Inmate medical costs and F.S. 951 rate cap
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Uh the next uh one on our list is uh from corrections and we'll ask you students to come up.
Yeah. What we're looking at doing and welcome to jail operations.
So jail's expensive in innate medical costs are expensive. Your medical uh provider is taking about 20, 25 five percent of the overall jail budget that that operate um the medical piece. Um So last year we had a $1.5 million outside medical cap, which meant for inmates that were leaving the facility
and going out and getting treatment at a hospital or if a specialist was coming into the jail, we had a 1.5 million dollar cap written into our medical budget in order to to fund the cost of those services for the inmate. We went over that $1.5 million dollar cap. It was $2.25 million. Um this year when you um came to the county uh uh from the sheriff's operation. We
put in place a $2 million cap knowing that we had gone over last year. So that was written in our in our current contract. So what we're looking at is a legislative change to Lord of Statute 951. So currently Florida Statute nine fifty one and it's point hold on here um point two three Um it provides that the county is responsible for medical care of of the inmate. So
when we send an inmate out, initially the the hospital will look at that inmate uh to pay and most of our inmates either had Medicaid when they came in or they had no insurance. Um so um Medicaid goes away upon an inmate being incarcerated in the county jail. Um so
we're gonna talk about that in a second.
Yeah, and so um because we're not a Medicaid expansion uh state, um so therefore those costs again um Medicaid's not available uh for the inmate population. Um the inmate can be billed, but most of them are indigent. Um and therefore the cost the hospital is supposed to seek payment from that inmate prior to coming to the county, but we know that we get those bills. Those
bills can take anywhere up to six months to come in after treatment, and we are And those those cost that only is. So right now there is not a designated cost or contract of cost across the board for all of our hospitals and for all of our providers. And um the Department of Corrections does have a statute that provides that Um they paid 110%.
of Medicare, not Medicaid rates, but Medicare rates, and it may be up to a hundred and twenty-five percent of Medicare rates. We are just looking um at a a statute change that kind of caps the expenses that the county is paying for inmate medical costs.
Mr. Starkman.
Well I'm a hundred percent for this, but there's I wanna expand on it a little further and um So at NACO and as chairperson of the FAC Federal Policy Committee. We've been looking at the issue of when Uh someone is arrested And they go to jail. Not not charged and, you know, Becoming a customer of our jail. for a you know, a sentence. But when
they're arrested and spend time in our jail, they immediately lose their Medicare and Medicaid their federal benefits. Uh My understanding is they have now um waived that for states that suspend Medicare federal benefits, but Florida is a termination state. So Um so what we need to find out is what does it take for Florida to move from a termination of federal benefit state to
a suspended um, state so that we can take advantage of though of that policy change. And I've spoken to Congressman Bilarakis about it. It's actually Part of his committee. Um But I I think it takes uh language uh in Tallahassee to switch us from one to the other. Okay. Um but we have full support of all the counties in Florida and frankly across the country. Um Two be
able to keep have these in these people who've been arrested keep their benefits um while until they Get um charged.
And correct me if
I'm wrong I'll be found guilty.
Oh that's a county attorney.
Yeah.
And when when I um I showed this to Senator um Rubio in Washington last year and he couldn't believe it. And as an attorney Um, he's reading it and he said and and this comes from the Social Security Act in nineteen fifty six. And he said they they just didn't define it right. And then all these years we've had to live with with this cost to the counties. So he didn't think it was a hard fix. Um and he saw the issue right away. Yeah. Scott's
um people, but there are there this is a high priority at NACO. And and right now we could fix it here in Florida if we just went from a termination state to suspension state. It doesn't help everything that you spoke about. Because these are just for people who Um Aren't adjudicated yet. Uh it's a problem. And and if you have a family under your federal benefits, they lose their federal benefits as well.
Ralph and I just learned something today. No
the first part you're talking about this.
I didn't realize that
a federal decision or is it a state decision?
that um they lose it that they lose their benefits. So that's a congressional fix. Right. But I'll check
in to the suspended state. Yeah.
They have fixed it for suspended states, but not states that terminate and we are a termination state. So we need to maybe Sean you can help me with Congressman Bilarakis to help him understand it. I tried to explain it.
The question is is that tied to the for Medicaid expansion? It may very well be. So it's not a decision the legislature or the governor can make.
Okay.
I don't know. I don't know the differen I don't know the nuances between a suspend or termination.
I I think we can research it and we will on that
part. So
makes sense.
So going back to what Stacey said, I know she was going to Talk about that one bill that they tried to do this before in twenty twelve and so we have some information there, which is which is good, makes it easier. It passed the Senate. Um like any bill sometimes it gets bogged down uh and it uh got stuck in the house. Um don't know why it's not been addressed. I'm looking at the uh sponsors from twenty twelve. Of course they're no longer here. Yeah. Um but uh Um it makes it easier if this
is an issue that you want to pursue and you think absolutely I think this should be our priority for us and you know.
