When an inmate enters the Boone County Jail, Medicare and Medicaid will not cover injury or illness, so resources to pay medical bills are limited.
Now, physicians who provide medical care for inmates will be paid by the county about 36 percent of the bill. The rate is equivalent to what Medicare or Medicaid would pay.
Previously, the inmates were responsible for the entire charge, unless the care required resulted from an injury sustained while in the custody of the sheriff.
“Some vendors were being paid full price; others weren’t being paid at all,” County Auditor June Pitchford said.
Sheriff Ted Boehm began lobbying in January 2003 for a partial reimbursement policy to be enacted. A section of the Missouri Revised Statutes “permits but does not require the county … to pay prisoner medical costs it determines to be reasonable and necessary.”
The Boone County Commission has been negotiating with the medical community to establish a rate of payment since last fall. On June 15, the commission approved a letter to be sent to vendors that explains the rate, “approximately 36 percent of standard billed charges.” Inmates are responsible for the remainder of the bill.
The letter will be sent along with payment to vendors that do not have an official contract with the county. The commission has been working to establish contracts with hospitals that provide care routinely.
Now that the letter has been approved and contracts with vendors are being formalized, the auditor’s office will begin processing bills. Currently, there are invoices totaling about $145,000 for this year, according to documents provided by Leasa Quick, a budget administrator with the sheriff’s department. The county will pay between 26 and 36 percent of that, depending on the service or contract with the vendor.
There is $50,000 set aside in the general fund to cover the costs incurred in 2004.
According to Pitchford, a contract has been signed with Missouri Medical Affiliates LLC; one is almost finalized with Boone Hospital Center; and one is in the works with University of Missouri Health Care. Presiding Commissioner Keith Schnarre said vendors have been hesitant to sign contracts because if they do, it implies the county will bring all their patients to them.
Pitchford said inmates are “not the most popular clients” because they arrive in jumpsuits and are often in shackles.
The jail, which typically houses about 190 people, tries to handle most of the prisoner’s medical needs on site. A new medical director began work in May, and trustees of the Boone Hospital Center provided funding to the county for an additional registered nurse position. The funding is on a trial basis in an attempt to have inmates treated at the jail and not their facility.
Boehm said the hours of coverage have been extended and that new equipment, including an EKG machine, have been added.
“With the staff and additional coverage we believe that we can reduce the amount of times that we have to take someone to the ER,” Boehm said.
But when an inmate does need outside care, Pitchford said the partial reimbursement approach will be more fair and consistent than in the past.