County Law Update

from Fall 2015 County Lines

AAC staff profile: Melissa Hollowell

Using private option insurance to pay inmate health care costs

The combines and cotton pickers have taken to the field harvesting crops planted months ago — crops planted with no guarantee to make it to harvest. Today’s high tech farmers are using new methods and technology to reduce costs and increase yields. Yet, some still choose to not learn about new technology or to invest in upgraded equipment. More and more of the “old school” farmers are going out of business. While no farmer can control the weather or the commodity market, every farmer has to work to control their costs and increase yields by using the tools and technology that are now available to them. Jail Inmate health care costs are no different.

In April 2013, Gov. Mike Beebe signed into law the Arkansas Healthcare Independence Program. This is the program commonly referred to as “the private option.” It allows the state of Arkansas to use federal money to purchase private insurance policies for individuals who have a household income at or below 138 percent of the federal poverty level. A single individual can make up to $16,242 a year and receive a private insurance policy at no cost to the individual. The policy requires only a $4 to $8 co-pay. If an insured has no income, there is no co-pay, no monthly premium, no deductible and no coinsurance; its 100 percent free. Plus, a medical provider getting paid through private option health insurance gets paid at a rate higher than the traditional Medicaid rate. The private option health insurance program has the potential to almost eliminate uncompensated health care in Arkansas. So far, hospitals like UAMS in Little Rock have seen their uncompensated care costs reduced by as much as 50 percent, resulting in millions of dollars in savings.

With the encouragement of the Arkansas Department of Human Services, some Arkansas sheriffs are already using this new private option health insurance program to reduce county jail inmate healthcare costs. Under the traditional rules, federal Medicaid dollars are available to pay for jail inmate healthcare only after the inmate has been admitted to a hospital for 24 hours or more. A county jail inmate already enrolled in Arkansas’ private option insurance program has health insurance that will pay any approved medical provider — regardless of the length of stay. By being enrolled in the Arkansas private option insurance program instead of the Medicaid program, a county jail inmate literally has “private” insurance. Private insurance cannot be terminated until an inmate has been held for the lesser of 30 days or the end of the month in which detained. This means most county jail inmates can have private health insurance to pay for health care while in jail.

Pope County Sheriff Shane Jones was one of the first sheriffs to start implementing the private option health insurance program for county jail inmates. Jones said his effort to enroll county jail inmates in the private option health insurance program will reduce inmate healthcare costs over time and pay big dividends for Pope County.

“For a number of different reasons we end up arresting the same offenders over and over. Most of the time these offenders are not employed and qualify for the private option health insurance. If we can get them enrolled in the private option while they are in our jail, it can possibly serve two purposes. First, many of these offenders suffer from untreated mental illness and as a result they end up committing crimes and coming back into the jail and becoming a financial burden on the county. If we can get these individuals enrolled in the private option health insurance and then seen, treated and properly medicated, we may never see a number of them again. Mental health treatment reduces the likelihood of reoffending. Second, some people are just habitual offenders. It’s not uncommon at all for us to see the same guy four or five times a year. Well guess what? If we enrolled him in the private option the last time he was here then we don’t have to worry about the cost of health care for him. We can simply give the hospital or the doctor’s office his insurance information. It’s a no-brainer for us. I think over time this program has the potential to save the tax payers of Pope County a ton of money,” he said.

Mississippi County Jail Assistant Administrator Bonnie Brooks said the process of getting someone enrolled in the private option has been very simple for them.

“When an inmate is released we offer them the opportunity to apply for the insurance. It’s no extra work on us. Even if it was, it would still be worth it. We can’t make them apply for it and believe it or not some of them actually refuse to do it, but a large percentage of them actually fill out the applications. Someone from Fidelity then comes by once a week and picks the forms up, processes them and that’s it. We don’t have any other involvement in the process at all until they show back up in our facility and need medical treatment. We have been participating in the program since May and expect that by this time next year 50 to 60 percent of the offenders we house will come in with the private option. Most of our inmates are not held here for 30 days, so we see this program as a huge benefit to us,” Brooks said.

The key to a viable health insurance program is a large group of insured users. Enrolling county jail inmates into Arkansas’ private option health insurance program is legal and will actually help Arkansas build the large base of insured people that is needed for the new federal health insurance program to work. The program is available for free to all AAC members. Each county is encouraged to call the Fidelity Insurance Group to get the enrollment program started in your county jail. For more information please call Matthew Glass at 501-247-0560.