So just to say though So the hospitals are gonna be the one that that fight this, correct? Because they're not getting the
Now I and you addressed this and you had a a point raised. So what can we do via the contract process? And and when you set up that contract, it's an annual contract that you set up i with each individual hospital?
It it's not. So um Previously, um I can tell you that I personally years ago went to multiple hospitals. We went to Trinity, we went to uh Bayonet Point, we went down to Cancer General. And um we ended up with um one contract from uh Bannette Point who tends to be um the provider that we utilize the most at the jail. Um but it was a Medicare um plus um and that has
changed because now they're going strictly on DRT rate. So um the The contracts right now are set up with by the medical provider. So I do not um negotiate rates with the hospitals. Okay. The medical providers negotiate the rates with the hospitals.
I'm just thinking about this just a little bit here. Stacy, um so it it it I mean to me it sounds like if if these are indigent folks and they were outside of jail coming to a hospital, they they would be the hospitals would He's stuck with the bill. Uh but because the local government is coming forward, we're in a must pay situation and we're not uh we're not being afforded uh protections that say other government entities that are with our guaranteeing payment. We're paying whatever the rate prevailing private rate might be. I
mean this sounds like an inflation health care issue. Seems like it's in line with a lot of the priorities. I think it's something we really we really need to tackle here.
inmates um we're treating a lot of inmates for uh cancer. And they'll um obtain their treatments while they're in the jail. When they're released, they do not get treatment, they're re arrested and they're in worse shape than when they have done previously and we um picked that.
And and was that who's the medicate who's the medical provider then?
Right right now we have the C supplier that certainly you won't have, but we are out on it to negotiate right now.
Well I don't know, that's a that's a question back, but I don't think they're incentivized to negotiate. It it doesn't seem like it.
Well we They
want two million dollars.
I mean that's gonna be part of the negotiation process. We we're going to uh we just went out. They're they're currently answering all the questions. Some medical providers do a not go succeed, almost like a CMAR. And then you split the cost savings if there's cost savings, but then you you know whether or not you split the overages. So they're incentivized also, like they don't get dollar for
dollar if they go over. So but that's part that'll be part of the process we go through. Uh we're not putting a hard line, or hopefully not, put a hard line because they go over with when you pay the bill how we do that.
Yeah, so just being as I mentioned earlier, that you you're I I I agree with the policy, I absolutely understand it. You know, I think we've already said it you're you're fighting the Florida Hospital Association, those individually, they already feel that they don't get the funding that they should for indigeno indigenous care. I mean I know you guys there's pots of money, but don't we part of our agreements, don't we pay part of that state agreement for the indigenous care from the county also? Yeah, I defer right.
Right. What's it called?
Hecqua. H C R A. Hitco.
It it's it's it's just a big issue in Tallahassee. It's one of the last items in the budget that they agree upon what hospitals get for energy care. So I'm just uh and this will be uh it's uh I don't know what the pot of money would be statewide for them, but it's pretty big. Just think we should we should have some conversation, something with the legislators, but and again it may be the right time, right year with the health care conversation.
Stacy I wouldn't mind seeing a breakdown. Show show us what these major costs are. I'm sure these cancer treatments are like phenomenal in cost and percentage wise for the the people there. It would seem to me if I was an indigent person and Don't say it.
Don't say it. No, I whispered that to Oakley.
Well don't give them the idea. Logic's logic. I mean th th th there's a push for them to come back in just to so they can keep cancer treatment. Well I mean some of them's broken.
Medica not it's just and that's just crazy. You get arrested and you're in jail and then you lost that health care that you had before you
And you can be found not guilty and and then you've lost everything and you have to re reapply. And
that affects the families, like you say. Then
we have high num high amounts of recidivism. Yeah.
Just come back in so I can get care. I don't know. Def that definitely a complex issue to go forward with
Well we'll we'll get together with with Sean and and let's let's flush it out into some very you know using your KISS principle there and um we'll continue that competition.
Thank you for bringing us a simple issue. Yeah.
Let me let me float an uh an idea out there. I know we talked about this, we did the jail construction as we're going through and looked at different things and try to incorporate the medical And I suggest we put a building out beside it. For like a clinic. where they don't have to go to a regular hospital. Now they go right in. And kinda I think Charlotte County did something like that where they had built in they built it in for behavioral health, mental health, drug addiction. And just regular care so that when they went They didn't have to go to a hospital. They could
go right there, get treatment. And After four years, five years, I think Eric was telling me it it was working pretty well down there.
Yeah, we have um we've been down to Charlotte County and we have all the similar services that Charlotte County um has. Um I think the only thing that we may not be doing that they may be doing currently is on dialysis. And um we do have a And the new bill for dialysis. But it does not have the equipment. So right now a provider would have to go in with that equipment.
I mean I I just said that before we actually check them in and maybe they lose their coverage, let's go treat them medically first if we need to and then bring 'em in.
Well we have several more, so I think we want to definitely want to get to your uh your items as well.
Right,
exactly.