AUGUSTA, Maine — Medical care for inmates in the state’s correctional system is expensive and the state foots the bill, although a 1997 ruling by the federal government would allow some inmates that are hospitalized to get the mostly federally funded Medicaid program.
“To the best of my knowledge, it has never been done here in Maine,” said Corrections Commissioner Joe Ponte. “I don’t know why it has not been used even though it has been available to a limited number of inmates.”
The federal Department of Health and Human Services informed states in 1997 that inmates that leave prison facilities and are admitted to a hospital for more than 24 hours and meet the poverty and other state rules of Medicaid are eligible for coverage. The federal government pays for roughly two-thirds of Medicaid, with the state paying the rest.
“We don’t have that many cases where this would apply, but there are some,” Ponte said. “We also are limited in that the inmate has to agree to apply for the Medicaid and they certainly won’t always do that.”
He said the department is actively working to shift medical costs from the state where possible. He said a program in juvenile corrections requires parents of children in the two state facilities to continue to cover their child on their private health insurance while the child is in state custody.
“We are exploring if there are any situations in the adult side where inmates have private insurance and whether there is any thing we can do there,” he said.
Ponte said he is doing whatever he can to cut costs through policy changes. He said there are many examples of medical procedures covered in the past that no longer will be approved. He said a recent example was the case of an inmate in his 60s who wanted rotator cuff surgery even though his arm still had good movement. It was denied because it did not meet the “medically necessary” standard used by insurers.
“We have also lowered drug costs just by comparing to the national average,” Ponte said. For example, he said the state has been paying $35 for a psychotropic prescription when the national average cost of the drug was $8.
Ponte said his efforts are aimed at reducing state health costs for inmates until 2014, when the federal health care reform act will cover all inmates with incomes less than 133 percent of the federal poverty level.
“That’s 95 if not 99 percent of the inmates,” he said. “That will be a significant savings because it will cover all health care costs under Medicaid, not just the hospital part.”
Sen. Richard Rosen, R-Bucksport, is the co-chairman of the Appropriations Committee and has served several years on the panel while in the House and Senate. He was surprised that the federal government had allowed even limited Medicaid coverage for inmates and that the state had not explored that option years ago.
“It’s a question that those of us on the committee have repeatedly asked over the years, whether or not inmates are eligible and can receive services through the program. If there is an opportunity there, we should explore it,” he said.
Rosen said the fact that some level of coverage has been available since 1997 and that the state has not taken advantage of it is both surprising and troubling. Rep. Peggy Rotundo, D-Lewiston, the Democratic lead on the panel and a former co-chair of the committee, agreed.
“We certainly should be looking at this again,” she said. “This is something that some of us have been talking about for a long time.”
Rotundo said the Department of Corrections should also look at other ways to leverage federal funds to help pay for corrections costs. She said with a growing number of inmates reaching old age, there should be consideration of a nursing home-type facility to house elderly inmates.
“We are already looking at that,” Ponte said. “We are looking at doing a lot of things differently.”
Rosen said the issue is sure to come up as lawmakers consider a supplemental state budget in the January session of the Legislature.