Emerging state approach to long-term care gives 'criminal intent' a whole new meaning

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John O'Connor
John O'Connor

States are beginning to consider a bizarre new long-term care strategy that has many providers rightfully concerned.

Kentucky recently became the second state (after Connecticut) to approve a plan that forces the state to parole some infirm inmates — excluding sex offenders and death row inmates — to private nursing homes. The move has nothing to do with recognizing convicts' payment of debts to society. It has everything to do with shifting who pays for long-term care services.

As prison inmates are not Medicaid eligible, they must be declared ex-prisoners in order for the scheme to work. And once they are paroled, states can pass along most caregiving costs to the federal government, via Medicaid.

Is this a legal loophole? The folks behind it seem to think so. But it's a fairly safe bet that bean counters in Washington will soon begin reviewing the practice – if they haven't already.

In a field where filled beds are an elusive goal, you might think that providers would welcome these new residents. But that's not necessarily the case. Consider: Kentucky operators already face some of the nation's highest liability costs. Adding ex-cons to the patient mix is unlikely to help, many operators note.

Should providers in the 48 other states be worried? Yes, for two compelling reasons. One is the fiscal condition many states now find themselves in. In two words: not good.

The other is that the aging prisoner population is, shall we say, a growing market. According to a recent study by Human Rights Watch, the number of inmates over age 55 quadrupled between 1995 and 2010.

So don't be surprised if more states decide to make today's prisoner tomorrow's resident.

John O'Connor is the Editorial Director and Vice Publisher of McKnight's.

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McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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