County Indigent Health Care Program Jan Maberry Program Manager, Primary Care Group Department of State Health Services 1 Overview Overview of County Indigent Health Care Program Local Responsibilities State Responsibilities Resource Information 2 What is CIHCP? Locally administered and funded program that provides medical coverage to eligible residents of your county or hospital district Subject to state law Chapter 61 and Texas Constitution Require coverage of certain populations and services Application, documentation, and verifications Provides flexibility in administration, providers of services, and optional health care services, 3 1
Who is responsible for CIHCP? 143 County-run programs 142 Hospital districts 18 Public hospitals 4 5 Who Does CIHCP Serve? 6 2
CIHCP Eligibility CIHCP serves: Residents of county or hospital district Low-income individuals under 21% FPL Low assets or resources Generally Adults (18 to 64) People with disabilities awaiting a final decision from Social Security Administration CIHCP does not currently serve: Medicaid eligible population 7 Income Standards CIHCP Monthly Income Standards March, 2012 # of Individuals 21% FPG in CIHCP Household 1 $ 196 2 $ 265 3 $ 335 4 $ 404 5 $ 473 8 What Services Does CIHCP Provide? 9 3
Basic/Mandatory Inpatient hospital services Outpatient hospital services Physician services Rural health clinic services Laboratory and X-ray services Family Planning services Prescription Drug services Skilled Nursing Services Preventive & Primary Care Immunizations Medical screenings Annual Physical exams CIHCP Benefits: Basic/ Mandatory Services 10 CIHCP Optional Services In addition to the basic services, the county may choose to provide other services the county determines cost effective. Optional services include services such as: Ambulatory surgical center Diabetic & colostomy supplies & equipment Home & community health Social Work Psychological counseling Dental Vision care Federally qualified health centers Emergency (transportation) services Physical & occupational 11 Local Responsibilities Provide application process Establish who will determine eligibility Determine Services Providers Use mandated providers only or all providers Optional services Finance the program 12 4
State Responsibilities Establish the eligibility standards and application, documentation, and verification procedures for counties, Define basic and department-established optional health care services, Establish the payment standards for basic and department-established optional health care services, Reporting procedures 13 State Responsibilities Administer the state assistance fund for counties not fully served by a public hospital or hospital district that spend more than 8% of their general revenue tax levy (GRTL), Resolve eligibility disputes between a provider and a county, public hospital, or hospital district and DSHS County Indigent Health Care staff provide training and technical assistance to counties, public hospitals, and hospital districts. January, April, July, October 14 State Budget for CIHCP After a county-run program has expended 8 % of their general revenue tax levy, they may apply for state reimbursement above the 8% spending. State fund FY 12/13 - $247,000 FY 11- $2, 600,000 15 5
Healthcare Transformation 1115 Waiver The Texas Health Care Transformation and Quality Improvement Program 1115 Waiver includes: Managed care expansion Expands Medicaid managed care services statewide Includes legislatively mandated pharmacy carve-in and dental managed care Hospital financing component Preserves upper payment limit (UPL) hospital funding under a new methodology Creates Regional Healthcare Partnerships (RHP) 16 Healthcare Transformation 1115 Waiver Under the waiver, trended historic UPL funds and additional new funds are distributed to hospitals through two pools: Uncompensated Care (UC) Pool Costs of care provided to individuals who have no third party coverage for the services provided by hospitals or other providers (beginning in first year) Delivery System Reform Incentive Payments (DSRIP) Support coordinated care and quality improvements through RHPs to transform care delivery systems (beginning in later waiver years) 17 An investment in knowledge pays the best interest. Benjamin Franklin 18 6
Additional Resources CIHCP Program: http://www.dshs.state.tx.us/cihcp/default.shtm County Spending Information: http://www.dshs.state.tx.us/cihcp/cihcp_spending_data.shtm Approved Healthcare Transformation 1115 waiver www.hhsc.state.tx.us/1115-waiver.shtml 19 Contact Information Jan Maberry, Program Manager 512/776-7728 DSHS CIHCP Main Line 512/776-7706 Internet questions - ihcnet@dshs.state.tx.us 20 7