Ten Texas counties received approximately $2.6 million in state matching funds in 2007 to help offset the cost of indigent health care, said Jan Maberry, County Indigent Health Care Program (CIHCP) manager for the Texas Department of State Health Services (DSHS).
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 are approximately 142 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, Maberry said.
In FY2007, the state was able to reimburse 100 percent due to available funds, Maberry said. In fact, some $2.6 million was leftover at the close of FY2007, due in large part to the absence of Hidalgo County, which received more than $1 million in matching funds last year.
Hidalgo County is now participating in a health care consortium that receives supplemental Medicaid payments, known as upper payment limits, said Eduardo Olivarez, chief administrative officer for Hidalgo County Health and Human Services. Consequently, the county does not qualify for state matching funds. Hidalgo County was able to provide indigent care the entire year and pay all providers, Oliveraz said.
This year, FY2008, the Texas Department of State Health Services has just under $5.2 million to dispense to county programs, a portion of approximately $11.2 million allotted by the state for the 2007-2008 biennium.
Proposed Change in the Rules
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:
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
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 PH.D. psychologist
Physician assistant services
Advanced practice nurse (a nurse practitioner, a clinical nurse specialist, a certified nurse midwife (CNM), or a certified registered nurse anesthetists (CRNA) services
Vision care, including eyeglasses
Federally qualified health center (FQHC) services
Emergency medical services
Pending final approval, optional health care services will be expanded to include “any other appropriate health care service that the local governmental municipality or entity deems appropriate and cost-effective,” Maberry said.
“I think this is significant,” she continued. For example, before this addition if a county called and asked to use a particular machine and it was not specifically named in the “durable equipment list,” the county would not be eligible for matching funds for that machine, even if the county surpassed its 8 percent. Once this change becomes official, the state can cover these types of requests after the 8 percent is met, Maberry said.
“We’re trying to give more control to the local entity and say,