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Study: Mass. per capital prison health care spending seventh in U.S.


By Matt Murphy


STATE HOUSE — Massachusetts trailed only six states in per inmate spending on prison health care in 2011 as an aging population contributed to the growing cost of care for inmates, which has been on the decline since 2009 in line with the experience of most other states, according to a new study.

A new report on state prison health care spending published by the Pew Charitable Trusts and the MacArthur Foundation showed that between 2007 and 2011, per inmate spending on health care in Massachusetts grew from $7,527 to $8,427 as the daily prison population climbed from 10,837 to 11,315.

Though only California, Vermont, Wyoming, New Hampshire, Alaska and Montana spent more per inmate than Massachusetts, the 12 percent growth rate in Massachusetts over that five-year span only slightly exceeded the 10 percent average across the country.

The rising age of inmates, along with proximity to hospitals and the prevalence of diseases like Hepatitis C and mental illness, was cited by Pew as one of the three main contributing factors to rising prison health care costs across the country, which largely peaked in 2009 or 2010 and has begun to fall.

Maria Schiff, director of Pew’s state health care spending project, said the nationwide trend of steady growth in prison populations and spending on inmate health care ended in 2010 as many states, after years of enacting tougher sentencing laws and more restrictive parole and probation policies, began to reexamine their practices.

In recent years, Massachusetts lawmakers have enacted tougher habitual offender sentencing guidelines, but Gov. Deval Patrick has also pushed to reexamine the terms on imprisonment for non-violent offenders, such as those convicted of minor drug offenses. Sentencing reform, which generated a lot of debate in 2012, fell off the Beacon Hill radar during the current two-session despite pledges from legislative leaders to revisit the subject.

“Higher spending is not necessarily a sign of waste and lower spending not a sign of efficiency,” Schiff said during a briefing on the new report.

Using a 2007-2011 average, Massachusetts had the fifth highest percentage of inmates over the age of 55 at 9.4 percent, and spent more per inmate than any of the top five states with the exception of Vermont at $11,015. The number of state and federal prisoners older than 55 increased 204 percent from 1999 through 2012 compared to just a 9 percent uptick in younger prisoners.

Overall spending on prison health care in Massachusetts grew from $81.6 million in 2007 to $95.3 million in 2011, an increase of 17 percent compared to a nationwide 13 percent average. Costs peaked in 2009, as they did nationally, at $102.4 million. Twenty-two states spent more on an annual basis, according to the report, and 39 states saw increases over the study’s timeline.

While the overall prison population in the United States remained flat over the five years reviewed in the study, Massachusetts saw a 4 percent increase in its population. In New England, New Hampshire, Connecticut, Rhode Island and Vermont all saw their prison populations decline over the five-year period, while Massachusetts and Maine experienced increases.

“Health care and corrections have emerged as fiscal pressure points for states in recent years as rapid spending growth in each area has competed for scarce revenue. Not surprisingly, the intersection of these two spheres – health care for prison inmates – also has experienced a ramp-up, reaching nearly $8 billion in 2011,” the report found.

Nationwide, general medical care accounted for the largest percentage of health care spending on inmate populations followed by hospitalizations and then pharmaceuticals and mental health care, which both made up 14 percent of total costs.

The report recommended as possible cost-containment strategies the greater use of telehealth services to reduce transportation expenses, the outsourcing of health care services, concerted efforts to enroll eligible prisoners in Medicaid, and adopting geriatric or medical necessity parole programs.

The report stated that states can save money by paroling older, terminally ill or incapacitated inmates even if they retain responsibility for the parolee’s health care outside prison.

“By paroling offenders who qualify, states eliminate the need for expensive around the clock guarding and frequent transportation costs for them,” Schiff said. Under the Affordable Care Act, more prisoners and parolees without dependent children have become eligible under Medicaid for a 50 percent reimbursement on offsite, inpatient care.

Some states that have moved in this direction have paroled relatively few people due to narrow eligibility criteria and lengthy review processes, Schiff said.

Another obstacle to paroling sick and aging prisoners, according to Pew, is that many older inmates were convicted of violent crimes or sentenced under habitual offender laws, generating opposition among both politicians and the public to the idea of releasing them early.

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