The NCSL Blog


By Mark Wolf

Los Angeles—In just the past week, rising prison health care costs in both Florida and Vermont have come under scrutiny.

From left, Frances McGaffey, Representative Paul Ray of Utah, Daniel Mistak and Dr. Stacey Trooskin.A panel at NCSL's Legislative Summit grappled with how to manage strategies for prison health care expenses that cost states $8.1 billion in 2015 to treat a population with high rates of both physical and behavioral health issues.

Frances McGaffey of the Pew Charitable Trusts presented an overview of the prison health care landscape:

  • 20 states contract health care, 18 states are direct providers, eight use a hybrid system, three use universities.
  • Per-prisoner health care spending ranges from $19,796 in California to $2,178 in Arkansas. "Costs can be unrelated to care," said McGaffey. "A low number could indicate either efficient care or low-quality care."
  • Aging populations drive up health care costs. The 55-and-older prison population grew 264 percent from 1999 to 2015. Massachusetts (14.4 percent) had the largest percent of older prisoners; Connecticut (6.8) had the lowest.
  • 44 percent of prisoners had a chronic health condition, compared to 31 perent of the general public.
  • Prisoners were four times more likely to have an infectious disease than the general public and three times more likely to have HIV/AIDS.
  • General medical care (37 percent) is the major health care cost for prisons, followed by hospitalization (20 percent), pharmaceuticals and mental health care (14 percent each), substance abuse treatment (5 percent) and dental care (4 percent).
  • Prescription drugs are a huge cost driver; hepatitis C costs have risen 487 percent in the last five fiscal years, one official told Pew.

"The challenges I talked about are real," said McGaffey, who added that a common thread in solutions olften involves collaborations, particulary between corrections officials and Medicaid. "They are stakeholders in each other's success."

Daniel Mistak, of Community Oriented Correctional Health Services, cited projects that have had success in dealing with costs.

Vermont created a request for proposals that required vendors to use performance metrics that improve overall health.

In Dallas, an ad valorem tax was created to focus specifically on the jail to eliminated battles for funds between safety net providers.

Medicaid ends when a person is incarcerated so Maryland ruled that everyone leaving jail is presumptively qualified for Medicaid.

Dr. Stacey Trooskin, a hepatitis specialist who is with Philadelphia Fight-Community Health Center, said corrections officials are disadvantaged for competitive drug pricing. The Big Four (Veterans Administration, Public Health Service, Department of Defense and Coast Guard) are guaranteed to get the "best price" for drugs and Medicaid gets a standard discount plus negotiated rebates.

"Corrections don't have those," she said. "Pharma doesn't want to cut you a great deal, which would set a new low for 'best price.' If you can get a waiver it gives pharma a little more freedom to negotiate."

Mark Wolf is editor of the NCSL Blog.

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.