County Indigent Health Remains Firmly in Black

Tom Green County's Indigent Healthcare Program is not in danger of overspending despite assertions from Treasurer Diana Spieker that illegal immigrant healthcare bills pose a huge threat. 

Tom Green County's 2016 budget shows nearly $376,000 for Indigent Health and $1.8 million for Transformational Waiver DSRIP IGT, which levers federal Medicaid funds.   These two expenditures total $2.18 million of the $2.88 million the state requires the county to set aside for Indigent Health, leaving a $700,000 surplus.

The County's $1.8 million turns into $3 million for local providers after the federal match.  Shannon Medical Center receives 95% or nearly $2.9 million, while SACMC gets 5% or roughly $150,000.  These percentages are a change from 1998-2000 era when Shannon provided 80% of the County's Indigent Health, while Community delivered 20%.  In exchange for these funds both hospitals agree not to bill the Indigent Healthcare program for care provided within their system.  The fund pays independent providers with its roughly $200,000 patient care budget. 

Spieker talked about the time when the program needed state help, ably provided by Representative Rob Junell, Chair of the Texas House Budget Committee.  She did not mention the volunteer group of local leaders who helped put the Indigent Healthcare program on a better course.  They included Shannon's Insurance Executive Marinan Freeman, and Community's Chief Financial Officer Ed Romero.

This group recommended a series of coverage changes that would enable the program to spend its resources more effectively.  The last year Indigent Health needed state subsidies occurred in 2000.

	Budget	Spent	Surplus/Deficit (-)
1998	$      1,266,266	$     1,612,048	$           (345,782)
1999	$      1,282,296	$     1,969,953	$           (687,657)
2000	$      1,325,920	$     1,545,253	$           (219,333)
2001	$      1,461,856	$        925,307	$            536,549
2002	$      1,505,039	$     1,144,784	$            360,255
2003	$      1,505,039	$        700,032	$            805,007
2004	$      1,635,235	$        582,773	$         1,052,462
2005	$      1,750,555	$     1,028,674	$            721,881
2006	$      1,920,942	$     1,288,048	$            632,894
2007	$      1,920,942	$     1,221,172	$            699,770
2008	$      1,920,942	$     1,327,742	$            593,200
2009	$      2,039,178	$     1,806,595	$            232,583
2010	$      2,015,580	$     1,358,386	$            657,194
2011	$      2,086,095	$     1,432,062	$            654,033
2012	$      2,227,722	$     1,311,760	$            915,962
2013	$      2,339,750	$     1,203,472	$         1,136,278
2014	$      2,493,543	$     1,311,097	$         1,182,446
2015	$      2,788,617	$     1,597,798	$         1,190,819
			$       10,118,561

Since then it's been a cash cow, but the years under Treasurer Spieker have produced the greatest gains. It's hard to see how that's at risk with federal matching funds and existing provider contracts.