Human Services Department of Health Care Services Fiscal Year 2017 Hillsborough County Health Care Plan (HCHCP)
FLA. STAT. 212.055(4)(a)1 & 3 Permits County’s with population of at least 800,000 To adopt an ordinance by super majority vote to levy a sales surtax not to exceed 0.5% For Health Care Services For Qualified Residents
FLA. STAT. 212.055(4)(a)3 & 4 Ordinance to set forth “Qualified Resident” Means plan: Providing broad Resident of authorizing county range of health care who is: services to qualified • Indigent as certified by residents. authorizing county; Plan to include : • Medically poor, as defined in the Statute; or Primary care Preventive care • Participating in innovative, Hospital care cost effective programs Services to be approved by authorizing provided by Level I county Trauma Center
FLA. STAT. 212.055(4)(a)4 “Medically Poor” means persons ◦ Having insufficient income, resources, and assets to provide the needed medical care without using resources required to meet basic needs for shelter, food, clothing, and personal expenses; or ◦ Not eligible for, or having medical needs not covered by, any other state or federal program; or ◦ Having insufficient third‐party insurance In all cases the authorizing county is intended to serve as the payor of last resort.
HCHCP Eligibility Criteria • All Hillsborough County residents may apply for Hillsborough HealthCare Assistance. The Health Care Services Department personnel determine who qualifies for Hillsborough HealthCare. T o qualify, they must: — Be a legal documented United States resident. — Be a Hillsborough County resident. — Have income at or below 110% of poverty level. — Have assets within established departmental guidelines. — Not be eligible for any other coverage through another state, federal or private insurance program, except as specified in plan descriptions. — Not be convicted of three (3) separate felony offenses on three (3) different days after April 6, 2005 in Hillsborough County. This is called the “3 strike policy”.
Plan Overview Started in 1991 and is funded by a statute restricted ½ cent sales tax. • National Recognized Program as the Most Innovative Government • Program by the Ford Foundation and the John F. Kennedy School of Government at Harvard University. Developed by the community and health care providers, and the State of • Florida. For more than 24 years, the HCHCP has provided health care to the most • vulnerable residents in Hillsborough County. Clients are men (49%) and women (51%), who are generally 18‐64 • years of age. Residents qualify with incomes at or below 110% of the Poverty Level, if • they do not qualify for any other insurance including Medicaid.
Plan Overview (Cont’d) In FY 2016, it served approximately 13,000 members per month and • approximately, 18,327 unduplicated members. During the last 10 years, our physicians and other medical professionals • have touched the lives of more than 260,000 unduplicated residents and processed almost 500,000 enrollments for clients, including some duplications. HCHCP provides both efficient and effective access to comprehensive • health care. Remains a nationally recognized and innovative program •
Health Care Advisory Board This Board improves accessibility and efficiency of care for medically poor residents of Hillsborough County through recommendations to the Board of County Commissioners for fund allocation, coordination, planning, and monitoring of health care delivery systems. HCAB Medical Mental Health Blue Ribbon Education/Outreach Management Subcommittee Task Force Panel Subcommittee Subcommittee
Health Care Advisory Board The membership of this Board shall be appointed by the BOCC and shall be comprised of 17 members. Composition is specified as follows: 1 USF College of Medicine representative 1 USF College of Public Health representative 1 Hillsborough County Medical Association representative 1 Health care business or professional representative 1 Mental health care provider 1 Community health care provider who is not a physician 1 Hillsborough County School Board representative 1 Health insurance industry representative 1 Person who represents the non‐healthcare business community 1 Network provider hospital representative 1 Consumer non‐profit organization representative 4 At‐large representatives 2 Persons who at the time of appointment or any subsequent reappointment, are participants in the Hillsborough County Indigent Health Care Plan
COMPREHENSIVE PRIMARY CARE BASED MODEL USED FOR MANAGED CARE GOVERNANCE AND CONTROL / GUIDING COALITION OUTREACH: CORE SERVICES: • Preventive • Outreach COORDINATION • Primary care • Awareness OF HOSPITAL SERVICES • Enrollment • Dental (palliative) • Transportation • Lab & X-Ray • Health Educ. • Pharmacy • Translation • Mental Health • Other Social • Disease Mgt. SPECIALTY Services COMMUNITY BEHAVIORAL SOCIAL SERVICES HEALTH (limited) LEGEND: PROVIDERS COORDINATION 10
Ambulance Services Covers transports for Health Care Plan Members (emergent & non‐emergent) Unfunded mandated Baker Act Transports Hillsborough County Fire Rescue (HCFR) receives payment for indigent plan members from HCHCP The indigent health care plan can only pay for “Qualified Residents”
Who will remain uncovered without broader Medicaid coverage? At or Below 110% of the FPL Represents HCHCP Eligible Population Source: Georgetown University Webinar – November 15, 2012
FY17 Budget Breakdown Revenue ½ Cent Sales Tax: $126,101,349 Refunds and Reimbursement: 2,822,235 Reserves: 14,254,437 Total: $143,178,021 Expenses Hillsborough County Health Care Plan (HCHCP): $83,474,105 Unfunded State Mandates: 22,795,298 Additional Mandates: 26,220,347 Pilot Programs: 10,688,271 Total: $143,178,021
Major Areas Funded by HCHCP Trust Fund Hillsborough County Health Care Plan (HCHCP) ($83,474,105) Unfunded Mandates ($22,795,298) ◦ Medicaid Match ($20,392,836) ◦ Baker Act (Evaluation ‐ Residents only) ($1,634,233) ◦ Baker Act Ambulance (Transport – Residents Only) ($558,712) ◦ Health Care Responsibility Act (HCRA) ($209,517) Additional Mandates ($26,220,347) ◦ Statutory Trauma Center ($3,500,000) ◦ Critical Treatment Fund ($7,821,969) ◦ 5% Required by Law ($6,314,845) ◦ Incurred but not received (IBNR) ($7,718,000) ◦ County Indirect Cost ($865,533)
Major Areas Funded by HCHCP Trust Fund Pilot Programs ($10,688,271) ◦ Mental Health Expansion ($4,000,000) ◦ Substance Abuse ($2,500,000) ◦ Healthy Living ($2,000,000) ◦ Jail Diversion Pilot Program (ACT and Sheriff) ($1,981,000) ◦ Housing First Multi‐Disciplinary Pilot Program (Cypress Landing) ($207,271)
Recovery Program and Coordination of Benefits • Collected Health Reimbursements • $5.423M through August 2016 recouped from: • Medicaid • Medicare • Litigation – Personal Injury/Malpractice and other legal Actions • Probate • Pharmacy Rebates • Other Health Insurance
Public Health/Population Health
Importance to the Community By providing health care to the most vulnerable and poorest • population in Hillsborough County, the HCHCP: Provides a safety net for those workers experiencing economic difficulties or who are unable to temporarily work. Ensures the patient has access to a medical home and primary care physician. Reduces costly emergency room visits, hospital stays and other costs that would be incurred by those providers without the HCHCP funding. Contributes to support of health care jobs for residents of Hillsborough County. Serves as the “Payor of Last Resort “ and pays only for care that would not otherwise be reimbursed.
Importance to the Community It is a major driver in the community helping to support • hospitals and providers who would otherwise not be paid for their provider services. HCHCP has 12 hospitals, 31 primary care clinics, over 3,000 • participating medical specialists, and a host of ancillary services. It provides $3.5M to the Trauma Center at Tampa General • Hospital to help support the Trauma I agency. The HCHCP and the Indigent Health Care Fund also support • other non‐funded mandates, such as: Medicaid, Baker Act Transports, and Pilot Programs
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