County Indigent Health Care Programs Tap Into State Funds
Training Sessions Open to County Judges, Commissioners
Eleven Texas counties received approximately $2.5 million in state matching funds in 2010 to help offset the cost of indigent health care, according to the latest Texas Department of State Health Services (DSHS) County Indigent Health Care Program (CIHCP) spending data report.
The Indigent Health Care and Treatment Act of 1985 requires counties that are not completely covered by a hospital district or public hospital to provide basic health services to indigent residents through a county-run CIHCP; there 143 CIHCPs in the state. Each fiscal year, a county is liable for $30,000 or 30 days of hospitalization or nursing-home care per eligible resident, whichever comes first.
Once a county spends 8 percent of its general revenue tax levy (GRTL) on indigent care, the county can then request state matching funds, with the state reimbursing the county at least 90 percent of all costs above the 8 percent spending level.
If the department fails to provide state assistance funds, the county is not liable for payments for health care services provided to its eligible residents after the county reaches the 8 percent expenditure level, said Jan Maberry, manager of the DSHS County Indigent Health Care Program.
In FY2010, the state was able to reimburse 100 percent due to available funds, Maberry said. Some $2.6 million has been budgeted for FY2011, and funding for the next biennium will be determined by the 82nd Legislature.
Basic, Optional Services
In order to qualify for state matching funds, counties are required to provide basic health care services to eligible residents and may elect to provide a number of DSHS-established optional health care services, Maberry said. Specifically, counties must provide the following:
Immunizations
Medical screening services
Annual physical examinations
Inpatient hospital services
Outpatient hospital services, including hospital-based ambulatory surgical center services
Rural health clinics
Laboratory and x-ray services
Family planning services
Physician services
Payment for not more than three prescription drugs per month
Skilled nursing facility services
Optional health care services include the following DSHS-established services:
Ambulatory surgical centers (freestanding) services
Diabetic and colostomy medical supplies and equipment
Durable medical equipment
Home and community health care services
Psychotherapy services provided by a licensed clinical social worker (LCSW), a licensed marriage family therapist (LMFT), a licensed professional counselor (LPC), or a psychologist
Physician assistant services
Advanced practice nurse – a nurse practitioner, a clinical nurse specialist, a certified nurse midwife (CNM), or a certified registered nurse anesthetist (CRNA)
Dental care
Vision care, including eyeglasses
Federally qualified health center (FQHC) services
Emergency medical services
Other medically necessary services or supplies that the local governmental municipality/entity determines to be cost effective
Effective March 2008, the optional health care services category was expanded to include “any other appropriate health care service that the local governmental municipality or entity deems appropriate and cost effective,” Maberry said.
Before this addition if a county wanted to pay for a particular service or equipment and it was not specifically in the rules, the county would not be eligible for state matching funds for that service or equipment, even if the county surpassed its 8 percent. With this change, these other expenditures can count toward the counties’ 8 percent expenditure and be eligible for state matching funds, Maberry said.
Training Opportunities
Commissioners courts interested in learning more about the varied aspects of their county’s indigent health care program are eligible to attend training sessions offered by the DSHS.
“I just encourage you as judges and commissioners to learn as much as you can about the program,” Maberry told new officials gathered at a training seminar in January. “Don’t go into it blindly. After all, you’re potentially going to spend quite a bit of money on indigent health care.”
DSHS conducts training sessions in Austin with the following remaining in 2011:
April 12, 13, & 14
July 12, 13, & 14
The target audience includes those who administer the CIHCP for their county, hospital district or public hospital. The training classes are beneficial for new staff, supervisors, and those simply needing a refresher course.
“I think it’s an excellent idea for commissioners court members to attend because it is an eye-opening process,” said Karen Gray, program specialist and primary care group trainer with the DSHS. “Even though you may not have a direct, hands-on responsibility or position with the indigent program, if it’s something that you manage or falls under your jurisdiction, it would be an excellent idea for you to attend.”
The classes cover Chapter 61, which is the legislation that authorized the program, and include eligibility and bill payment policies, Gray said. Classroom instruction is followed by hands-on exercises designed to “put the knowledge and new skills to the test.”
For example, participants are presented with unique situations, such as a self-employed applicant who does not have thorough bookkeeping in place, or a single mom who receives child support. Indigent health care applicants usually present extenuating circumstances; they are not your “typical two-parent, two-child, dad works, and mom stays at home with the kids” household, Gray said.
“We try to give participants the skills to handle the many unique situations,” she continued. And while the training certainly won’t address all possible scenarios, it will give the trainees a head start.
Throughout the past few years, a couple of commissioners court members have pursued DSHS training, Gray said.
“I think they do understand the program a lot better after they learn the complexities of eligibility and bill payment,” Maberry said.
Gray concurred, describing the training as an “eye-opening process” that would help commissioners courts appreciate the needs of their indigent health care departments.
To learn more about the County Indigent Health Care Program including handbook revisions, spending data and training dates, go to www.dshs.state.tx.us/cihcp. H – By Julie Anderson