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Mississippi Attempts to Offload Prisoner Healthcare Costs Onto Medicaid

by Anthony W. Accurso

On April 21, 2022, Mississippi Gov. Tate Reeves (R) signed H.B. 936, a new law creating “special care facilities” to house and provide healthcare for about 600 “medically frail” state prisoners eligible for parole whom the state Department of Corrections (DOC) refuses to release because they have no release address.

“They have nowhere to go,” explained state Sen. Daniel Sparks (R-Belmont). “Their family may have died. But they’re in [DOC]. Which is a problem for us as a state. We are paying for their medical, we are paying for their housing.”

Like many prison systems, DOC’s medical costs are rising sharply as its prisoner population ages — the inevitable consequence of draconian sentences that keep people in prison for decades in conditions that have deleterious effects on their health.

Yet rather than take more rational steps to solve the problem, such as releasing low-risk offenders, the Magnolia State has chosen to create quasi-prisons that look like nursing homes in hopes that Medicaid will pick up the tab.

As passed, the law allows parole-eligible prisoners to be placed in the new facilities and expands medical parole. But it has one potentially fatal flaw: a provision to revoke parole “if the person recovers.” Federal guidance adopted in 2016 prohibits payments by Medicaid for nursing care “if residents’ freedom of movement is restricted or if the criminal justice system retains a role in their health care.”

“A revocation [provision] like [Mississippi’s], it signifies that you’re still under control of the state,” said Dan Mistak, acting president of Healthcare Initiatives for Justice-Involved Populations at the non-profit Community Oriented Correctional Health Services.

State Rep. Otis Anthony (D-Indianola), a member of the state House Corrections Committee who worked on the bill, offered that “In order to get it passed, sometimes the other house will put in some language that will appease, you know, voters who don’t want to see people paroled for anything.”

A similar measure passed in Connecticut in 2013, establishing a special care facility for parolees in that state. Yet it was still sufficiently prison-like that Medicaid at first refused to cover the cost, citing “the presence of security measures that had no medical justification.”

Moreover, Connecticut had accepted expansion of Medicaid under the Affordable Care Act of 2009, commonly known as “Obamacare.” Mississippi, like 11 other states, has refused to do so because Republican lawmakers object that it provides a disincentive to work.

Ultimately in Connecticut, the will of the legislature gave way to Federal requirements, and its facility now looks like any other nursing home. So it’s likely Mississippi will also revisit the law if it wants the feds to pick up the tab for parolee healthcare. But another provision of the law requiring medical records to be shared with prosecutors may also be a sticking point, as it could compromise “personal privacy and confidentiality” of these records, something else that could trigger a Medicaid denial.

We’ll see how this plays out and whether Mississippi legislators will make the needed changes if Medicaid denies funding. That effort will be complicated, though, by lawmakers who opposed H.B. 936 because they are in the group objecting to any “Medicaid expansion.”

“They’re trying to figure out a way to still keep people under their control while at the same time trying to cost-shift to the federal government,” said Mistak. 

Additional source: Mississippi Today

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