Dakota County wrestles with medical costs in jail

Inmates arrive at the Minnesota's county jails with any number of ailments.

And for everything from minor infections to ongoing mental illness, the counties must provide medical treatment. But amid this year's budget squeeze, keeping jail health care spending in check is a necessity.

So some counties, including Dakota and Hennepin, are focusing on who pays the bill and helping eligible inmates apply for public assistance before their release.

"We're trying to focus on being the payer of last resort," said Kathy Anderson of Dakota County's community services division.

Dakota County's spending on medical care for inmates jumped 30 percent from 2006 to 2007. Last year, the tab was $1.3 million, including doctor and dental visits, prescription drugs and medical staff at the jail. In some cases, when an inmate was already covered by public medical assistance but the county didn't know it, taxpayers were in effect billed twice for that care.

But savings could be in sight. By determining which inmates have public assistance coverage and making sure the county is the last stop for payment, Anderson said, the county could lower its medical expenses by as much as $11,000 a month.

Figuring out who is on public assistance, however, isn't always easy.

That's where the new procedure comes in.

Ill inmates can sign a waiver allowing county employees to search for them in databases of the public assistance programs, such as General Assistance Medical Care. If an inmate has coverage that has not expired, the county won't have to pick up the bill.

Most weeks, the county estimates that 18 inmates participate in such public-assistance health care plans. It's not a large percentage of the 305 people in Dakota County custody on an average day, but it could save thousands of dollars.

Hospitals and clinics that serve inmates already have access to public assistance enrollment information, but if the county keeps track, it will serve as a check-and-balance in the billing system, Anderson said. The county also plans to double check billing for inmates with private insurance.

Hennepin County has had such a policy in place since 2002 at its detention and correctional facilities. In 2007, the county was able to bill the state about $507,000 for inmate medical care. So far this year, the county has passed medical bills worth $512,600 on to the state.

For the past three years, the county has also been helping eligible inmates apply or reapply for public assistance before release. Some inmates lose coverage during their incarceration, while others have never had coverage. Since 2007, a volunteer has helped set up public assistance for 271 inmates in advance of their release, Poidinger said.

Dakota County will begin a three-month pilot of a similar program in January or February. A county staff member will meet with inmates weekly to help those who are eligible learn about and file paperwork for public assistance.

If successful, it could save the county money in the long run because returning inmates would have coverage. It could also help inmates with continuity of care, which could keep some, such as those with mental illness who need medications, out of jail again, Anderson said.

"We're going to be catching those people who fall through the cracks," Anderson said.