Focus Report, Volume 76, Number 5, February 1999 Page: 7
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House Research Organization
By 2001, federal funds will be capped at $765
million, almost $200 million less than what Texas
received in fiscal 1997.
DSH funding losses could be offset by increasing
health coverage of populations now served by public
hospitals - for example, through CHIP, THKC, and
county indigent care programs. Also, the recent
agreement between tobacco companies and Texas
counties, hospital districts, and public hospitals calls
for the establishment of a permanent trust fund that
will receive $1.8 billion over four years. (See page
11.) This fund could help alleviate some of the
problems caused by reduced DSH funding.
County and Public Hospital Duties
The indigent health-care responsibilities of Texas
counties and public hospitals are defined under the
Indigent Health Care and Treatment Act (Health and
Safety Code, ch. 61). The act requires counties to
establish indigent health-care programs that conform to
minimum standards for eligibility, covered services, and
payment responsibilities. Counties are not responsible
for the care of indigent residents of an area served by
a public hospital or hospital district. To be reimbursed
for care of indigent residents, health-care providers must
notify counties according to specified procedures.
A county is eligible to receive state assistance once it
has spent 10 percent of its general revenue tax levy
(GRTL) on mandatory indigent health-care services for
eligible individuals. Counties are not required to report
expenditures to the state nor to spend more than 10 percent
of their GRTL. For fiscal 1996-97, the Legislature
appropriated $12 million for state assistance to counties,
but the counties drew down only about $7.4 million. For
fiscal 1998-99, lawmakers appropriated $11.4 million. To
date, the counties have used only about $2.6 million.
The law requires public hospitals, such as county- or
city-run hospitals, to provide at least the same level of
inpatient and outpatient hospital services that counties are
required to provide, along with any other services they
provided to indigent residents before January 1, 1985.
Public hospitals must establish eligibility standards that are
no more restrictive than those required for county indigent
programs, and they receive no state assistance in paying
for indigent care. In 1997, 157 public hospitals in Texas
reported providing $1.2 billion in charity care.
Hospital districts are responsible for providing medicalConstitution (art. 9, sec. 4) and may have additional, more
specific responsibilities for indigent health care under the
statute creating the hospital district. In 1997, Texas' 106
hospital districts reported spending $871 million on charity
care. Eligibility standards and the range of services
provided vary from district to district.
Major issues:
- Eligibility criteria. In 1985, lawmakers set county
program eligibility standards to conform with state
standards to receive cash assistance through the
federal welfare program, now called Temporary
Assistance to Needy Families (TANF). The income
limit for a single adult has changed very little since
1985. Because Texas' TANF income eligibility
standard has not kept pace with general cost-of-living
increases, the standard now represents about 11
percent of the FPL, down from about 25 percent in
1985. Critics say eligibility for indigent care should
no longer be linked to TANF eligibility standards,
which have reduced the number of indigent
individuals who may receive county coverage for
needed health-care services and have increased the
number of uninsured individuals whom health-care
providers treat without compensation.
Some say TANF-based eligibility determination
procedures are too cumbersome and time-consuming.
They maintain that eligibility should be streamlined
by linking it to a specific percentage of the FPL and
standardizing it for use by counties, hospital districts,
and public hospitals across the state. This would
create a consistent safety net for all poor and
uninsured Texans. For example, hospital districts'
standards for indigent care eligibility vary from 11
percent to 200 percent of the FPL. Opponents of
standardizing eligibility say this would increase state
and local expenditures unless across-the-board
standards were set so low that no counties had to
expand their programs.
- Services offered or required. Health-care services in
county programs must be identified as "mandatory
services" by law for a county to receive credit for
state assistance in paying for indigent care. However,
the current list of mandatory services does not include
many services that can prevent more complicated and
expensive medical problems from arising.
Hospital district responsibilities are not as clearly
specified under the Constitution as public hospital and
county responsibilities are by law. As a result, somehospital districts reduce their indigent care load by
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services to their "needy inhabitants" under the Texas
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Texas. Legislature. House of Representatives. Research Organization. Focus Report, Volume 76, Number 5, February 1999, periodical, February 4, 1999; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth641172/m1/7/?q=%22~1~1%22~1: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.