Saturday, August 15, 2009

St. Lucie County wants to pay less for inmate hospital care

ST. LUCIE COUNTY — St. Lucie County officials say they’re tired of paying higher-than-Medicaid rates in hospitals for their jailed inmates.

St. Lucie County is lobbying the state to force hospitals to accept the Medicaid rate for inmate medical care. But hospitals are warning that forcing more people on the Medicaid rolls could increase costs to taxpayers.

As it is now, when a Medicaid patient goes to the hospital, the county does not get the bill. Hospitals are required to accept and treat indigent patients. If that same person needs medical care at a hospital while an inmate, the county — and ultimately taxpayers — pay the bill, St. Lucie County Commissioners say.

The Medicaid rate — typically 34 percent — also disappears and counties are forced to negotiate with hospitals on the rates for inmates, County Commissioner Chairwoman Paula Lewis said.

The problem has existed for “quite some time,” and is being lobbied through the Florida Association of Counties, said Lewis. Lewis is the District 26 representative for the Florida Association of Counties.

“All medical expenses have just skyrocketed,” she said. “We’re not asking (the state) to put them on Medicaid. We see it as more of an equity issue.”

But Bruce Rueben, president of the Florida Hospital Association, said giving counties Medicaid rates for inmates would cost everyone else more.

Medicaid rates cover 53 to 89 percent of costs and force hospitals to cover the rest, Rueben said. Someone must make up for the difference in costs for those on Medicaid. Inmates also create additional concerns, including security, though sometimes the security is provided by the county.

“It would be outrageously inappropriate,” said Rueben about the state enforcing the Medicaid rate for inmate medical care. “That taxes the rest of the people in the county for their medical care.”

St. Lucie County — the largest in the Treasure Coast — paid more than $1.6 million in inmate hospital medical care expenses in 2008, Sheriff’s Office Maj. Patrick Tighe said.

Martin County, meanwhile, paid $219,483 and Indian River County paid $503,380.

St. Lucie County had about 1,484 inmates a day in 2008, compared to 614 for Martin County and 539 for Indian River County, but since negotiations are different in every situation, the amount paid for each county is uneven.

St. Lucie County pays far higher rates at Lawnwood Regional Medical Center & Heart Institute than its neighbors because of contracted rates. The county uses other hospitals or medical facilities when necessary, but Lawnwood provides a location nearest to the jail, acting County Risk Manager Dan Lutzke said.

The county has negotiated a 65 percent rate with Lawnwood and could have saved $250,000 through the hospital with the Medicaid rate applied, said County Risk Manager Wayne Teegardin.

Martin County paid 50 percent of the costs for its county inmates at the beginning of 2008, but the county negotiated the price down to 45 percent of the price to Martin Memorial Health Systems, Martin County Community Services Director Cheryl Bass said.

If the Medicaid rate applied, Bass said the county would have spent about $45,000 on inmate medical care as opposed to the more than $219,483 it paid. Martin County has a $20,000 cap per admission for inmates.

Indian River County generally pays the 34 percent Medicaid rate through Indian River Medical Center, Indian River County Sheriff’s Office General Counsel Jim Harpring said. There are exceptions where the county must pay more, Harpring said.

Medicaid rates differ at different hospitals. The rate is basically up to the negotiations between the local hospital and the county, Teegardin said, though each county has few options due to the expenses of transporting inmates.

But Lewis contends the rate the county requests would not be any different than if the inmate was not in jail and eligible for the Medicaid rate.

“They would simply be charging the rate that they would get for those folks anyway if they walked in the front door,” Lewis said.

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