Travis County Commssioners Court
June 8, 2004
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Item 15
15 is to consider and take appropriate action on the options addressing the projected budget shortfall in the rural medical assistance program. After this we'll go back and pick up 7.
>> good morning.
>> good morning.
>> on may 25th we held a work session where we talked about financial [indiscernible] for this fiscal year. During that time we communicated to you that we were experiencing a projected $1.2 million shortfall in the rural medical assistance program. During that session you talked about the $500,000 reserve that was set aside in f.y. '04 budget for health care. On today's agenda you have approved the transfer of that reserve into the rural medical assistance program. Even with that move we are projecting a $730,000 shortfall in rural medical assistance program. That projected shortfall is primarily due to the overall increase in enrollment. And I am not experiencing certain savings that we had projected. For instance, we had projected a $250,000 savings in the pharmacy program. That wasn't experienced. So that leaves us with about three options that we believe that we're presenting to you -- well, that you can actually consider to keep the program within the current budget. Also during that work session there was some discussion about the difference between the city of Austin's medical assistance program and our medical assistance program. And it was my understanding that I was to at least look at those and factor that into this equation. After looking at that situation again, we are making recommendations related to the adjustment of the eligibility requirements. Currently we have options to cap the number of enrollees or reduce benefits to all enrollees, but what we sought to do was to oppose a position that we -- an option we thought would minimize effect on patient services. There are three things that we believe you could do in order to make this program operational through this current year. The first one, and I'm reading the recommendation, is to reduce full benefit eligibility for certain current enrollees to 21% of the federal poverty level if enrollees do not have a job. If they don't, the level would be reduced to between 35% to 48%. This would impact approximately 800 enrollees and could save up to $250,000. This would also require 30-day notification period for our current enrollees. And we would actually implement this program effective July 15th. With this option, clients would still have an opportunity to access primary care on a sliding fee scale. The services that would not be paid for through the m.a.p. Full benefit program would be specialty care as well as hospital services. The second option is we have a liability that we had booked for approximately four years. I think we're in the 3rd year of that liability. The -- the statue of limitations on that liability is due to end October 1st. And what we would want to do is to use moneys from the allocated reserves and pay that money back to the reserves on October 1 of physical year '05. Even with those moves we will still be $250,000 short of our expected spend during for the program if it continues in its current state. Therefore we would also recommend that there be a $255,000 ear mark on the allocated reserve to ensure that we can make the budget projected expenditures for this fiscal year.
>> you confused me at one thing because you were saying that the [indiscernible] would occur on October 1st. That's a new fiscal year. Don't you really mean that it's a -- swapping out all of this stuff and it all shakes out for tending fund balance on September 30th and not October 1. Because i've just got a raised eyebrow from one or two auditors.
>> one of the reasons these two guys are sitting here is trying to make sure I use the correct terminology.
>> it's the settling out of everything falling down from the fund balance and it's all sorted.
>> yes.
>> the only thing that we would need to do that on the liability is we need a letter from the county attorney's office saying that that liability will be released as of September 30th for the 225,000. That's the one issue --
>> that's basically on the [indiscernible] medical claim?
>> yes.
>> okay.
>>
>> [one moment, please, for change in captioners]
>>
>> it says if you are not working you are eligible for less assistance than you are if you are working. My east Texas common sense tells me it should be --
>> it is.
>> you have an obligation to serve those individuals -- (indiscernible).
>> if you do not have a job, right? If not being the key word. If you have a job, then the eligibility standard goes to 35- 48 percent of poverty.
>> actually, I need to check that.
>> it says reducing the eligibility.
>> you're not expecting action today. You want to give us the shot of the three recommendations first and that will take at least a week, right?
>> that will be on somebody else's watch.
>> it's not that the requirement will be reduced. It will be increased.
>> I got it.
>> basically what you're saying is that we're trying to equalize the benefits. And for certain populations, the city has natural requirements of that really limited access to full benefits. Apparently we don't make distinctions between the populations. Urks check that positive me.
>> okay.
