Fort Bend County is proactively addressing the healthcare needs of its vulnerable residents through its comprehensive Indigent Health Care Program. Recognizing that individuals seeking medical assistance often face a web of interconnected challenges, the county employs a holistic strategy to ensure clients receive not only medical care but also access to a range of essential support services.
Martha Hernandez, Program Manager for Fort Bend County Health and Human Services (FBCHHS) Indigent Health Care program and former chairman of the Texas Indigent Health Care Association, highlights the program’s distinctive approach. “The core of our program is our community health workers. They conduct thorough assessments that consider the whole person, enabling us to provide the most effective support for our clients,” Hernandez explains. This comprehensive evaluation goes beyond immediate medical concerns to identify and address other potential needs.
The program actively seeks to connect patients with all available resources for which they may be eligible. Hernandez details the breadth of assistance offered: “We explore every avenue of support, from hospital charitable care and free cell phone services to SNAP benefits, prescription assistance programs, and Medicare. Our team is dedicated to guiding individuals through the application processes for these programs, as well as assisting with Social Security Administration documentation and follow-ups.” This proactive approach extends beyond program applicants; Fort Bend County residents can receive eligibility assessments for external programs regardless of their qualification for the county’s indigent health care program.
Recognizing the barriers to access, Fort Bend County implemented a significant improvement during the COVID-19 pandemic by allowing electronic document submissions and signatures. This shift, initially a temporary measure, has become a permanent benefit, streamlining the application process. “The ability to submit paperwork via secure email channels is not just convenient; it has demonstrably improved client retention within the program,” Hernandez notes.
The Fort Bend County Indigent Health Care Program also excels in prescription management. Despite the program’s limitation of three prescriptions per client monthly, strategic asset management enables clients to obtain all necessary medications. Furthermore, the program emphasizes preventative care and chronic disease management by referring clients to local free educational classes and facilitating access to yearly wellness exams, preventative screenings, immunizations, and specialized health checks for both men and women.
“We go beyond our program’s direct offerings by actively connecting clients with patient assistance programs offered by pharmaceutical manufacturers,” Hernandez elaborates. “These external programs often provide benefits that exceed our internal capabilities, allowing us to secure more comprehensive care for our clients.” This resourceful approach has yielded significant results in reducing the number of clients reaching the program’s annual limit. Impressively, only five clients reached their maximum benefit in 2023 and just four in 2022, representing a more than 50% decrease compared to previous years.
County Judge KP George underscores the county’s commitment to its residents’ well-being. “Prioritizing the care of our most vulnerable residents should always be a fundamental responsibility for government officials,” Judge George states. “I commend the FBCHHS Indigent Health Care program for its dedication to providing high-quality and impactful service to our community.”
Understanding the County Indigent Health Care Program (CIHCP) Framework
The Fort Bend County Indigent Health Care Program operates within the framework of the Texas County Indigent Health Care Program (CIHCP), established by the Indigent Health Care and Treatment Act of 1985. This legislation mandates that counties without complete hospital district or public hospital coverage must provide essential health services to eligible indigent residents through a county-administered CIHCP. Texas currently has 113 counties with CIHCPs covering the entire county and 24 counties where CIHCPs cover areas not served by hospital districts.
The financial responsibility of counties under the CIHCP is defined by state law. According to the Health and Safety Code (HSC) Chapter 61, Section 61.035, a county’s liability for each eligible resident is capped at $30,000 in healthcare service payments or 30 days of inpatient hospital or skilled nursing facility care, whichever comes first, per state fiscal year.
To mitigate the financial burden on counties, the State Assistance Fund provides reimbursement for counties exceeding a certain expenditure threshold. Once a county’s spending on indigent health care reaches 8% of its General Revenue Tax Levy (GRTL), it can apply for reimbursement. If approved, the state may reimburse at least 90% of eligible costs exceeding the 8% level, as outlined in HSC Chapter 61, Section 61.039. Crucially, if state funding is unavailable, counties are relieved of payment liability after reaching the 8% expenditure level. Recent legislative changes have removed previous caps on the amount counties can request from the State Assistance Fund, ensuring more robust financial support.
Recent legislative sessions have also focused on refining reporting requirements for CIHCPs. House Bill 4510, effective September 2024, amended the Health and Safety Code to allow the Texas Health and Human Services Commission (HHSC) to require counties to submit specific tax information to determine eligibility for state assistance. This information, to be requested by the indigent health care coordinator from the county tax assessor-collector and auditor, includes sales tax revenue, general revenue tax levy, and taxable property value. This measure aims to enhance the efficiency and accuracy of state assistance fund allocation.
Scope of Services and Program Flexibility
Counties participating in the State Assistance Fund are mandated to provide a set of basic health care services to eligible residents and have the option to offer additional services established by the DSHS. Significantly, a 2008 expansion broadened the scope of optional services to include “any other appropriate health care service that the local governmental municipality or entity deems appropriate and cost-effective.” This amendment granted counties greater flexibility to tailor their programs to local needs and ensures that expenditures on services not explicitly listed in state rules can still qualify for state matching funds once the 8% expenditure threshold is surpassed.
The Texas Legislature has also addressed the inclusion of healthcare for county jail inmates within CIHCPs. House Bill 2454 allows counties to credit healthcare expenditures for inmates in county correctional facilities towards their 8% expenditure level. This provision extends to inmates from other counties housed in their jail. Inmates seeking CIHCP assistance apply using the standard Form 3064, indicating their living situation as a county jail facility.
The 1115 Waiver and its Impact
Texas’s 1115 Waiver, approved by the Centers for Medicare and Medicaid Services in 2011 and extended to 2030, significantly impacts healthcare funding and delivery in the state. This waiver allows for Medicaid managed care expansion, incentivizes healthcare quality improvements, and directs additional funding to hospitals serving large uninsured populations. Counties can include 1115 Waiver intergovernmental transfer payments towards state assistance eligibility, up to 4% of their GRTL, subject to specific conditions outlined in Section 61.036(e) of the Health and Safety Code. These conditions ensure that the Commissioners Court determines the waiver participation fulfills the county’s indigent health care obligations, provides sufficient care, and receives reports documenting services provided to CIHCP-eligible individuals through the waiver program.
For further details on DSHS and CIHCPs, comprehensive information is available on the Texas Health and Human Services website: https://www.hhs.texas.gov/services/health/county-indigent-health-care-program.
In conclusion, the Fort Bend County Indigent Health Care Program exemplifies a commitment to community well-being through its holistic, resourceful, and efficient approach to serving vulnerable residents. By navigating the complexities of state regulations and leveraging available resources, Fort Bend County ensures access to vital healthcare services and support for those most in need.
