| TO: | Honorable Ray Allen, Chair, House Committee on County Affairs |
| FROM: | John S. O'Brien, Deputy Director, Legislative Budget Board |
| IN RE: | HB636 by Brown, Fred (Relating to county responsibility for indigent health care services.), As Introduced |
The bill would amend Subchapter B, Section 61.022, Health and Safety Code, to require a county to spend during a state fiscal year, at least 6 percent of the county's general revenue tax levy (GRTL) for that year to provide health care assistance to eligible county residents. A county that does not spend that amount would be required to adopt a less restrictive standard of eligibility for the next fiscal year. The bill would take effect September 1, 2005.
Chapter 61 of the Health and Safety Code is the Indigent Health Care and Treatment Act. Subchapter B applies to health care services and assistance provided to a person who does not reside in the service area of a public hospital or hospital district. Current statute does not mandate a specific percentage of the county's GRTL that must be used for health care assistance to eligible county residents, although for the county to be eligible for state assistance funding to offset the costs of providing indigent health care, the county must spend up to 8 percent of its GRTL.
The Department of State Health Services (DSHS) reports that the proposed change in statute would result in an increase in the number of quality assurance case reviews the agency would have to conduct to determine a county's eligibility for reimbursement from the state assistance fund once a county reports 6 percent spending. It is assumed that the estimated costs for new staff and travel could be absorbed using existing resources.
DSHS anticipates that there would be an increase in the number of recipients of indigent health care services (see Local Government Impact), which would result in the state assistance funds being depleted earlier in the fiscal year.
According to the Health and Human Services Commission, the changes proposed in the bill could require modification of the State of Texas Assistance and Referral System; however, the agency anticipates it could absorb those changes using existing resources.
According to DSHS, there are 142 counties to which the requirements of the bill would apply. DSHS estimates, based on fiscal year 2004 spending reports, that 40 of the applicable counties would reach the 6 percent spending level in fiscal year 2006, increasing to 57 counties in fiscal year 2007; 74 counties in fiscal year 2008; 114 in fiscal year 2009; and all 142 would reach the 6 percent spending in fiscal year 2010. Because not all counties would reach the 6 percent minimum immediately, those counties that do not would establish less restrictive eligibility criteria, which would result in an increase in the number of persons receiving treatment under the assistance program.
Based on finance reports submitted to DSHS by 114 of the 142 applicable counties in fiscal year 2004, the 6 percent GRTL for the 114 counties would represent $42.1 million collectively. The fiscal impact would vary by county.| Source Agencies: | 529 Health and Human Services Commission, 537 Department of State Health Services
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| LBB Staff: | JOB, JB, DLBa
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