Reprint from the Progress Times - October 19, 2007
©Progress Times 2007 - All Rights Reserved

County plays waiting game with indigent care

 

Last year the Hidalgo County Health and Human Services department took advantage of a federal funding program known as the Upper Payment Limit (UPL) which allows counties to invest their health care funding in private, not-for-profit, consortiums made up of local hospitals which, in turn invest that money in a federally subsidized escrow account with a 150 percent return. However, due to alleged abuses in other parts of the state of Texas, the federal government has put the entire state on deferment leaving Hidalgo County to wait until November 30 to find out if the program will still be available.
Traditionally, Hidalgo County has funded Indigent Care Services by using eight percent of its taxable revenue. That eight percent was then "matched" by the State which kicked in approximately $1.1 million via a formula used by the State.
According to Hidalgo County Health and Human Services Director Eddie Olivarez, it simply wasn’t enough.
"What would happen is that, eight months into the indigent care year, which begins September 1, all the money would have been used up," said Olivarez. "The money would go to hospitals, pharmacies, doctor’s offices and it would be gone."
The money came from a Texas pool. However, due to the area’s high indigent population, Cameron County and Hidalgo County were claiming 50 percent of the Texas pool’s funding. This year, in an effort to more evenly distribute indigent care resources, the state of Texas mandated that no county could take more than 10 percent of the state’s pool.
This, in essence is why Hidalgo County decided to enroll in the UPL. Last year, the county invested $9.8 million in the UPL which in turn invested that money in the federal Medicaid program. The county received a total of $24.5 million in return. This not only represented a major jump in resources for the county but also allowed them to effectively do away with their Indigent Care Department and let them focus on simply administering where the funds would go, leaving the rest to the consortium of local hospitals.
"They had us send them all their bills from indigent services and donated the money for all indigent services for the county," said Olivarez. "All we are doing now is administering it. Essentially what we have done is develop a regionalized, public private health care system for the poor. What happens here is if we do more clinical services through our clinics then we keep people out of the ER rooms."
The extra money the County received, and will receive should the federal government absolve the state deferment, allows the Health and Human Services Department to branch out into other areas they previously could not.
"We are working to develop a better primary care system where the county clinics will work as a gateway triaging unit for indigent care. The hospitals will pay for the doctors and nurses at the clinic. You come in with a common cold or knee scrape you go home. If you show up with serious medical complications we enroll you in our program then refer you to a medical home like El Valle Clinic or Hope Clinic," said Olivarez. "With the hospital help at the clinics that the hospitals pay for, we can help the ones that can be fixed quick and if it’s more serious get them more serious help."
Unfortunately, Hidalgo County will have to wait for a month to find out if this option will even be available to them.
"What Mr. Eufracio, the County Auditor, is worried about is the abuses in the Dallas and Houston area," said Olivarez. "Right now the feds aren’t giving out the matching 150 percent until they make a settlement with those few counties having problems."
In the last meeting of the Hidalgo County Commissioner’s Court, the courts decided to move ahead and prepare to invest $8.5 million to the local consortium. If the federal government decides to allow Texas counties to participate in the program again, then the money will be invested. If not, then Hidalgo County will simply return to their previous system.
"The county auditor’s office has control of when the money is invested," said Olivarez. "If they have said by November 30 that the state is still in deferment, then we won’t submit the money."
Olivarez said he hopes the county will be able to continue its involvement with the UPL as it gives the area a way to deal with the large indigent care population.
The first year we did this it benefited the county and poor significantly. We never stopped paying anyone and things went non-stop. I think this is a good opportunity to at least develop a model that can be used. The only way Hidalgo County can succeed in treating the indigent is with a public private partnership. We don’t have the huge faith based institutions or private infrastructure or philanthropic support bigger counties have. The only way we are going to be able to fully and efficiently keep up is partnering with the private sector."