Agenda 03/25/2008 Item #16F 3
Agenda Item No. 16F3
March 25, 2008
Page 1 of 11
EXECUTIVE SUMMARY
Recommendation to approve a Resolution tbat supports proposed legislation (HB
525) addressing loss of federal entitlement benefits for inmates wbicb would adopt
the policy that tbey would remain enrolled in Medicare or Medicaid on a suspended
status if incarcerated less tban a year
OBJECTIVE: To approve a Resolution of the Board of County Commissioners of
Collier County, Florida, supporting proposed House Bill 525 (attached) and companion
Senate Bill 1456 (attached) which would adopt policy that inmates enrolled in Medicare
or Medicaid would be put on a suspended rather than terminated status if incarcerated for
less than a year.
Once approved by the Board of County Commissioners, the Resolution and a letter in
support of the proposed legislation will be transmitted to members of the Collier County
Legislative Delegation, Senate President Ken Pruitt, House Speaker Marco Rubio and the
Florida Association of Counties.
~
CONSIDERATION: Currently federal law permits states to decide whether inmates
should have their entitlement benefits terminated or suspended upon incarceration.
Medical services inmates receive while in jail are paid for by the county and will
continue to be paid for by the county even if the proposed legislation passes. A person
incarcerated in a county jailor juvenile detention center in most states is ineligible to
retain Medicare, Medicaid or Social Security Disability Insurance (SSDI) once in the
facility. The U.S. Code of Federal Regulations, Title 42, Part 435.1009 states that
Federal Financial Participation (FFP) is not available for services provided to individuals
who are inmates of public institutions. As a consequence, the cost of medical care for
these inmates becomes a non-federal responsibility upon arrest and detention. The cost to
counties for persons who would otherwise be receiving federal entitlement payments is
significant. If an individual has been terminated from these programs, it may take
months for these federal benefits to be restored once they are released. In fact, there is an
immediate cessation of benefits prior to the issuance of formal charges or conviction.
Many persons awaiting trial who are charged with crimes are released upon posting bond,
released on their own recognizance, released under house arrest or other alternative
means of detention. The accused continue to be eligible for benefits while awaiting trial.
The application process to receive entitlement benefits takes a minimum of 90 days to
qualifY through local, state and federal government efforts. Suspending versus
terminating eligibility would eliminate the bureaucratic and duplicative paperwork for
those coming into the jails and prison systems for a year or less.
.-
Suspending versus terminating eligibility stops the unnecessary "gap" that currently
exists between being released and actually receiving benefits once again, explains the
Agenda Item No. 16F3
March 25, 2008
Page 2 of 11
Florida Association of Counties (F AC) fact sheet, which strongly supports the proposed
legislation. Inefficient government spending results from the breakdown in 1he
continuation of1he inmate's care. During 1he minimum 90-day interim, a person may go
off their medication because 1hey cannot afford it, and 1hen violate 1he law again. This is
where 1he criminal justice system sees repeat offenders who have mental heal1h and
substance abuse problems.
F AC reported 1hat on March 11 HB 525 by Rep. Roberson passed out of its fIrst
committee of reference, Heal1h Innovation, with no opposition. In addition to F AC, 1he
American Bar Association, 1he Florida Sheriff's Association, 1he Department of
Corrections, 1he Blueprint Commission and the Supreme Court Committee on Mental
Heal1h also endorse HB 525 which was en route to 1he Heal1hcare Council and then to
Policy and Budget as ofthis writing.
Also, F AC reported 1hat the Senate companion, SB 1456 by Sen. Wilson, was discussed
in 1he March 13 Criminal Justice Appropriations Committee and endorsed by the
Department of Corrections as a critical component of reducing and containing medical
costs. The Senate bill has four committee references, beginning wi1h Healthcare Policy.
Wi1h passage ofHB 525, by suspending versus terminating 1he inmate's eligibility,
he/she upon release is immediately covered under the same benefIts as prior to
incarceration. Passage of this Resolution in support ofHB 525 promotes a continuum of
services 1hus reducing tax dollars needed for corrections at the state and local level.
FISCAL IMPACT: There is no fiscal impact associated with this executive summary.
GROWTH MANAGEMENT IMPACT: There is no growth management impact
associated wi1h this executive summary.
LEGAL CONSIDERATIONS: There are no legal considerations associated with this
executive summary.
RECOMMENDATION: That the Board of County Commissioners approves a
resolution supporting proposed legislation (HB 525) addressing loss of federal
entitlement benefIts for inmates by adopting a policy that they would remain enrolled in
Medicare or Medicaid on a suspended status if incarcerated less than a year.
