Pondering the Affordable Care Act: Newly covered patients!

Currently, inmates in city jail, county jail, state prison or federal penitentiaries are seen by providers in their facilities. Mid-level providers (nurse practitioners, physician assistants) do much of the care in the CTCs (correctional treatment facilities). Physicians oversee care, and specialists in the community are used for specialty care, like cardiac, pulmonary (lung) or diabetes. There are regulations for every state about minimum standards of care and expectations. While many of us find it odd, inmates are promised medical care via constitutional rights (8th amendment) while those of us not wards under care of the government do not have that. This also includes inmates who are incarcerated in government controlled mental health facilities.

The ACA now qualifies for many incarcerated inmates to be covered for medical care. Currently, whichever government entity owns/operates the facility is responsible and the city, county, state or federal government is billed for care~the last bastion of 100% compensated care. They pay what is billed, and not many other places do that anymore. Both current inmates, and those on parole will be affected. Parolees may be referred to ACA clinics for care and follow-up for chronic conditions as they leave incarceration. How will that be coordinated? Who will be responsible?

For those of you who work in acute care facilities or specialty physician offices are about to see an interesting conflict. Who will pay for these patients now? If inmates are eligible for ACA, who will sign them up? What are they entitled to? How will that reimbursement work in tandem with the government’s? While the government will always primarily be responsible, it is my guess that they will want to spread around the cost to these ACA eligible plans. Hide and watch, a showdown will begin in the next few years!

Posted by Susan Odegaard Turner- MentorRN