Council Approves Policy Changes to Indigent Healthcare Program
The Los Alamos County Council voted 5-1 this evening to approve a resolution that includes a revised policy for the County Indigent Health Care Assistance Program that is intended to change current policy and establish standards for determining residency and domicile.
Councilor Pete Sheehey voted against the measure and Councilor Steve Girrens is absent.
The resolution also will establish new standards for determining allowable costs for sole community provider hospitals, ambulance services, establishing and defining hospital services, establishing and defining health care services, establishing criteria and limitations for medical care, and other necessary and proper administrative and ministerial provisions to effectuate the purpose and intent of the Indigent Hospital And County Health Care Act.
The Los Alamos County Health Care Assistance Program is a County program that is funded by the gross receipts tax and administered by the Los Alamos County Council. The Health Care Assistance Program reimburses contracted providers for the care and treatment of qualified individuals.
As discussed during the budget hearings earlier this month, the County's Health Care Assistance Program (HCAP) is facing a decline in existing revenues coupled with a significant increase in claims activity.
Los Alamos County Deputy Administrator/Chief Financial officer Steven Lynne briefed Council on the financial struggles of the County's Indigent Hospital and Health Care program this evening in Council Chambers. He explained that the outlook projects a 19 percent decrease in GRT Revenue and a 35 percent increase in Healthcare Assistance.
In addition to the added General Fund transfer that Council incorporated into the FY14 budget, modifications to the existing HCP policy are necessary so that service levels are brought more in line with available resources, he said.
Through February, the County has paid some $500,000 in claims and projects some $900,000 in claims and without a change in policy to establish standards for determining indigency and eligibility similar to 2004 standards, Lynne said the County's Indigent Healthcare Fund would end the year in a deficit situation.
Covered Services Under Current Program
Qualified individuals of the Health Care Assistance Program are eligible for $25,000 of medical reimbursement payments to contracted providers per fiscal year (July 1 to June 30) for the following services:
- Medical Care
- Prescription drugs
- Nursing home services
- Prenatal care.
- Hospital outpatient services
- Ambulance transportation
- Durable medical equipment.
- Vision benefit payments to include one (1) optical eye exam and (1) pair of glasses or one year’s supply of contact lenses, shall not exceed $200.00 per fiscal year.
- Dental benefit payments are not to exceed $1,500.00 per fiscal year.
- Day Habilitation Services.
- Nutrition Counseling Services.
- Behavioral Health, to include mental health and substance abuse treatment centers.