Tom Green County's Cash Cow: Indigent Health

With two months left in the fiscal year the Tom Green County Indigent Healthcare Program spent $22,098 out of a $2 million budget. On the plus side, the County makes quarterly Upper Payment Limit (UPL) contributions, which leverage state and federal money for local hospitals. Payments in 2010 are below:

January 26- first quarter UPL, up to $250,000
May 18- second quarter UPL, "continue as in the past"
August 17- third quarter UPL of $250,000

Shannon Medical Center receives 81% of UPL payments and San Angelo Community Medical Center 19%. A letter states Tom Green County "did not fund the non-federal share of supplemental payments to these providers in the listed programs prior to October 1, 2008." Minutes indicate Commissioners Court approved UPL agreements with area hospitals in March 2009.

August 2009 minutes show the TGC Indigent Health program spent nearly $1.1 million vs. $22,000 in 2010. It seems hospitals aren't billing the county for indigent care that fits within their UPL contribution.

UPL leverages state and federal money for area providers. That is a positive. However, the Tom Green County Indigent Health Program served as a cash kitty, boosting county reserves by over $6.3 million the last nine years. The tenth boost seems likely, given the implausible spending of $1.98 million in three short months. Consider the program's history:

1998-2000-- $1.71 million in annual expenditures (average)
2001-2009-- $1.04 million in annual expenditures (average)

The latest budget information/projections for Indigent Health shows:

2009 actual--$1,357,000
2010 budget--$500,500
2010 revised--$500,900
2011 budget--$465,300

The County wasn't the only entity to do less in the health care arena. Long before the City eliminated its pharmacy and planned to shift social services to a community agency, they quit providing primary care to the public. However, the City did start a clinic for employees. The City Health Clinic also cares for Tom Green County employees.

Every individual, business and government entity is struggling to deal with rising health care costs. The County made a change in this regard, budgeting $1.6 million less for indigent care in 2010 than the statutory requirement. UPL contributions will offset this decrease and given local hospital silence, it must be to their advantage.

The impact on area citizens remains an open question. I look forward to reading the first Community Indigent Health Care Needs Assessment, as required in the UPL contract. Given the difficult financial environment, I can't imagine there are fewer folks in need.


Update 8-27: Judge Brown stated UPL contributions in 2009 were $450,000. This money was leveraged 2.55 times by the federal government. The County will contribute $1 million to UPL in 2010 and 2011. These are a separate line item in the County budget. The Feds bumped up the match to 3.55 times to 1. The county continues to qualify and enroll people into the program. Income qualifications remain at 21% (or less) of federal poverty level. Despite the County's nine year positive cash experience with Indigent Care, there is no consideration of increasing the income qualification. Hospitals agree to care for all IHP enrollees in exchange for UPL funds. They do not bill the program for care. The Indigent Health budget (referenced above) pays for care provided by Esperanza and independent physicians.