Prepared by Debbie Wight, Assistant to the County Manager
Page I of 1
Agenda Item No. 16F3
March 25, 2008
Page 3 of 11
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
Item Number:
Item Summary:
16F3
Recommendation to approve a Resolution that supports proposed legislation (HB 525)
addressing loss of federal entitlement benefits fOf inmates which would adopt the policy that
they would remain enrolled in Medicare or Medicaid on a suspended status if incarcerated
less than a year.
Meeting Date:
3/25/2008 9:0000 AM
Approved By
James V. Mudd
County Manager
Date
Board of County
Commissioners
County Manager's Office
3/18/2008 1 :56 PM
fiJe://C:\AgendaTest\Export\ I 03_March%2025,%202008\16.%20CONSENT%20AGENDA \... 3/19/2008
Agenda Item No. 16F3
March 25. 2008
Page 4 of 11
Resolution No. 2008 -
LOSS OF FEDERAL ENTITLEMENT BENEFITS
WHEREAS, U.S. Code of Federal Regulations, Title 42, Part 435.1008 states
that federal financial participation (FFP) is not available in expenditures for services
provided to individuals who are inmates of public institutions; and
WHEREAS, States being unable to assume the federal share of providing
medical services to FFP eligible persons being held in county jails and detention
facilities, tend to terminate or sometimes suspend eligibility; and
WHEREAS, this immediate cessation of benefits occurs prior to the issuance
of formal charges or conviction; and
WHEREAS, counties must provide medical services to all persons incarcerated
in local jails and detention facilities; and
WHEREAS, as the result of this regulation to immediately cease FFP for
medical benefits, all costs of medical care must be borne solely by counties.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA requests and strongly urges
Congress to amend necessary federal statutes to allow federal financial participation for
medical benefits to incarcerated individuals until convicted and sentenced to secure
detention.
DULY PASSED AND ENACTED by the Board of County Commissioners, Collier
County. Florida, this _ day of , 2008.
DATE;
ATTEST:
DWIGHT E. BROCK, CLERK
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
, Deputy Clerk
By;
TOM HENNING, CHAIRMAN
Approved as to form and legal SUfficiency;
Assistant Collier County Attorney
Agenda Item No. 16F3
March 25, 2008
Page 5 of 11
~
FLORIDA
'\.",:""!()(! .'Il!( )"~ (iF
COUNTIES
.-\H ~.o\"Ofi.t FToddd
STOP the "GAP". SUPPORT HB 525
By Rep. Roberson
Health Innovation Tuesday March 11, 2008 8:00 am
. Federal law permits states to decide whether inmates should have their entitlement
benefits terminated or suspended upon incarceration,
. HB 525 would adopt the policy that inmates remain enrolled in Medicare or Medicaid on
a "suspended" statlls if an inmate is incarcerated for less than a year. Medical services
received while in jail are paid for by the county and will continue to be paid for by the
county even if this legislation passes,
. The application process to receive entitlement benefits takes a minimum of 90 days to
qualify through local, state and federal government efforts, Suspending versus
terminating eligibility would eliminate all of this bureaucracy and duplicative paperwork
for those who come into our jails and prisons for a period of less than a year.
. Suspending versus terminating eligibility stops the unnecessary "gap" that
currently exists between being released and actually receiving benefits once
again. This break down in the continuum of care creates a cycle of inefficient
government spending. During the minimum 90 day interim folks go off their medication
because they cannot afford it and are more likely to reoffend - which is one of the
primary reasons we see so many "frequent flyers" in our criminal justice system who
have mental health and substance abuse problems.
. By suspending versus terminating the inmate's eligibility we can ensure that upon
release he/she is immediately covered under the same benefits as prior to
incarceration,
. Supported by the Blueprint Commission chaired by Frank Brogan, the Supreme Court
recommendations, the Florida Mental Health and Substance Abuse Corporation (DC F),
American Bar Association, Partners in Crisis and the Florida Sheriffs Association.
VOTE yes on HB 525 and promote a continuum of services that statistically
has been proven to reduce recidivism thus reducing the tax dollars needed
for corrections at the state and local level at the federal government's
expense.
If you have any questions, please contact Amanda Ghaffari with the Florida Association of Counties at
aahaffari@fI-coul1ties.com or 850--228-7922.
