clasped hands, prison bars

The public cost of providing health care to Virginia prison inmates increased 40 percent in the last decade, and a new state report offers recommendations on how the state could save money.

Virginia spent more than $201 million in fiscal 2017 to provide health care to about 30,000 inmates at 41 state facilities, which comes to about $6,500 per inmate — similar to what other states spend on inmate health care.

Virginia uses state employees and private contracts to provide care; the report by the state’s Joint Legislative Audit and Review Commission notes that some states are partnering more closely with university health systems to reduce costs.

“DOC pays more than other public payers for health care services and prescription drugs,” said Jeff Lunardi, a commission team leader, in a presentation Tuesday.

The Department of Corrections could save $10 million to $15 million per year by using a lower rate structure and making other changes, the report found.

The department is paying too much for certain prescription drugs, according to the report, and it could save money by amending a restrictive release policy for inmates who are dying or have long-term medical conditions.

Among findings and recommendations by the commission, which does policy analysis and oversight of state agencies:

  • The Department of Corrections pays rates higher than Medicare and Medicaid. It should design a pilot program to test whether it could use Medicare rates as a basis of reimbursement to providers who treat inmates.
  • The DOC should work more closely with the health systems at Virginia Commonwealth University and the University of Virginia to treat inmates who need high-cost prescription drugs, and possibly create a pilot program. The department buys 60 percent of its prescriptions through a private vendor and the rest through VCU Health.
  • The DOC should work with VCU and U.Va. to develop a pilot project to provide inmate health care for at least one state facility.
  • The General Assembly should consider allowing seriously ill inmates to petition the Virginia Parole Board for release.

“One of the most direct ways to reduce spending on health care is to have fewer inmates in VADOC custody, and compassionate release is one way that an inmate may be released early,” the report said.

  • The governor should allow more inmates to be considered for medical clemency. Currently, someone with a life expectancy of three months is eligible for consideration; only Kansas is stricter. The report recommends inmates with a life expectancy of 12 months or less be considered for medical clemency.

Health care costs are the second-largest part of the DOC’s budget, behind inmate security and management, according to the report. Inmates are more likely than the general population to have chronic medical conditions, substance abuse problems or mental health problems.

While health care spending was 13 percent of the DOC’s operating budget in 2007, it is now 17 percent, according to the report, and spending is increasing at nearly twice the rate of the state’s Medicaid program.

Care for inmates outside of prisons, such as hospital stays, and prescription drugs are main reasons for rising costs. The legislature and governor earlier this year opted to expand Medicaid coverage under the Affordable Care Act, and that will result in substantial savings to the state general fund, the report said.

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