again I would rather be paying Medicaid rates than for the full retail price of medicine, which is sometimes 10 times what you get” under Medicaid, Medicare or even Blue Cross Blue Shield of Alabama. Aderholt said Thursday at one time the jail administration had negotiated a 40 percent discount with Walker Baptist for inmate bills, but he said that could still amount to 10 times as much as the new deal with the hospital.

At Tuesday’s meeting, he said Abercrombie had been “gracious” in allowing the agreement with the hospital. He said he was unaware about the new Jan. 1 program when it was agreed upon. He thanked him for the deal, but he noted the county will need to merge the local agreement with the new program that starts Jan. 1 so the county doesn’t pay more than it has to. Fikes noted the 30-day clause to get out of the local agreement.