LobbyTools
Agenda It!?it8~d. lJ'ti23
March 25, 2008
Page 6 of 11
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HB 525 - Relating to Medical Assistance Eligibility of
Inmates - 2008
Sponsor(s)
by RObeCsgrr CoSponsors: );t~QCoss3vlindirr9211, Gibt>pJ]!>
Tagged to: --
[Add To Folder] tl
Summary
General Medical Assistance Eligibility of Inmates: Provides for suspension of medical
assistance for certain incarcerated persons while such persons are inmates; provides
exception; provides for eligibility following release from incarceration; provides that, to
extent permitted under federal law, time during which such person is an inmate shall not
be included in any calculation of when the person must recertify his or her eligibility.
Effective Date: July 1, 2008
Actions
Date Chamber
01/14/08 HOUSE
01/23/08 HOUSE
01128/08 HOUSE
Action
Filed
Referred to Healthcare Council; Policy & Budget Council
Referred to Committee on Health Innovation by Healthcare
Council
On Committee agenda - Health Innovation, 03111/08, 8:00 am,
212 K
03/07/08 HOUSE
Identical Bills
SEUA56 - Relating to Inmates/Medical Assistance/Medicaid by \I\IilsPD
02/21/08 SENATE Referred to Health Policy; Criminal Justice; Health and
Human Services Appropriations; Criminal and Civil Justice Appropriations
Bill Text and Filed Amendments
@ H 0525
No amendments to this bill text.
01/14/08
[TEX-TI ~ PQf]
Staff Analysis
No analysis of this bill.
Vote History
No vote history for this bill.
Related Documents
No related documents.
Statute Citations
409 9025
Codes and Comments
[Hide Comments]
http://lobbytools.comltools/t.cfm ?a=bills&b=surnmary &sessionid=22&billnum=525
3/1012008
F LOR
D A
HOUSE
o F
R E PRE S E
Agenda Item No. 16F3
March 25, 2008
Page 7 of 11
NTATIVES
HB 525 2008
1 A bill to be entitled
2 An act relating to medical assistance eligibility of
3 inmates; creating s. 409.9025, F.S.; providing for
4 suspension of medical assistance for certain incarcerated
5 persons while such persons are inmates; providing an
6 exception; providing for eligibility following release
7 from incarceration; providing that, to the extent
8 permitted under federal law, the time during which such
9 person is an inmate shall not be included in any
10 calculation of when the person must recertify his or her
11 eligibility; providing an effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15
Section 1. Section 409.9025, Florida Statutes, is created
16 to read:
17
409.9025 Eligibility while inmate.--
18 (1) Notwithstanding any other provision of law other than
19 s. 409.9021, in the event that a person who is an inmate in the
20 state's correctional system as defined in s. 944.02, in a county
21 detention facility as defined in s. 951.23, or in a municipal
22 detention facility as defined in s. 951.23 was in receipt of
23 medical assistance under this chapter immediately prior to being
24 admitted as an inmate, such person shall remain eligible for
25 medical assistance while an inmate, except that no medical
26 assistance shall be furnished under this chapter for any care,
27 services, or supplies provided during such time as the person is
28 an inmate; however, nothing in this section shall be deemed as
Page 1 of2
CODING: Words stricken are deletions; words underlined are additions.
hb0525-00
FLORIDA
H 0 USE
o F
R E PRE
Agenda Item No. 16F3
March 25, 2008
Page 8 of 11
SENTATIVES
HB 525
2008
29 preventing the provision of medical assistance for inpatient
30 hospital services furnished to an inmate at a hospital outside
31 of the premises of the inmate's facility to the extent that
32 federal financial participa!ion is available for the costs of
33 such services.
34 (2) Upon release from incarceration, such person shall
35 continue to be eligible for receipt of medical assistance
36 furnished under this chapter until such time as the person is
37 otherwise determined to no longer be eligible for such
38 assistance.
39 (3) To the extent permitted by federal law, the time
40 during which such person is an inmate shall not be included in
411 any calculation of when the person must recertify his or her
42 eliqibility for medical assistance in accordance with this
43 chapter.
,
441
Section 2. This act shall take effect July 1, 2008.
Page 2 of 2
CODING: Words stricken are deletions; words underlined are additions.
hb0525-00
l"
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Page I of3
Agenda Item No. 16F3
March 25, 2008
Page 9 of 11
muddj
From: muddj
Sent: Friday, November 30, 2007 6: 13 PM
To: wight_d
Subject: FW: Loss of Federal Entitlement Benefits
FYI.
