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'Three Strikes' removal means some Hillsborough convicted felons will now get health care

The policy was meant to save money by disqualifying people convicted of three or more felonies.
Published Feb. 26, 2019

TAMPA — It's hard to know if health insurance could have saved Eduardo "Lalo" Fernandez's life.

The 41-year-old's parents left him in a park in DeSoto County when he was just 13, and he spent most of his life on the streets, dealing and using drugs to get by. He suffered from heart failure, diabetes, renal failure, neuropathy and was nearly blind.

But because he had three felony convictions on his criminal record — two for possession of a controlled substance and one for petty theft — Fernandez couldn't qualify for Hillsborough County's indigent health care plan even though his legal "personal representative" was the former director of the county's Division of Health and Financial Services.

Earlier this month, county commissioners unanimously agreed to remove that "Three Strikes ''policy, a controversial eligibility requirement for Hillsborough's health care plan that was enacted in 2005. The policy change, championed by Commissioner Sandra Murman, will go into effect March 15.

And for Ray Reed, the now-retired county director who held Fernandez's hand as he died Sept. 20 at Tampa General Hospital, his role in seeing through the policy's reversal has brought him one step closer to finding closure after his friend's death.

"As staff, we couldn't defend the Three Strikes policy. If Charles Manson were on probation and moved to Hillsborough County, he would be eligible while someone who gave false information to a pawnbroker on three separate occasions wouldn't," Reed said. "This policy was not the main factor, but it helped kill off my friend and it cost the citizens of Hillsborough County untold dollars every day."

The decision to eliminate the policy is the first in a series of steps the commission has taken to support the health services paid for by the county's half-cent sales tax. Commissioners also moved this month to add basic vision benefits to the plan and expand eligibility from anyone living at or below 125 percent of the federal poverty level to those living at or below 138 percent of the poverty level.

Those changes will close the eligibility gap with federal Medicaid and Medicare plans and are expected to add about 1,760 new members to the plan — 550 as a direct result of eliminating "Three Strikes."

"I have multiple clients on my caseload who will be eligible for county insurance for the first time," said Krystal Filsinger, criminal case manager at Gracepoint Wellness. "Finally, Hillsborough County is addressing health care as a basic human right, not just for those who can afford it or for those with clean backgrounds."

Former commission chairman Jim Norman proposed the "Three Strikes'' policy in 2005 as a way for the county to taper the health care plan's ballooning medical costs. It was part of a series of cost-cutting overhauls to the program, including limiting eligibility to only those living below the federal poverty line, refusing payments for "catastrophic care" in favor of covering more "traditional primary care" appointments, and eliminating coverage for most mental, eye and dental care.

Since then, an average of 400 people have been denied coverage and 50 people have been kicked off the county health care plan every year as a direct result of the "Three Strikes'' policy, said Gene Earley, the county's new director of health care services.

Earley's staff conducted an audit of the policy this month and found that the county's "three strikes" restriction is the only one of its kind in the nation. Not one commercial health care plan comes with a similar restriction on eligibility and neither do the federal Medicare and Medicaid plans.

And when county staff asked the Public Defenders Office to provide criminal records for each person denied coverage, the agency's records showed that 72 percent of the felony convictions that made the population ineligible were for drug-related 3rd degree felonies, many of which had been elevated from a misdemeanor due to multiple compounding charges.

Less than 1 percent of the crimes that deemed applicants' ineligible for coverage were punishable by a life sentence, and less than 3 percent were for a 1st degree felony crime.

"When the policy was enacted it was in hopes that it would deter recipients from committing a crime against the people who paid for their health care, but these are people committing crimes against themselves because they're sick," Murman said. "They're mentally ill or have serious substance abuse problem and they need help. They're the people going through the revolving door at the jail where they know they can get care until they let them out, they go off their meds, they go back on the streets and then get arrested for taking drugs."

Earley's audit of the program concluded that eliminating the policy would result in lower crime rates countywide, fewer indigent emergency room visits paid by taxpayers, a reduction in homelessness and a lower recidivism rate in county jails. The additional members could be easily absorbed by the program, which served about 19,000 members last year.

And an independent cost analysis of the program found that in 2017, the health care expenses absorbed by taxpayers as a result of the "Three Strikes'' policy" exceeded the cost of covering those individuals on the indigent health care plan by $1.8 million. The new policy changes are estimated to save tax payers a cumulative $43.1 million, Earley said.

"When we're paying the bill for a $110 a day stay in jail, we're not really solving the problem," Murman said.

Contact Anastasia Dawson at or (813) 226-3377. Follow @adawsonwrites.