Position Statements

Third Party Reimbursement for Correctional Health Care

Increasingly, experts are recognizing that correctional health care is a vital part of public health in American communities (Glaser and Greifinger, 1993).  Those who are behind bars suffer from a number of maladies - mental illness, homelessness, substance abuse, violent behavior, Human Immunodeficiency Virus (HIV), sexually transmitted diseases (STDs), tuberculosis - at a rate higher than that reported for the general population.  Significantly, most of these people will return to their communities so that, to the extent their maladies can be treated, they will return healthier and pose less of a risk to the public health of the community (Bell, 1992).

As a vital component of the community public health program, the financing of correctional health care is a responsibility that all in society must share.  In the free world, private (i.e., health insurance and out-of-pocket expenditures) and public (i.e., Medicare and Medicaid) programs pay for this health care.  The health care provided to those in jail or prison, however, is not included in these expenditures.  Those who are incarcerated lose eligibility for private or public health insurance entitlement benefits even though they may have been eligible prior to arrest.  Upon arrest, detention, conviction and sentencing, the burden or providing health care falls upon counties (i.e., jails) and the states (i.e., prisons).

An ever increasing number of Americans, including a high proportion of minorities and an increasing number of women and juveniles, are presently behind bars.  Others, including the mentally ill and the homeless, are behind bars because there are no other alternatives available in our communities.  Most return to these communities after relatively short periods of incarceration. Those incarcerated in the nation's jails and prisons have a constitutional right to basic health care while "serving time" (Kay, 1992).

"Coverage for everyone", one of the important principles in the current health care reform movement, becomes "coverage for some" if it excludes those behind bars.  Our counties and states can no longer bear the burden of providing health care for those behind bars on their own.  Neither should the sickest and most disadvantaged in our society be denied eligibility for quality health care solely because of incarceration.

If our jails and prisons are expected to serve as health facilities, they must be funded as such and tied to other health agencies in the communities (Anno, 1993).  Integrating community health services with those of corrections would not only improve the continuity of care for inmates but should prove more cost effective as well.

The National Commission, therefore, urges that the Nation's health care reformers recognize that the health of our communities is closely linked with the care provided to jail and prison inmates.  And, the National Commission recommends that:

1. Congress immediately enact legislation to restore the eligibility for the incarcerated of health benefits available under Medicare and, consistent with state requirements, Medicaid;
2. State legislatures enact legislation prohibiting private health insurance programs from denying eligibility for beneficiaries who are incarcerated but otherwise eligible to receive health insurance benefits; and,
3. National health reformers hold good on their promise of "coverage for everyone" including those who are incarcerated in our nation's jails and prisons.

References
Anno, B. J., "Health Care for Prisoners:  How Soon is Soon Enough?", February 3, 1993.  Journal of the American Medical Association:  633-634.

Bell, C., "Correctional Health Care:  A Prescription for a Healthier America", testimony before the Subcommittee on Labor, Health and Human Services, U.S. House of Representatives, Washington, D.C., April 28, 1992.

Glaser, J. B. and Greifinger, R. B., "Correctional Health Care:  A Public Health Opportunity", Annals of Internal Medicine, January 15, 1993, pp. 139-145.

Kay, S. L., The Constitutional Dimensions of an Inmate's Right to Health Care, National Commission on Correctional Health Care, Chicago, 1991.

Weiner, J. and Anno, B. J., "The Crisis in Correctional Health Care:  The Impact of the National Drug Control Strategy on Correctional Health Services," Annals of Internal Medicine, July 1, 1992, pp. 71-77.