---_......,_.,.~".""_.,-'"----
-,+._--~-_._'-~
From: ColettaJim
Sent: Friday, November 30,20076:05 PM
To: mudd.J
Cc: ResniCkLisa
Subject: FW: Loss of Federal Entitlement Benefits
Jim Mudd
Lets talk about this at our next one on one.
Thank you.
Jim Coletta, Chairman
Commissioner, DEstrkt 5
Collier County Government
3301 E. Tamiami Trail
Naples, FL 34119
Phone (239) 774-8391 I Fax (239) 774-3602
jimcolgUa@col!iergov.net
Please note: Florida has II very broad public records law.
Most written communications to or from officials regarding county business
are public records available to the public and media upon request.
Your e-mail communications may therefore be subject to public disclosure.
_._--"-~~~-'---'~'-'--
.._-,--------------_.._._-,._-~.._-~_.
From: Lieberman, Ilene [mallto:ILIEBERMAN@broward.orgj
Sent: Friday, November 30, 2007 10:21 AM
To: ColettaJim
Subject: Loss of Federal Entitlement Benefits
November 30, 2007
Dear Commissioner Coletta:
RE: Loss of Federal Entitlement Benefits
I was surprised to leam some time ago that currently a person incarcerated in a county jailor juvenile
detention center in nearly all states is ineligible to retain Medicare and Medicaid benefits or Social
Security Disability Insurance (S501) once they enter the facility. U. S. Code of Federal Regulations,
Title 42, Part 435.1009 states that Federal Financial Participation (FFP) is not available for services
provided to individuals who are inmates of public institutions. As a consequence, the cost of medical
care for these inmates becomes a non-federal responsibility (typically bom by county govemments)
upon arrest and detention. The cost to counties for persons who would otherwise be receiving federal
entitlement payments is Significant based on county estimates. The vast majority of states are unable
2/22/2008
Page 2 oD ........
'. Agenda Item No. 16F3
March 25, 2008
Page 10 of 11
to provide the non-federal cost of providing medical services to FFP eligible persons and tend to
terminate or sometimes suspend eligibility, If the individual has been terminated from these programs,
it may take months for these federal benefits to be restored once they leave the institution. In fact,
there is an immediate cessation of benefits prior to the issuance of formal charges or conviction. Yet
our country is founded on the presumption of innocence.
Many people awaiting trial who are charged with crimes are released upon posting of bond, released on
their own recognizance, released under house arrest or other alternative means of detention. These
accused people (who have not been convicted of a covered crime) continue to be eligible for benefits
under Medicare, Medicaid, or 5501 while awaiting trial. Some individuals who are charged with crimes
and incarcerated in county jails are ultimately acquitted of the crime or the charges may be dropped
and the individual released. Nonetheless, because they remain in jail until trial, these innocent
individuals lose their benefits.
All individuals who are eligible for medical benefits prior to arrest should continue to be eligible until
such time as they have been convicted of a crime and become a ward of the state or county, Counties
have found that the cessation (however temporary) of their benefits leads directly to further criminal
activity, perpetuating a cycle of their being in and out of the justice system. Health and income support
benefits for this class of people should continue until the point of actual incarceration.
Congressmen Wexler and Hastings have asked the federal government to consider
changes to federal regulation and statute. I hope you will consider supporting their
efforts by passing the resolution drafted below.
Thank you, and please feel free to contact me if I may provide additional information.
Ilene Lieberman
Broward County Commissioner
FAC Second Vice President
Loss of Federal Entitlement Benefits
Draft Resolution
WHEREAS, U.S. Code of Federal Regulations, Title 42, Part 435.1009 states that federal
financial participation (FFP) is not available in expenditures for services provided to individuals
who are inmates of public institutions, and
WHEREAS, States being unable to assume the federal share of providing medical services to
FFP eligible persons being held in county jails and detention facilities, tend to terminate or
sometimes suspend eligibility, and
WHEREAS, this immediate cessation of benefits occurs prior to the issuance offormal charges
or conviction, and
WHEREAS, counties must provide medical services to all persons incarcerated in local jails
2/22/2008
I
'.
Page 3 of3
Agenda Item No. 16F3
March 25, 2008
Page 11 of 11
and detention facilities, and
WHEREAS, as the result of this regulation to immediately cease FFP for medical benefits, all
costs of medical care must be borne solely by counties;
NOW THEREFORE BE IT RESOLVED that the Board of
requests and strongly urges Congress to amend
necessary federal regulation to allow federal financial participation for medical benefits to
incarcerated individuals until convicted and sentenced to secure detention.
2/22/2008