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As population ages, N.H. prison health care costs rise quickly to 2nd-highest in nation

The cost of health care for New Hampshire’s state prison population more than tripled between 2001 and 2008, according to a new study.

New Hampshire spent $9,055 per inmate on average in 2008, the second-highest per-inmate cost and a 306 percent increase from 2001 costs of $2,232, according to the study, released late Tuesday by the Pew Charitable Trusts.

Jeffrey Lyons, public information officer for the New Hampshire Department of Corrections, said costs have been declining since 2008, and were pushed up in the early part of the decade by court-ordered changes. The 2014 state budget allocated slightly more than $24.5 million for medical and forensic services for 2,766 inmates, or a per-inmate cost of $8,865.

In 2004, a judge ruled that the department had failed to establish a residential treatment unit, group therapy and counseling programs. The order also faulted the department for not moving inmates on suicide watch to hospital settings, and there was no organized system for refilling medications.

Since 2008, however, the state has renegotiated with health care providers to pay the same rates as Medicare, Lyons said.

Dialysis treatments that once cost more than $900 are now $300, and prescriptions that once cost on average more than $32 are now $10, he said.

The Pew report points to a rapidly aging American prison population as a force behind rising costs, and the New Hampshire prison population aged more dramatically than the national average, according to available data.

Inmates tend to have a higher incidence of mental illness and chronic and infectious diseases than the general population, and experience the health effects of aging sooner than people outside of prison, “because of issues such as substance abuse, inadequate preventive and primary care prior to incarceration and stress linked to the isolation and sometimes violent environment of prison,” the Pew authors wrote.

Nationally, the portion of prisoners over age 55 increased from 3 percent to 5 percent from 2001 to 2008, according to the study.

The increase in older inmates was even sharper in New Hampshire, according to demographics information available on the state Department of Corrections website.

In 2001, 61 prisoners, or less than 6 percent of all inmates, were over the age of 49. The Department of Corrections’ annual report for 2008 says 423 inmates, or more than 15 percent of the total prison population in 2008, were 51 years old or older. At the beginning of October, 586 prisoners, more than 21 percent of all inmates, were older than 49.

The Pew study pointed to several strategies being used by states to control costs.

Many states are using telehealth technologies to eliminate paying doctors to travel to the prison or costs related to transporting inmates and guarding them at a hospital. Telehealth commonly includes videoconferencing technology, but can be used in other ways as well.

In Texas, for example, inmates complaining of chest pain are connected to monitors and evaluated by a clinician who is off-site, instead of being immediately sent to a hospital.

New Hampshire does not have telehealth capabilities in any of its corrections facilities, but does have a medical parole law the study cited as another cost-saving step, Lyons said.

Medical parole reduces costs related to guarding and transporting inmates.

In 2011, for example, California paroled 25 inmates who were deemed to be permanently medically incapacitated and not a threat to public safety.

Keeping those inmates in prison would have cost California more than $50 million, including $21 million in correctional officers’ salaries and benefits, according to the study.

New Hampshire has had a medical parole law since 2004. The first inmate paroled under that statute, in August of that year, saved the state $40,000 in medical costs because she was covered by private insurance, according to news reports at the time.

The Pew report also pointed to Medicaid as a potential alternative for state corrections spending on health care.

New Hampshire was cited as a specific example: In a report commissioned last year by the Department of Health and Human Services, consultants from The Lewin Group estimated that the state would save almost $22 million on inmate health care by accepting expanded Medicaid as authorized by the federal health care reform law.

The Legislature is scheduled to meet in a special session next month to consider expanding Medicaid.

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

Legacy Comments4

Saving $22 million by expanding Medicaid -- I sure hope the Republicans in the legislature are paying attention. And for more savings, how about treating the mentally ill BEFORE they get into trouble with the law?

I suspect it would be quite expensive to treat every democrat voter

It might be cheaper to treat every Republican voter since there are fewer of them.

Paranoid schizophrenia and delusional thinking are very resistant to treatment

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