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While presenting his proposed 2027 budget Tuesday for the Kosciusko County Jail, Sheriff Jim Smith told the County Council about a problem with the medical provider for inmates.
“I’m just going to start out by telling all of you that as much as I hate that it’s come to this, we will be coming before you for an appropriation, probably this fall,” he said, as there’s a shortfall in the medical care for inmates. “A lot of that is attributed to our current provider and the changes they made.”
The current provider is Quality Correctional Care (QCC).
“One of the biggest ones ... is the medical scrubbing that they’re doing with bills, and it’s basically on savings. So if we have an outpatient, has a medical bill, the provider is scrubbing that, trying to get it as inexpensive as possible. So we’re paying what they get it down to, but we’re also paying for each one of those 12% of the savings. So it’s a lot of unforeseen costs that are causing us to be overbudget,” Smith said.
He said it’s been a year of that and they’re trying to sort through it.
The county has a contract with QCC. If everything fell within that contract, it would be perfect, but it’s the unforeseen expenses, especially this year, that are burdening the budget, he said.
“Several times a week, it seems we’re sending inmates out to the hospital. And it’s not because that’s where we want them to go, it’s because that’s what the medical provider suggested that we do. There’s a lot of expenses that are incurred with that,” he said.
The jail staff also have to be paid to go to the hospital with the inmate and wait there with them as the inmate can’t be sent to the hospital alone. There’s an ambulance bill if the inmate is transported by an ambulance, and then there’s whatever procedures the inmate needs.
“On top of that, now we’re paying this 12% savings, 12% basically fee, if you will, on whatever that savings is from whatever the provider is getting it reduced down to,” Smith said. “In addition to that, the same provider has began their own pharmacy. We’ve seen a significant increase on what we’re paying for prescriptions now.”
The budget for inmate medical has historically included a cushion for unforeseen expenses.
“What’s happening is, we are far exceeding that cushion,” Smith said.
Due to the “great” work his staff has done with the new food provider, he said they’re going to have a surplus in that food budget this year, though that’s only a projection right now, of between $80,000 to $100,000. Smith said he’s going to request the council approve a transfer of that savings to cover the inmate medical shortfall, though he wasn’t sure if that would be enough to cover it this year.
“Because of that, and so much more, we are deep in conversations with another medical provider to a point where I’m ready to move forward with (them),” Smith stated. “Their contracted amount, it’s a proposal, around $790,000.”
The sheriff’s office did their budget earlier this year for next year at around $800,000 for inmate medical. Smith said that doesn’t leave much of a cushion for next year.
“This provider that we’re talking with, rather than the 12% scrubbing, or fee, her claim is only $15, regardless of how much that is. It’s built into the proposal, it’s built into the contract. You have more of an idea of what you’re paying. You’re not going to know how many claims, but you’re going to know that each one is $15 rather than you’re paying a medical bill plus a 12% fee for all the money that they saved, if that makes any sense. There’s a lot of value in that,” Smith continued.
Part of the contract with the new company is the licensor of the level of care, he said. Currently, the jail is operating with EMT-level providers. The new company - TK Health - would be at the minimum of LPN.
“Why is that important? Well, it’s important when you’re checking vitals and treating someone, you’re having that conversation with a doctor on the other end. I’ve got to think that, that level of care with the person on the other end helps dictate whether or not they can be staying in the facility to be monitored, or do we just need to take them to the hospital. That’s why that is a big deal, liability,” he said.
A big share of tort claims and lawsuits come from medical care.
“I come to you with complete confidence in TK Health. For everything that I know, we’ve done our due diligence on meeting with them, asking the appropriate question so they are the right answer moving forward. I know this is not the ideal time to do that, but I’m urging you to support us in this. It’s that important because moving forward with a provider, brand new, going into another year, I don’t know what that looks like,” Smith said.
Council President Tony Ciriello said they’re leaving QCC because of the costs associated with it, “hidden costs that for some reason got above and beyond the contract levels.”
Smith said a person who the sheriff’s office has trusted that was with QCC has been hired by TK Health. Ciriello said that person provided services to the jail staff and the jail staff were comfortable with that person and that person knows the jail. That person’s name was not said at Tuesday’s meeting. Smith said that person was a huge plus in considering TK Health.
Ciriello said he and Smith had discussions about the jail medical situation. More money could be added to the jail budget, if the council wanted to. A new contract with TK Health would need to be reviewed by county attorney Ed Ormsby, and then approved by the County Commissioners before Smith came back to the Council for the financial end.
QCC’s contract would have to be denied 30 days prior to it ending, so Smith would have until Dec. 1 to get everything else done, Ciriello said.
“There are a lot of steps he has to take between now and then to get that done,” Ciriello said.
Matron Michelle Hyden said part of the budget cushion goes toward prescription costs. QCC started their own pharmacy, and compared to the jail’s previous pharmaceutical provider, “we’re paying, on average, $4,000 more using QCC’s pharmacy - a month - than we were using our previous.”
Hyden continued, “As far as medical claims, I did have the new company we’d like to go with process two two-week cycles. And those averaged, even with the fees and everything included, almost $2,000 less a month.”
For the 2027 budget, the council reduced the jail meals to $300,000; took $25,000 out of that; and added it to the medical coverage for a total of $825,000.
Ciriello told Smith his next steps were to work with Ormsby, have the contract with TK Health reviewed and take the contract before the commissioners “sooner than later.”