>> john, let's do 29 next week. If it need to be tweaked, et al, then tweak it down as soon as possible. Is that all right?
>> (indiscernible). It will be if it were to quantify the level of supplement, are we talking about a little bit, are we talking about the same for the people to access the services who receive federal benefits or who have -- [overlapping speakers].
>> what you're saying is we will no longer be here. You would have to pay for primary care services on a sliding fee scale basis. We would no longer pay for specialty care or hospital services or the full benefit package.
>> the sad thing is these people are not able to pay for these services. If the same is true in the future and they're forced to do without, what services are we talking about that would affect their lives.
>> okay. If we're forced to do without the primary care because after they receive the designation they need to be seen on a sliding scale basis. On the sliding scale basis there is a basis of zero pay.
>> and also in that third option that we're looking at, $255,000 of it are we looking at as far as the allocated reserve. What would be the problems of the allocated reserve if the court decided to use this $255,000, which would that actually fall in the reserve going into the -- going into the next fiscal year? Also, also there is a possibility of funding. (indiscernible) the remaining money that would be in the allocated reserve, whichever the 255,000 is.
>> the 157,000-dollar basis and that was earmarked, so in terms of the ear marks, you only have $269,000 for the rest of this year. 269,000-dollar balance after ear marks for the remainder of this year, so in essence it would take it down to 14, $15 for the remainder of this year on -- on the-million-dollar budget. And although some of these ear marks we probably should look at to see whether or not they're still valid, we're seeing 400,000 of them on the indigent rolls, and we we may be able to have those lifted, but you're running close.
>> let me ask this then. Is there any -- as far as the funding, those other ear marks are -- what they are, and you end up with $14,000 that's going into the next fiscal year and then going into the ending fund balance. Is there a possibility of looking at the emergency reserve, the $1.7 million sitting there.
>> you would not run into default. You have other reserves that you can pull from.
>> and I was wanting to make sure that if that is the case, we could look look at that also as far as funding to make sure that the shortfall, the 730,000-dollar shortfall that they're running into will take us up into the end of this fiscal year, and of course looking for this transition into the hospital district way of doing business with the county. And also the city in the future. So that was just a couple of things I wanted to bring up. To make sure that we look at those possibilities if we're going to bring this back next week.
>> one of the questions -- I know we're doing it just to kind of keep reminding folks. During the hospital district election it was kind of an assumption made in terms of the accounting does. [papers shuffling - audio interference] it is clear from the actions today that that additional $500,000 and the potential of even more, that that 1.3 cents is incorrect. It will be more than that. And we're not even talking about what the projections are for next year. So I'm saying out loud and early that the idea that somehow there's this, quote, steady state in this budget is not true. We also need to keep an eye on what we call in our own health insurance, incurred, but not paid in terms of closing that with our indigent health care program. We need to make sure that the billing -- that we've got the correct encem brans there to correctly close out everything that might be coming in in terms of building.
>> [ inaudible ].
>> we'll do that before next week.
>> anything else?
>> that needs to be done.
>> yes. I wanted to make sure we understood, and perhaps it's going to be. On the first item of changing the eligibility, there was a 250,000-dollar savings that was identified for 75 days that's not annual analyzed number. And so for the purposes of the '05 budget and determining the transition between the county and the hospital district, it would be beneficial to have a reasonable projection of the annual savings that will occur as a result of this policy change that has been put on the table, which may indeed have some other kinds of beneficial impacts on some cost increases.
>> that's true.
>> so in terms of --
>> so the legal standard that we must comply with.
>> yes.
>> I'm not sure that legal standard allows that rationale. We can find out between now and the end of the fiscal year.
>> if you save 250 in 75 days, wouldn't you save more for 365?
>> yes, but I think the question is how much do we spend on health care this year.
>> I understand that. I'm just looking at incrementally. I'm not looking at the total. [overlapping speakers]
>> I see your point.
>> there are plenty of lawyers able to answer that question. We'll have it back on. Thank y'all.
Last Modified: Wednesday, June 9, 2004 7:25 AM