The Collin County Observer™

In a major blow to the survivability of some of the charity indigent care clinics in Collin County, the amount of county grants paid declined by 26% in the 2nd Quarter ended March 31.

Since last October, the county has been changing the rules for the grant awards. Many predicted that the county's goal was to cut funding while denying that was their intent. Last week, those predictions looked to be true.

For the last several years the county has awarded grant money to several charitable clinics. The funds were earmarked for a specific purpose, such as buying equipment or for rendering services. Beginning in 2008 however the county changed the grant awards to a "fee for service" model - offering subsidies for each patient seen.

Back in October, 2007, the county awarded over $275,000 in grants to assist local charities in providing healthcare services to poor, uninsured residents of the county.

After the grants were applied for and awarded, the clinics were surprised to see brand new paperwork requirements to redeem the funds. The paperwork limited the types of service the subsidies would cover to specific "illness codes". "Well baby" care, for example, was no longer covered.

The new paperwork also required a full name, address, diagnosis, and last 4 digits of a social security number in order to claim the subsidy. Most of the charities protested the new requirements. Some see the paperwork as an onerous violation of patient privacy.

"turning down this significant amount of money is a most difficult decision; however it is more important to the CCHC Board of Directors that we stay true to our mission and clinic patients."
CCHC President Mary Cummins

The commissioners court counters that there is no privacy issue, they only want to be certain that no taxpayer money is being spent on healthcare for illegal immigrants. The county says it has software that will verify that a person is a legal resident from the information on the forms. They have offered no reason why the diagnosis code is critical to their software.

The county routinely checks the citizenship of all applicants to its own indigent health plan. Those applicants found to be illegal are turned over to federal immigration authorities. While the commissioners have stated that it is not their intent to do the same with clinic patients - several clinics are wary.

Privacy issues, however were cited by the Community Lifeline of McKinney and by Children's Community and Health Clinic of McKinney . Both have declined to accept county funds already granted.

In an report earlier this year by WFAA-TV, "Mike Mixson, a board member of Children's Community and Health Clinic of McKinney, says that request was enough for his clinic to decline the money."

"If this information is released to the county or anyone else, how are we going to guarantee that confidentiality?", Mr. Mixson said.

"Every kid deserves to be treated."
Dr. Paul Reyes, medical director of Frisco Cares

Other clinics who are accepting county funds have seen the "pay for service" and documentation requirements lead to drastic declines in their awards. Plano Children's Medical Clinic was due to receive $11,111 as the pro-rata share of their $50,000 grant. Instead they were only able to apply for $9,100 - a loss of almost 18%,

The Bridge Breast Network provides mammogram services to the uninsured. It was due $10,483 this quarter, but because of the paperwork, it was only able to apply for $9,439 - and the county only approved $8,547 - $1,936 less than the original grant approved.

In all, 26% of the original grant for this quarter was not dispersed.

Many of the clinics find themselves "between a rock and a hard place". They have made the decision that sick children who need treatment will get it. If the child does not have the proper documentation available, then the clinic can not seek reimbursement. Even if the paperwork is in order, the county subsidy does not completely cover the cost of care. So the clinics struggle even harder for funds.

Sick children know no nationality or class. They are not at fault, but when they suffer, they need medical care.

Collin County, the richest county in Texas, is also the largest county in Texas without a public hospital. Here, if you have no insurance, your choices are very limited...and can be fatal.

Last year, Commissioner Jerry Hoagland said that if the clinics could not raise enough private donation money to stay open, they should go out of business. He may get his wish.

Of the 11 charities the county Health Care Trust Fund approved grants for - one, The Journey Home, has closed its doors due to lack of funds.

Bill

Previous Observer articles on the 2007-2008 Grants:

Dec 6, 2007 DMN - Groups criticize Collin County's patient data rule
Dec 5, 2007 - Indigent health care is not about immigration
Dec 4, 2007 - WFAA - Collin County health grants linked to immigration status
Dec 1, 2007 - DMN - Collin County grants require some data on patients
Nov 27, 2007 - Commissioners revise rules for charitable grants
Nov 20, 2007 - McKinney Children's Clinic refuses $30,000 county grant
Oct 10, 2007 - Commissioners Court budgets grants for clinics