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Indigent health care

Commission caught off guard by spike in costs

Jesse Hollett
Posted 5/24/17

GREEN COVE SPRINGS – With the 2016-2017 fiscal year just over halfway through, Clay County must appropriate an additional $150,000 to pay for out of county indigent health care, double what the …

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Indigent health care

Commission caught off guard by spike in costs


Posted

GREEN COVE SPRINGS – With the 2016-2017 fiscal year just over halfway through, Clay County must appropriate an additional $150,000 to pay for out of county indigent health care, double what the county expected for the entire year.

The Board of County Commissioners tackled the issue Tuesday with reluctance, considering the county has no choice on whether to pay the bill for local indigent residents who get treated in other counties. Statutory requirements straddled counties with the cost of uninsured out of county hospital bills since the passage of the 2013 Health Care Responsibility Act.

The bill aimed to remove the burden counties had from unpaid medical bills from residents of other counties. Failure to pay results in the state withholding the cost from state shared revenue, resulting in the same cost burden.

Normally, the county budgets $70,000 a year for these costs, but Tuesday the county moved an additional $150,000 from its contingency general fund to cover the spike in costs.

“We can’t guarantee that what we receive today will be sufficient to get us through the end of the year,” said Finance Director Clayton Meng Tuesday.

The change left Meng with questions if this year is just an abnormally expensive year, or if it represents a trend.

“The only thing that I can surmise given that we’ve seen a drastic increase in the size of the bills that we’re receiving is that, potentially, the hospitals are shepherding patients through the process – they would obviously have a financial incentive to do that,” Meng said. “They’re aware that we are financially liable for those charges if they’re valid and they come our way.”

The costs come not from a number of indigent bills, but rather inflated bills themselves.

Hospitals first identify if a patient meets the basic requirements for being declared indigent based on income and other specifications. If the hospital deems them medically indigent, then the hospital submits the bill to their county of residence for payment.

From the 124 bills received this year, only about 10 percent were accepted. Because the county must only pay the Medicaid rate for those bills, the financial burden remains a fraction of the gross cost for those bills. The county would have spent nearly a million dollars without this caveat.

The county has spent roughly $294,000 on indigent bills to out of county hospitals over the last nine years.

“Maybe it’s the start of a trend, I don’t know, but bottom line is we have to pay,” said Commissioner Mike Cella.

To qualify as a hospital that can accept indigent payments from a local government, state law mandates hospitals provide a certain amount of charitable care. The legislature additionally puts a cap on payments from local governments for this type of care at $4 per capita, so there are a number of safeguards for systematic abuse by healthcare providers, but those safeguards don’t go far enough to stop county officials from fearing a trend in hiking healthcare bills.

A number of the invoices received this fiscal year were for open-heart surgeries, which resulted in such a bloated bill.

However, the county can’t escape specialty deficiencies that give neighboring counties an edge in patient attraction. For example, Wolfson Children’s Hospital is in Duval County. In addition, if medical emergencies take place out of county, patients tend to stay in the county where the incident occurred for treatment.

By comparison, the county pays roughly $175,000 a month for in-county indigent care. This money is taken from state shared revenue and not the county general fund. Free clinics such as The Way Free Medical Clinic in Green Cove Springs offers uninsured patients preventative care. The clinic doesn’t serve all Clay County residents who have a need and are considered indigent. Some patients fall just above federal poverty guidelines for their family size, and simultaneously make too much for any subsidies and make too little to afford private insurance.

For a family of three, the current income cap is $20,420.

Each county has different ways of paying for indigent care therefore bypassing the need to use general fund balances. Polk County, for example, has a half-cent sales tax it uses to pay for indigent care. Voters reaffirmed their commitment to the tax by a broad margin last November. The tax comes for re-approval again in 25 years.

“As a society, let me say we all agree that when there are people in need of healthcare we don’t give hospitals an option, they have to take care of that person,” said Diane Hutchings, BCC vice chairman.