LEGISLATIVE BUDGET BOARD
                          Austin, Texas

                           FISCAL NOTE
                       74th Regular Session

                          April 7, 1995



 TO:     Honorable Judith Zaffirini, Chair      IN RE: Committee Substitute
         Committee on Health & Human Services                   for Senate
         Senate                                 Bill No. 1096
         Austin, Texas








FROM: John Keel, Director

In response to your request for a Fiscal Note on Senate Bill No.
1096 (Relating to certain health care service a county may
provide under the Indigent Health Care and Treatment Act.) this
office has determined the following:

The bill would make no appropriation but could provide the legal
basis for an appropriation of funds to implement the provisions
of the bill.

The bill would expand services that counties may provide which
shall be credited toward eligibility for state assistance through
County Indigent Health Care Program currently administered by the
Department of Health.  The services subject to credit and
approval by the Department of Health include: 

*  primary and preventive services that meet the need of a
community, such as immunizations, medical screenings, dental
health care, and annual physical examinations; and
*  medically necessary services that the county determines to be
cost effective for the care of the resident, including but not
limited to ambulatory surgical center services, home and
community health care services, and diabetic and colostomy
medical supplies and equipment. 

The bill would also allow a county to credit premium payments for
health insurance coverage for certain persons toward eligibility
for state assistance.  An individual for which counties may make
premium payments include one diagnosed as having HIV or AIDS, or    




other terminal or chronic illness, who is unemployed, and whose
income is less than 200 percent of the federal poverty level even 
though that person may be eligible for benefits under the
Medicaid program or a medical assistance program of the county.

Under current law, a county must expend 10 percent of its general
tax levy on indigent health care for services identified in
statute prior to becoming eligible for state assistance.
Additionally, income eligibility for those served by counties in
order to receive credit towards state assistance is tied to the
State's AFDC guidelines, currently 17-18 percent of federal
poverty guidelines.  After a county fulfills the 10 percent
threshold, the State shares costs with a qualifying county by
paying  80 percent of subsequent expenditures made on indigent
care by that county.

In the event that the expansion of eligible services and
allowable expenses enables counties to qualify for state
assistance sooner or allows more counties to qualify for state
assistance, the cost to the General Revenue Fund would increase. 
The extent to which the Department of Health will approve the
expanded services for credit or counties will make payments for
health insurance for certain individuals cannot be determined.







The Department of Health indicates no fiscal implications would
be associated with this bill, stating the department would assess
the cost effectiveness of a service proposed by a county and that
no additional costs would accrue because the expenses of
preventive services would be offset by reduced hospital stays and
emergency room visits.  The department made no reference to the
provisions related to premium payments by counties.


The fiscal implication to  the State or units of local government
cannot be determined.


Source:   Department of Health
          LBB Staff: JK, KF, AZ