Tom Green County Indigent Health Care
Program Adjustments Benefit County, Clients
When it comes to managing her myriad of county duties, Dianna Spieker does not swap out her symbolic hats. Rather, she stacks them on top of one another.
For example, as Tom Green County treasurer since 1999, Spieker is responsible for paying, applying, and disbursing county funds in such a manner as directed by law. When she took on the task of Indigent Health Care director in 2009, Spieker relied on her treasurer’s mindset – attention to detail, meticulous application of the law, and procedural efficiency.
Spieker is one of the only, if not the only, county treasurer in the State of Texas to run a County Indigent Health Care Program (CIHCP). When Spieker accepted the directorship some two years ago, she turned attention to several key issues that have benefited not only the county’s indigent population, but county coffers, as well.
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 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.
In the spring of 2009, Tom Green County began participation in an upper payment limit (UPL) program, which leverages county funds to access state monies and federal Medicaid funds. As of press time, every dollar Tom Green County sends its participating providers results in a state and federal match of $3.40, Spieker said. Money spent on UPLs is not included in the 8 percent GRTL tally; the county is still eligible for the state reimbursements if it uses 8 percent in other direct payments.
Tom Green County has had sufficient funds to maintain its CICHP program and has not spent more than 8 percent of its GRTL since August 2002.
In another fiscally related move, Spieker consulted with the local pharmacy that services the CIHCP and learned that some clients were not receiving an available discount because of difficulty completing the client paperwork required by the pharmacy. Since Tom Green County ultimately pays for the prescription, Spieker adjusted the paper trail on the county end to include information required by the pharmacy. In addition, Tom Green County provides copies for the client to take to the pharmacy, enabling the client to receive any applicable discounts.
“These clients are the poorest of the poor,” Spieker explained. “They often have no transportation, and many must use the city bus service to get to the county, health provider and pharmacy,” she continued. Consequently, it is difficult for them to travel to and from their residence when they’ve forgotten forms or need to look up additional personal information.
“By us combining everything, our office can become sort of a ‘one-stop-shop’ for them to assemble their paperwork,” Spieker maintained.
In September 2010, Spieker asked the commissioners court to approve an e-mail notification system to streamline communication between the county and health care agencies that provide indigent service.
Incidentally, improving communication is also a key focus of the Texas Indigent Health Care Association, of which Spieker is president-elect (www.cuc.org/TIHCA/aboutTIHCA.aspx).
Other initiatives Spieker has taken in Tom Green County include:
v Instituting the use of indigent client photo identification cards which include the dates of eligibility. This assists health care providers when processing incoming patients.
v Establishing a fraud response procedure. For example, in one case a client adjusted the pill dosage and refill amounts on a prescription. The pharmacist noted the adjustment and informed the county, prompting Spieker to initiate a policy for dismissal from the program.
v Disseminating information about the indigent health care program to the community. Spieker instructed program staff to provide qualifications for receiving indigent health care on the county website and send a news release to local media outlets (see boxed information).
(Boxed Information Below)
Tom Green County Indigent Health Care Program
Tom Green County will use rules and procedures found in the County Indigent Health Care Handbook, published by the Texas Department of State Health Services. In summary, the rules are as follows:
1. The application form must be completed in its entirety.
2. Verification of income, termination of income, residence, household composition, and resources are required information.
3. Net income is calculated utilizing a gross monthly screening table located in the County Indigent Health Care Program Manual.
4. Liquid resource assets cannot exceed $2,000.00 or $3,000.00 if the residence contains a relative who is aged or disabled. The equity value of an automobile cannot be greater than $4,650.00. Personal property and homesteads are exempt assets.
5. Eligible persons must be residents of Tom Green County and must intend to stay.
6. Applicants must provide all information and documentation requested or applications will be denied.
7. Applicants will be required to provide proof of application for SSI.
8. Applicants have the right to appeal adverse decisions.
Pursuant to Health and Safety Code Section 61.030 Tom Green County has designated La Esperanza Clinic; Shannon Medical Center and affiliates; San Angelo Community Medical Center and affiliates; Shannon Clinic and affiliates; and San Angelo Regional Employee Assistance Program as the mandated providers for indigent health care services. Shannon PAP Pharmacy has been designated for prescriptions services.
Tom Green County will only accept and pay the standard payment rate (approximate Medicaid rates) as determined by the Texas Department of State Health Services. Tom Green County will pay inpatient medical bills by percentage rates until further notice. Tom Green County Commissioners Court reserves the right to re-evaluate the payment method at anytime; all parties will be notified if payment method changes.
Tom Green County has no financial responsibility for Non-Emergency Services or Prescriptions rendered to eligible residents by Non-Mandated Providers.
When it comes to ensuring a cost-effective, efficient county indigent health care program, Spieker encouraged elected officials to familiarize themselves with their county’s program and even speak on behalf of the program for the benefit of the county.
Indigent health care directors are quite capable of running effective programs and bringing together all interested parties, Spieker emphasized. Elected officials need to be willing to support these efforts by partnering with their directors if needed, especially when it comes to making arrangements with area providers.
In addition, she said, “the participation, and/or leadership of an elected official may lend extra credibility to the program and prompt participants to carefully consider the needs and statutory requirements of indigent health care, to the benefit of both the indigent client and the county as a whole.” H – By Julie Anderson