When Stan Egger attended the first meeting of the Indigent Health Care Advisory Committee, he thought he might need a little health care himself. The initial use of terminology such as “statewide regionalization” and “100 percent poverty level” left the Taylor County commissioner feeling a little weak.
“At first, I thought I was about to have a heart attack,” Egger joked.
Thankfully, Egger’s anxiety was relatively short-lived as the committee entered into one of many frank discussions on Texas indigent health care. As the only representative of the Texas county commissioners court, Egger communicated the county perspective and assured fellow members that “counties do not have the money to fix this problem.”
When all was said and done, the committee emerged from months of meetings with an official Report of Recommendations characterized by Egger as “okay for Texas counties.” The report was released in September 2006 to the Texas Health and Human Services Commission and presented to the Texas Legislature in November 2006.
Legislative Mandate
Senate Bill 44 passed by the 79th Texas Legislature required the executive commissioner of the Health and Human Services Commission to establish an 11-member advisory committee “to advise the commission on rules and policies concerning indigent health care services.”
The committee received several other charges including:
conduct a feasibility study and develop recommendations regarding the implementation of a pilot program for the regionalization of county indigent health care services and assistance and hospital district services and assistance; and
review and propose recommendations regarding the allocation method used for distributing state assistance funds and county reporting requirements and enforcement by the Department of State Health Services.
The committee conducted six public meetings and individual workgroup sessions that involved several committee members and stakeholders from counties, hospitals, other health care providers, and organizations that represent indigent health care entities. The workgroups sent written questionnaires to counties conducting indigent health care programs, brainstormed problems, identified issues, and conducted phone interviews with county officials and health care providers.
“They tried to include viewpoints from as many interested parties as possible in the thought process,” said Jan Maberry, County Indigent Health Care Program manager for the Texas Department of State Health Services.
“Input from counties, public hospitals, and hospital districts through surveys and comments at the public hearings was vital, as was the informative speakers present at the public hearings,” said Lynda G. Davis, director of Hardin County Indigent Health Care and vice chair of the Indigent Health Care Advisory Committee.
Recommendations
The committee report details the following set of recommendations:
Implement pilots for regionalizing health care among counties, hospital districts, and public hospitals as a collaborative approach to levering regional resources. The regional pilots should expand coverage above the current eligibility level and focus on providing more preventive and primary care services, beyond the currently required basic services. The regional pilots would be supported through a combination of local and state funds to improve health care delivery, manage costs, and provide efficient access to health care to the indigent population.
Require all entities (counties, public hospitals, and hospital districts) to provide the same services and be eligible for state assistance funds for unreimbursed basic and optional services under Sections 61.028 and 61.0285 of the Health and Safety Code. The committee also recommends moving some services currently listed as optional into the required basic services category for prevention and cost efficiency.
Raise the minimum standard for eligibility from 21 percent of the federal poverty level (FPL) to 25 percent FPL and increase the maximum individual health care liability for each fiscal year from $30,000 to $35,000.
Increase the state’s match from 90 percent to 100 percent of county expenditures after a county spends 8 percent of their General Revenue Tax Levy (GRTL).
Require all Chapter 61-covered entities to follow reporting requirements currently in place for county-run programs.
Add compliance review activities for all entities and require an entity found not to be in compliance with Chapter 61 to come into compliance within 90 days.
Amend Chapter 61 to correct obsolete agency references, clarify terms, and update additional provisions as identified by the committee.
Regionalization
Egger said hours of discussion centered on the first recommendation: regionalization of indigent health care.
“Texas is too varied to mandate statewide regionalization,” Egger said. “What works in the Metroplex won’t work in West Texas,” he told the committee.
Egger also explained that a regionalization of sorts