CROWN POINT — Lake County Jail officials are now registering the accused within their iron and masonry walls — for health insurance.
Mark Back, who is directing the work, said signing up incarcerated criminal defendants for Medicaid is not only a public good, but also is expected to ease a rising burden on local government and property taxpayers who are the bill payers of last resort for a segment of the population we all have to live with, eventually.
The Sheriff’s Department said the jail received 11,207 men and women inmates in 2015. Some 58 inmates had to be rushed to a hospital for acute medical problems that had to be stabilized before they could even be admitted to the jail.
Inmates made 7,196 sick call requests last year, and in all but a handful of cases were treated in the jail health clinic by clinic staff within 24 hours.
Some 1,396 required a full evaluation for problems including trauma from fighting, mental anxiety, chest pains, seizures, dizziness, asthma and low blood sugar.
More than 1,200 required chronic care, which can add up for long-term inmates who spend months and sometimes years in the lockup awaiting trial.
Infectious diseases are rife among inmates. Some 435 suffered from Hepatitis, 95 had HIV infections, 26 had Methicillin-resistant Staphylococcus aureus or MRSA infections, and 37 had sexually transmitted diseases.
The jail’s clinical staff also provides treatment for many addicted to heroin, opiates, alcohol, Valium, Xanax and other street drugs, including bath salts.
The jail’s population also is aging. Of 722 inmates being held in the jail last month, 32 were 55 or older, and 11 were older than 65. They are at higher risk for more acute treatments because of a longer negligence of health problems.
Healthier inmates mean less cost overall
“We are working on registering inmates who have been with us for at least 30 days,” Back said. “Our goal is to systematically enroll all inmates booked into the jail by April 2017.”
Back and two part-time clerical workers are paid from a state grant to put these inmates on a path to afford to control their infections and mental health issues driving their violent behavior after they leave the jail. He said if they re-offend, as they often do, Medicaid would then help pay any new hospital bills and reduce the cost to local taxpayers.
Back said they interview inmates, coach them through the Medicaid application forms and submit the paperwork to the state for its approval. They have completed 200 registrations since late January.
They would have more signed up if the state’s eligibility requirements weren’t so restrictive, Back said.
“They require proof of citizenship and residence. A lot of these inmates are homeless or don’t have identity papers on them when they are arrested,” he said.
He said giving federal health benefits to this population makes sense.
Changes in the law and government policy explain why jail officials have to attend to the health benefits of the incarcerated.
Indiana created a system of six state-run hospitals, including Norman Beatty Memorial Hospital at Westville, to improve service to the mentally ill more than a century ago, according to an Indiana Department of Mental Health report.
The hospitals’ population rose to more than a half million in the 1950s, but was in sharp decline by the 1970s because of a de-institutional movement to move hospital inmates into community health centers and cheaper outpatient care.
Most recently, Indiana cut non-Medicaid state mental health budgets by $4.3 million from 2009 to 2011, according to the National Alliance on Mental Illness, which also notes that 21 percent of local jail prisoners have “a recent history” of a mental health condition.
The courts have ruled that inmates have a right to medical and mental health treatment.
Feds required many improvements
The U.S. Justice Department’s civil rights division declared the jail deficient in terms of 99 federal standards in 2009 following a series of suicides and complaints about health care and sanitation within the lockup.
The county signed an agreement with the federal government to improve heath care. The cost in terms of jail consultants and medical health-care providers has added millions of dollars annually to the jail’s $17 million non-medical budget.
The county also has had to sink many more millions into remodeling the jail’s clinic to provide top-quality medical and dental equipment. The county also has divided up the former open space within the jail’s clinic to provide more privacy for inmates being treated.
Back said Medicaid registration won’t reduce any of the cost of treating and counseling inmates inside the jail, but is expected to have a follow-along benefit.
“Once they are registered and released, we hope they continue treatment and won’t have the behaviors that caused them to be arrested. If they do offend again, they will be less sick when they are next incarcerated.”
New state and federal laws would permit the jail to apply for 50 percent reimbursement for inmates who are hospitalized for more than 24 hours. Back said, “That could amount to $700,000 in savings.”
“Some people refuse Medicaid. They think they don’t need health care, or they think they are still covered by their own insurance. But if they have been in jail for a year, that probably isn’t the case,” Back said.
“I’ve talked with inmates who have heard of our program and want to be signed up. They understand the benefits. I think we are making great progress here.”