Belknap County officials warn August law change could raise jail medical costs

Michelle Weatherby, superintendent of the Belknap County correctional facility, told the Belknap County Board of Commissioners that a change in state law last August has removed the jail’s ability to require that detainees be medically cleared before intake — a change she said could shift costly emergency-room bills to the county.

"I no longer have the ability to ask a police officer to bring someone to the hospital prior to incarceration," Weatherby said, describing how the previous practice of asking police to obtain a medical clearance kept many bills off county books.

Weatherby told commissioners that under the current rules the county becomes financially responsible for a detainee’s medical bills if the person is held in custody for more than 24 hours. She said that previously, when police brought a person to a hospital first and obtained clearance for incarceration, the individual — not the county — was billed for that care. "Once a person comes into the jail and they're held for more than 24 hours, then the county is responsible for all of their medical bills," she said.

Why it matters: Commissioners were told the change could have an outsized fiscal effect during large events such as concert season and motorcycle week, when more arrests with potential injuries or intoxication occur. Weatherby gave a recent example of a motorcycle crash this past weekend in which medical attention was needed and said one recent inpatient cost the county roughly $30,000.

Sheriff's office response and operational concerns

The county sheriff, who spoke during the same discussion, said the statutory change removed the portion of the law that had required jail staff to obtain a medical evaluation before intake; he said superintendents historically asked for medical clearance in cases of obvious injury or overdose but that the amended statute now focuses on a jail-conducted medical evaluation within 24 hours. The sheriff said his office has been assisting correctional staff during daytime hours but objected to being asked to take on routine night transports.

"If you're gonna ask my personnel to come out and take custody [of] intoxicated or broken people... we're gonna have to talk about an increase in budget and increase in personnel," the sheriff said, adding that his office already provides some medical transport and supervision during daytime hours but that routine night calls would strain staffing.

Commissioners' direction to staff

The commissioners did not adopt a new policy at the meeting. Instead they asked Weatherby to track instances when a detainee required a hospital visit and to coordinate with the county administrator to estimate any additional out-of-pocket expenditures resulting from the August 2024 law change. Weatherby said officers are already filing forms to record each incident; commissioners asked that those cost figures be provided for budget planning.

Other details and constraints

Weatherby and the sheriff described a practical distinction: if a police cruiser takes a person to the hospital and returns, the individual may not be formally in the jail’s custody; if a correction officer accompanies a person to a hospital and the person remains in custody and does not make bail, the county assumes responsibility for medical bills. County staff reported the jail carries a $70,000 catastrophic medical threshold for inmates; once the jail’s insurer (reported as PrimeCare/PrimeX) is billed, the county absorbs costs beyond the deductible and the catastrophic threshold.

Officials said police chiefs in several local departments have refused to resume the prior practice of bringing detainees to hospitals for clearance, leaving the county to consider operational or budget changes. Commissioners asked the sheriff and superintendent to continue discussions with their staffs and to return with a proposal and cost estimates for the next budget cycle.

The board took no formal vote to change policy at the meeting.

Ending

Commissioners said they would review the expense tracking before budget hearings in October and consider whether to add staffing or a line item to offset any new medical expenses stemming from the statutory change.