Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Jail Health Medicaid topic
No spam. Unsubscribe anytime.
Sheriff details jail Medicaid transformation; billing delays threaten intended savings
Summary
Sheriff King said the county began a Medicaid transformation for jail clinical services on July 1 to capture reimbursements for in-jail care, but billing codes and state rules lag the project; he said staff will meet the Health Care Authority to seek clarity and additional short-term funds for billing infrastructure.
Sheriff King told the advisory board the county started a Medicaid transformation project in the jail on July 1 to expand clinical services and capture Medicaid reimbursements for care provided to incarcerated people. "That began July 1. That has been the challenge. And so our biggest challenge right now... is Medicaid billing," he said.
King said the transformation aims to treat more conditions inside the jail—examples include medication-assisted treatment for opioid use disorder (MOUD), expanded management for diabetes and in-facility diagnostic work such as EKGs—to reduce emergency-room transports and officers’ time. "Part of the intent of the transformation project too is to, like, limit ER admissions," he said, noting ER transports are resource intensive for the local hospital and for officers who accompany inmates.
The sheriff said the county has created a combined clinical services model to serve the jail and juvenile services to reduce redundancy and compete more effectively for nursing staff. He listed hires made in June–August including a clinical services director, nurses and reentry coordinators; those staff are providing services now even as billing systems are not yet catching up.
King said the primary problem is that new Medicaid coding for carceral settings is not yet finalized by the state Health Care Authority (HCA); that means the county cannot yet consistently bill for many services. He said the county will meet HCA the next day to ask whether reimbursements can be retroactive and whether the state can provide temporary funding for coding and billing work. "We created this transformation project. We want you to create clinical services... and part of the intent... is to limit ER admissions," King said. "we've got to provide care to everybody constitutionally to anybody in incarcerated. We can't deny care."
He warned that medical costs in the jail have risen significantly in recent years and that the county anticipated recapturing some of those costs through Medicaid. King described unusual medical trends in the jail, including increased diabetes he linked anecdotally with the fentanyl epidemic: "the fentanyl epidemic has created a lot of diabetics," he said, adding he has observed more severe chronic conditions. He also described the difficulty of providing very high-risk treatments in a jail setting and the limits of local capacity: for example, he said chemotherapy presents infection-control and liability concerns and that the Department of Corrections infirmaries typically handle long-term, high-acuity cases in sentenced populations—DOC told the sheriff they were reluctant to accept pretrial patients who require such care.
King said the county is preparing more elaborate medical documentation and coding to satisfy HCA requirements and is asking whether short-term administrative funding can be provided to build billing capacity. He said improved on-site diagnostics (labs, EKGs) and nursing capacity could reduce costly outside transports and free officer time.
The board and attendees suggested local partners such as the fire department and hospital could help with triage or EKG capability; King said local EMS and hospital staff already assist sometimes but that the jail is trying to improve internal capability and billing to make the model sustainable.
The board did not take formal action on this topic; King said staff will hold a scheduled meeting with HCA to clarify billing, retroactive reimbursement and potential state support for coding work.
