Dane County Jail inmate Christopher Beierle says he is in constant pain from an untreated hernia, but he cannot get a surgery that would alleviate his symptoms because he is not eligible for health care while incarcerated.
Inmates are excluded from federal health and veterans’ benefits when they are admitted into jail. The jail will not cover costs for the procedure because it is considered an elective surgery, Beierle said.
“Without medical benefits, there is nothing I can do until being released from jail,” Beierle said during an interview Monday with representatives from the National Association of Counties. “We need better. A lot better.”
The Medicaid Inmate Exclusion Policy is one piece of the recidivism puzzle that members of a joint task force between the National Association of Counties and the National Sheriffs' Association hope to address. Under this policy, inmates admitted to jail are ineligible for Medicaid, known as BadgerCare in Wisconsin.
The task force was formed to reduce jail inmate recidivism by addressing the continuity of health care services — or how seamlessly care continues for someone who is entering jail or re-entering the community. Members of the task force, which includes county leaders from across the nation, will also explore the effects of the national mental and behavioral health crises that county jails are forced to address.
"We think that the Medicaid Inmate Exclusion Policy needs to go away, and we need to ensure that everyone has the health care they need," National Association of Counties communications director Paul Guequierre said.
Dane County is being hailed as a model for how to best provide medical and mental health treatment and transition inmates from jail back into the community. A short film about the Dane County Jail and Sheriff’s Office will air at conferences for both national organizations this summer.
NSA executive Jonathan Thompson said the organization often turns to Dane County Sheriff Dave Mahoney as an authority on how a local correctional institution can care for inmates.
“(Dane County) stands at the front of the pack,” Thompson said.
Mahoney is the third vice president of the NSA and is a member of the task force.
The national recognition comes as Dane County is grappling with a solution for an outdated jail facility in the City-County Building that puts the lives of the inmates and staff at risk on a daily basis.
“What has been the trend across the country is sheriffs and their jails have become the stop of last resort for the treatment and safety of the chronically mentally ill,” Mahoney said.
However, the Dane County Jail does not have any medical beds and uses solitary confinement cells to house individuals with behavioral health and developmental disabilities.
“It’s really both counter to the treatment that they need and, in our case, inhumane,” Mahoney said.
Proposals to redo the Dane County Jail include providing medical and mental health beds for inmates.
Beierle said he thinks the jail provides the best medical care it can while also dealing with limitations.
“If the jail had more options, they would be able to use them more,” Beierle said.
The law prohibits the payment of federal Medicaid matching funds for the cost of any services provided to an “inmate of public institution” except when the individual is a “patient in a medical institution.” This leaves the cost of medical care up to counties and states.
People in jail can be enrolled in Medicaid while incarcerated, but Medicaid will not cover the cost of their care unless they're hospitalized for 24 hours or longer. Inmates are also not allowed to purchase private insurance plans through the Marketplace.
Michele Chiuchiolo, an economic support supervisor with Dane County Human Services, said BadgerCare policies do not differentiate between people in jail awaiting a conviction and people serving a sentence.
Wisconsin terminates Medicaid when people are in jail, while some states suspend it. The jail works with inmates before they re-enter the community to make sure they are connected to health insurance once they are released.
Greta Berger is a BadgerCare outreach specialist, a position funded through the AmeriCorps program, who meets with inmates on the 20th of the month before they are released to evaluate their health insurance needs. The goal is to minimize the time someone may be without health coverage.
“We’re working with a population that has a great health need,” Berger said in the interview with NACO representatives.
Berger appreciates the emphasis Dane County places on re-entry efforts. However, Dane County cannot work around the federal law.
“The policy to turn BadgerCare or Medicaid off in jail, especially for those who may not be convicted yet, is unfair and unjust,” Berger said.
‘Most in need’
Mahoney said that he wants the Dane County Jail — and jails across the country — to be much more than a place to “warehouse” inmates.
“We spend too much in taxpayer dollars at the federal, state and local level to just warehouse people,” Mahoney said. “We should be using those dollars to try and address the fundamental reasons why people come into the system in the first place.”
The Dane County Jail contracts with Correct Care Solutions for its medical and mental health services. During the week, there are four mental health professionals available, including a director of mental health, nurse practitioner, psychiatric nurse and discharge planner.
Medical and mental health staff conduct an evaluation of people coming into jail during the booking process. Following a nurse’s examination, a member of the mental health staff asks questions to determine if an inmate has past mental health issues, is currently involved in mental health treatment or taking medication.
“If you're going to have individuals in jail with with (alcohol and other drug abuse) and mental health issues, we need to provide health care to them because often times they’re the ones in the community most in need of medical and mental health care,” Mahoney said.
Dane County is also a part of the Stepping Up initiative, which is a national effort to reduce the number of people in jail with mental illnesses. Beginning this year, a mental health worker has been accompanying deputies on calls to determine if alternatives to jail are appropriate.