The Collin County Observer

Collin County nonprofit health clinics struggle to get by

Sunday, June 14, 2009
By ED HOUSEWRIGHT / The Dallas Morning News

Bess Spear of Plano has no job, no health insurance and few options for affordable health care.

With no public hospital in Collin County, she turns to a storefront clinic that's staffed by volunteers and that's open one night a week.

On Thursday, she and 80 other people crowded into the nonprofit Collin County Adult Clinic in Plano. For $10, they get prescription refills and a visit with a doctor.

"Thank God for these people," said Spear, 64, sitting on a folding chair. "If I couldn't come here, I'd be up a creek."

Unlike Dallas County, which treats uninsured indigent patients for no cost at its Parkland hospital, the more affluent Collin County farms out much of its indigent health care to small private clinics.

The Adult Clinic and eight other nonprofit agencies shared grants from the county this year that totaled about $200,000.

Now a new citizen group, citing the economy and the county's rapid growth, wants the county's elected officials to spend much more.

"I think they are mandated to take care of the indigent," said Marge Langteau, who helped organize the Collin County Healthcare Committee.

Members of the group say they plan to pack Monday's meeting of the Collin County commissioners to make their case.

But the commissioners give no indication of wanting to change a long tradition of frugality by increasing health-care spending on the poor.

Despite calls to raise expenditures, officials point out that Collin County exceeds the state's minimum requirements for indigent health care.

"I'm happy with our policy," said County Judge Keith Self, who heads the Commissioners Court.

In Dallas County, taxpayers hand over $400 million a year to help run Parkland. Collin County, however, treats the poor without taxing residents. Health care is financed by a trust fund set up 25 years ago when the county sold its deteriorating public hospital for $13 million. With interest and investments, the health-care trust fund grew to more than $20 million earlier this decade. Now it stands at $15 million.

Commissioner Jerry Hoagland worries about the fund's decline. If the county increased indigent health care, the fund would shrink faster, he said.

"I'm trying to conserve that fund as long as possible so we don't have to tap the taxpayer," Hoagland said.

The trust fund pays for Collin County's three-pronged approach to indigent health care.

• It provides free services at a county-owned clinic in McKinney? for uninsured people who meet strict income guidelines. A single person can't make more than $10,830 a year; a family of four, more than $22,050.

• Uninsured people who meet those same income guidelines can visit PrimaCare? clinics in Frisco, Plano and McKinney?. The county has a contract with PrimaCare? to provide care for a $20 patient co-pay.

• Uninsured residents can get care at nonprofit clinics that receive county funding. Some offer free care; others charge a nominal fee.

Commissioners forbid the clinics to treat illegal immigrants with county money. They also require the clinics to record patients' names, diagnosis codes and the last four digits of their Social Security numbers.

Some clinics, such as the Children and Community Health Center of McKinney?, no longer seek county funding because of the reporting requirements.

"It was a lot of work, and we didn't want to turn over patient records to the county," said Mary Nelle Cummins, clinic founder.

On Monday, commissioners will consider adding another restriction on nonprofit agencies. If the proposal is approved, the patients would have to meet the same income guidelines as those visiting the county clinic or PrimaCare? locations.

Several nonprofit agencies object to the additional restriction. They say they're underfunded, understaffed and swamped with needy patients. Verifying income will be an additional burden that will cut into treatment time, said John Ernst, executive director of the Collin County Adult Clinic.

"With this economy, we and others need money and volunteers, not increased administrative drudgery," he said.

Commissioner Joe Jaynes said he has misgivings about imposing an income guideline on clinics.

"I think it would be an additional strain on them," he said.

Collin County's income guidelines are more generous than the state requires. It treats individuals who earn up to $10,830 annually, while the state says counties can decline to treat those who make more than $2,274 a year.

Last year, the clinic treated 254 low-income residents, records show. In 2007, it saw 148.

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