The Collin County Observer

12:00 AM CST on Sunday, January 21, 2007

Ed Housewright

Government will never devise the perfect plan to treat poor, sick people.

For more than two years, Collin County commissioners have debated indigent health care without finding a solution that pleases everyone. At all cost, they want to avoid creating a county hospital like Parkland Memorial in Dallas.

The first question – and the hardest – remains: How do you define "poor"?

The county has income and asset guidelines to determine who qualifies for free care.

I looked at the benchmarks recently, and they may surprise you. Some will think they're too strict and exclude deserving people. Some will think they're too lenient.

If you apply for indigent health care, here's what you'll find:

• A single person can't earn more than $9,800 a year. A family of four can't earn more than $20,000.

• If you have more than $2,000 in savings, you don't qualify for care.

• Your car must be old. If it's valued at more than $4,650, you fail the asset test.

Critics say the guidelines are unreasonable and intentionally limit the number of people who get care. For instance, many people with full-time jobs and no company health insurance earn too much to qualify.

I've also heard complaints about the automobile value. It's difficult to find a dependable car for $4,650. If a person doesn't have a car, how are they supposed to get to work?

In addition, some critics have accused the county of making the application process too onerous. For instance, applicants must fill out a 12-page form to qualify. It asks for two references and grants the county permission to conduct a background check.

Applicants also must read and sign the county's health-care fraud policy. If they intentionally misrepresent information, they have to reimburse the county for benefits they received, may face criminal prosecution and are ineligible for care for two years.

Last year, 116 people met the qualifications and received treatment, records show. The county spent $1.3 million to care for them.

By comparison, 123 people applied and were rejected, according to records.

I received a spreadsheet from the health department showing the reasons for denial. Many involved a vehicle that was worth too much or income that exceeded the limit.

To be fair to Collin County commissioners, their income guidelines are more lenient than what state guidelines stipulate, and their plan covers more medical procedures than are required.

For instance, under state guidelines, counties don't have to provide care to a single person who earns more than $2,058 a year or a family of four that makes more than $4,200 a year.

In addition, the state doesn't require counties to cover diabetic supplies, dental care or vision exams, but Collin County does.

I've often wondered, why don't more people apply for indigent health care?

Collin County has roughly 700,000 residents, and about 40,000 people meet the income guidelines for care, officials say. Last year, only 239 applied – or about one in 200 who might qualify.

No one is sure why the numbers are so low. Some blame the long application form. Others suggest that residents of the county – one of the richest in the state – are reluctant to accept a government handout.

I asked what the county does to publicize its indigent health-care services. The program is mentioned on the county's Web site, www.co.collin.tx.us. Officials say local nonprofit clinics and hospitals know about the program and encourage people to apply for benefits.

"We're not doing anything to hide it," Commissioner Phyllis Cole says.

Commissioner Joe Jaynes says the county does a good job balancing its responsibility to the poor with its responsibility to be fiscally prudent.

"A lot of people who have concerns that we're not serving enough people don't have to pay the price tag," he said.

Repeatedly, county officials have said they don't want Collin County to turn into Dallas County. That is, they don't want to establish a public hospital like Parkland with an ever-increasing budget supported by a separate hospital tax.

Collin County officials say they can develop a better plan to care for the poor. They think they're on the right track, but it's a work in progress.