Hillsborough County Health Care Plan (HCHCP) FLA. STAT. - - PowerPoint PPT Presentation

Hillsborough County Health Care Plan (HCHCP)

Human Services Department of Health Care Services Fiscal Year 2017

• 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 plan: Providing broad range of health care services to qualified residents. Plan to include:

 Primary care  Preventive care  Hospital care  Services to be

provided by Level I Trauma Center “Qualified Resident” Means Resident of authorizing county who is:

• Indigent as certified by

authorizing county;

• Medically poor, as defined

in the Statute; or

• Participating in innovative,

cost effective programs approved by authorizing county

• 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
• ther 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. To 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

Management Subcommittee Education/Outreach Subcommittee

Medical Subcommittee Mental Health Task Force Blue Ribbon Panel

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

10

OUTREACH:

• Outreach
• Awareness
• Enrollment
• Transportation
• Health Educ.
• Translation
• Other Social

Services SPECIALTY BEHAVIORAL HEALTH (limited) COMMUNITY SOCIAL SERVICES

COORDINATION OF SERVICES

GOVERNANCE AND CONTROL / GUIDING COALITION CORE SERVICES:

• Preventive
• Primary care
• Dental (palliative)
• Lab & X-Ray
• Pharmacy
• Mental Health
• Disease Mgt.

HOSPITAL LEGEND: PROVIDERS COORDINATION

COMPREHENSIVE PRIMARY CARE BASED MODEL USED FOR MANAGED CARE

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?

Source: Georgetown University Webinar – November 15, 2012

Represents HCHCP Eligible Population

At or Below 110% of the FPL

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

• ther 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
• ther non‐funded mandates, such as:

 Medicaid, Baker Act Transports, and Pilot Programs

Final Comments



The Hillsborough County Health Care Plan:

• $130M dollars in lost revenue to the community
• Adversely would effect 18,000– 26,000 unduplicated clients per year with no safety

net/access to care  12 hospitals, 2500‐3000 physicians, mental health providers, substance abuse facilities  25 Federal Qualified Health Care Center clinics (Tampa Family Health Center and Suncoast Community Health Center, Inc.  Multiple partnerships with non‐profit organizations  Disparity issues with indigent minority populations receiving services  65 county jobs not counting other community jobs that can no longer be supported



Loss of Revenues to the County

• Unfunded Mandates ($22,795,298) – General Fund in the absence of another

funding source  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)



$3.5M TGH Trauma Payment is solely controlled by Tampa General Hospital

• Statute provides that the Clerk of the Circuit Courts pay either AHCA or Tampa General

Hospital at TGH direction.

Questions or Comments