Just as the expense of healthcare services are crippling the rest of the American economy, so too have counties felt the pinch – arguably more so – when paying the hospital bills for jail inmates.

 

Orange County spent roughly $4.2 million last year on inmate hospitalizations, up from $4 million the year prior, said Donna Loyko, RN, health services administrator for Corrections Health Services.

 

Loyko’s office had a total annual budget last year of $22 million, including personnel and in-jail healthcare services. Last year, Orange County booked roughly 64,000 people into its county jail, maintained an average daily census of slightly less than 4,000 inmates and transferred 241 inmates to the hospital.

 

“You have to realize that most of these people haven’t taken care of themselves on the outside,” Loyko said. “Most of their healthcare needs are more complicated than the normal person.”

 

Orange County has contractual arrangements with both Florida Hospital and Orlando Health, but even those agreements haven’t insulated the county completely from the costs of providing care.

 

In an effort to curb runaway costs, Florida lawmakers proposed a bill in the recent legislative session, which ended April 31, that would have set limits on how much hospitals could charge counties for inmate services.

 

The Florida Hospital Association opposed the bill because it would have tagged rates to Medicaid, said Bruce Rueben, association president. An amended version that set the rate at 110 percent of Medicaid passed the Florida Senate but failed to pass the House.

 

“Wherever it makes sense, we encourage hospitals to have relationships with their local counties,” Rueben said. “And if there’s a need to provide hospital services to prisoners, certainly hospitals are there for that purpose. What we’re opposed to is having yet another government entity impose Medicaid rates on hospitals that provide those services.”

 

Rueben said any policy that fixes charges below what it costs to provide care serves as a hidden tax that gets imposed on all other hospital patients or forces hospitals to cut services. “It won’t be less expensive, it just changes who pays for it,” Rueben said.

 

In the end, the position of the hospital association beat out that of the Florida Sheriff’s Association and the Association of Florida Counties, which supported the bill.

 

When criminal suspects in police custody or those booked into jail need hospital care, federal law mandates local governments provide it. That goes for basic healthcare services while inmates are behind bars as well.

 

A Florida law passed in 1983 goes further, saying counties have to pay the bill out of their general fund when inmates lack the ability to cover their own medical costs while in custody.

 

Hillsborough County has all but given up entirely on collecting unpaid medical bills, said Beth Weaver, MD,medical advisor to the Hillsborough County Sheriff’s Office. Last year, the county spent $2 million on inmate hospitalizations.

 

“If you had an address you could try and collect something,” Weaver said. “We haven’t spent a lot of money doing that. You could spend a lot of money trying to collect and get nothing.”

 

Hillsborough County contracts all of its healthcare services to Armor Correctional Health Services, including administering a 50-bed infirmary and handling any hospitalization charges. Through Armor, the county has a negotiated per diem contract with Tampa General Hospital, but they’ve been unable to reach equal accords with other area hospitals.

 

“Working out a contracted payment plan with one hospital where you can send all your inmates really helps contain the costs,” Weaver said. “That’s tremendous and terribly important. At least we know that if someone is admitted to Tampa General we can estimate based on how many days at the hospital. If a patient has to go to another hospital, everything gets billed.”

 

The idea behind the Florida legislation that fell short this past session would have basically created mandated contracts similar to the ones Hillsborough and Orange Counties have with their local facilities. But Loyko, the Orange County administrator, said the bill probably would not have worked very well.