Hospital care while incarcerated: A tale of two policies

Medicaid for Medical-Correctional Care: Time to Manage What is Reimbursed

“…14 When caring for such patients, clinicians follow correctional principles embedded into medical center policy and often defer to custody officers when presented with conflicts to usual care. 2 Yet practices that benefit correctional needs rarely benefit patient care. For example, when outside dedicated medical forensic units, incarcerated patients in community hospitals are regularly shackled indefinitely with metal cuffs to mitigate escape risk and are kept unaware of discharge plans to facilitate safe transport back to the carceral facility.…”

“…These patients continue to experience exceptions to health privacy, restraint, informed decision making, and transitions of care at odds with conditions of participation in accredited institutions. 2 With new scrutiny on Medicaid's role in carceral health care, now is the time to reexamine the absence of medicalcorrectional CMS standards. At a hospital and health care provider level, we suggest enrolling patients in Medicaid during hospitalization, whenever administrative resources are available to facilitate.…”

“…1 Under Eighth Amendment protections, incarcerated persons have a constitutional guarantee to have their serious medical needs addressed, though the treatment these patients receive in both carceral and community facilities differs from that provided to free patients, with access to quality health care often deficient. 2,3 The medical care delivered to people who are incarcerated lacks oversight from usual governing bodies. 4 Here we provide historical context for the exclusion of individuals experiencing incarceration from federally funded health insurance, describe the lack of oversight that follows the absence of federal reimbursement mandates, and reveal lessons learned about quality of care from the treatment of incarcerated individuals who are transferred to community hospitals.…”

Cooperation Between Medical and Correctional Stakeholders

“…As long as incarceration exists, proceeding in a unilateral manner and disregarding the presence and potential partnership of correctional stakeholders will delay efforts to improve the health of the 2 million adults held in the US criminal justice system. Collaboration between medical and correctional systems is required if we envision a future where health care professionals and correctional officers are similarly invested in the well-being of the individuals in our dual charge, with clear delineation of responsibilities, unified guiding principles for care, and a commitment to ethically sound practices …”