When an Oregonian gets arrested and booked into jail, they don’t just lose their freedom while awaiting trial.
They also lose any federal medical benefit they’re getting. The list includes payments from Medicaid, Veterans Affairs and the Children’s Health Insurance Program.
Instead, the medical costs get passed to counties and municipalities running the jails — and their budgets of local tax dollars.
It’s a scenario that unfolds across the United States and U.S. Sen. Jeff Merkley, D-Oregon, wants to see it change. Earlier this month, he introduced a bill that would preserve the federal medical benefits for an inmate who is in jail awaiting trial.
In a Thursday call with reporters, Merkley said the current situation is “problematic and perhaps unconstitutional,” because the inmates haven’t been convicted of any crime and stripping them of their benefits is unfair.
Merkley said keeping inmates in their federal health programs would preserve a “continuity of care” that allows inmates to continue medical treatment without an interruption. Essentially, the legislation would let counties to access medical records and keep an inmate’s health services continuing without any interruptions.
“They should not be losing a federally protected benefit just because they happen to be staying in my facility,” said Tim Svenson, Yamhill County sheriff and secretary of the Oregon State Sheriff’s Association.
By law, county jails must provide medical care that meets certain federal standards. But law enforcement can still face challenges in ensuring inmates access all the treatments they need, included mental health services.
Outside jail, it’s easier to enroll in a mental health therapy program and get counseling to prevent a crisis. But some of those same programs cannot be billed by county sheriffs for counseling in jails.
As a result, local law enforcement officials are welcoming the potential change.
Polk County Sheriff Mark Garton budgets close to $500,000 each year for inmate health care, which includes staff wages, prescriptions and medical tests.
“If we were able to recoup that amount of money, that would be fantastic,” he said. “We’d have more available dollars to save our local tax payer dollars.”
With mental health care, for example, someone outside jail can get therapy and Polk County health officials can recoup the costs if there is insurance involved. But, once in jail the jail cannot bill or get reimbursed, Garton said.
Having people get continual, consistent treatment for mental health challenges in and out of jail would drive the overall costs down, he said.
The sheriff’s office has an 18-hour rotation of nursing and medical assistance staff who are also on-call for emergencies. A contracted doctor comes in for regular visits each week.
“If they’re in our custody and they’re in jail, we’re out of luck,” Garton said. “We have to eat all the costs.”
In Marion County, $2.8 million is budgeted for inmate medical costs this year, though the annual figure can fluctuate based on medical conditions of inmates under their care. Even with that investment, the jail cannot afford to provide some of the services within treatment plans of federal programs, Sheriff Joe Kast said.
“The current system ends health care for persons in custody who are being held pre-trial, both adults and juveniles,” Kast said in a statement. “Oftentimes this impacts some of the most vulnerable people in our system. It is preferred that those needing medical assistance, especially those already on a prescribed treatment plan, get the necessary help so they do not lessen the effectiveness of their treatment plan.”
Some unknowns remain with Merkley’s proposal, including whether an inmate not previously enrolled in a federal program could apply while in jail.
Oregon state officials and advocates say the changes would address long-standing problems.
“Many people in the justice system need health coverage to help overcome the physical and mental health challenges that led to their confinement,” Patrick Allen, Oregon Health Authority director, said in a statement. “Breaking the link to health care that Medicaid coverage provides cuts off a vital bridge that helps people who are incarcerated successfully return to the community. … Sen. Merkley’s bill fixes that problem.”
Disability Rights Oregon, an advocacy group, echoed that.
“A foundational principle of our criminal justice system is innocent until proven guilty,” said Jake Cornett, Executive Director of Disability Rights Oregon. “Yet, in every corner of Oregon, our county jails are filled with people experiencing behavioral health crises who are then denied access to health care and other social safety net services they need without ever being convicted.”