The Washington PostDemocracy Dies in Darkness

State spending on prison health care is exploding. Here’s why.

(Benjamin C. Tankersley/The Washington Post)
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CORRECTION: An earlier version of this post included a figure and cited data from a version of the report that has since been updated. Median, not average, growth on prison healthcare spending was slightly more than 50 percent.

Health care and prisons are two of the biggest drivers of state spending. So, when you throw them together you get… a whole lot of state spending.

The median growth on prison health care among states was slightly more than 50 percent from 2001 to 2008, according to official data from 44 states analyzed as part of a joint initiative of the Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation. Those 44 states spent $36.8 billion on prisons in 2008, and health care accounted for more than one-sixth of that spending. (2008 was the last year covered in the study by the Bureau of Justice Statistics, which Pew used for its analysis.)

Three factors in particular are driving up state prison health-care costs, according to Pew: aging inmates, a prevalence of physical and mental illness and the costly nature of delivering health care to a prison’s inmates.

The nation’s elderly prison population is still relatively small, but it’s taken up an increasingly larger share of the total population. In 1999, about 3.4 percent of the prison population was 55 and over. By 2011, it was 8.6 percent.

And an older population means more expensive health care. In Michigan, a state study found that in a single year (2009) health care for inmates ages 55 to 59 cost more than four times more than for those aged 20 to 24. In Georgia, caring for prisoners ages 65 or older costs about $8,565 per inmate each year. The average annual health-care cost for Georgian prisoners under 65? $961 per inmate.

So, what’s a state to do? According to experts interviewed by Pew,  states are trying to rein in costs by providing remote health care, outsourcing it altogether, enrolling prisoners in Medicaid and paroling elderly or sick inmates.

Mississippi’s three-year-old program to enroll prisoners in Medicaid generates about $6 million annually in federal reimbursements. Louisiana saved $2.6 million over fiscal years 2009 and 2010 through federal Medicaid reimbursements. And New York’s comptroller estimates that the state could save up to $20 million annually through such reimbursements. Under the new federal health-care law, eligibility for Medicaid will be expanded in 25 states, meaning more inmates will be able to qualify, offsetting state prison health-care costs.

Releasing low-risk older prisoners could help drive down costs and prison size, too. Ohio expects to save more than $46 million and slash the prison population by 7 percent over three years by granting parole to more of its elderly prison population. New York, Illinois, California and Connecticut have also pursued similar policies for low-risk elderly and/or sick inmates.