The Collin County Observer

The Collin County Commissioners Court is meeting in a 'Special Session' tonight at 6:00PM in Wylie City Hall.

While the commissioners frequently bemoan the fact that citizen attendance at these special evening sessions are sparse, three items on the agenda will likely cause a number of taxpayers to attend.

Last month, the commissioners, acting as the Health Care Trust Fund Trustees placed an item on their agenda that would add more grant restrictions to the nonprofit indigent clinics. The restrictions would require the clinics to only be paid to serve those whose incomes fall below 100% of the federal poverty line (approx. $20,020/yr for a family of 4).

After the Collin County Observer and many citizens objected to the proposed new rules, in part because there was no chance for citizen input, the commissioners voted to postpone consideration until this evening's meeting.

The county presently doles out a total of about $200,000/yr to 9 nonprofit organizations that operate clinics or health care services for the poor in the county. For the last 2 years, the grant funding has been reduced from the $300,000 high granted in 2007.

The county is required by law and the Texas Constitution to be the "provider of last resort" for the indigent, and to meet those requirements, the county operates a "County Indigent Health Care Program (CIHCP) The restrictions for entry into CIHCP are stringent, requiring a 19 page application and verification of all income, assets and insurability. In fact the restrictions are so severe that in 2008, only 207 Collin County applicants were approved for CIHCP.

Collin County also funds a program that allows uninsured citizens whose incomes are below 100% of FPL to get primary care at any PrimaCare clinic for a $20 copay. For fiscal 2009, the county has budgeted $300,000 for the PrimaCare program. In fiscal 2008, the county paid for over 2,300 low income patient visits to PrimaCare.

The third county indigent health care program is the grants (now called "fee for service") to the nonprofit clinics. In 2009, the county paid these clinics from $25 to $50 for each qualified patient seen. For the first half of FY 2009, the county has paid the 9 clinics about $72,000 in the Fee for Service program. These clinics see hundreds of patients every week.

Prior to 2007, the county simply awarded a specific dollar amount grant to the nonprofits based on their needs and request. In 2007 however, the county changed from a grant to a fee basis. The county requires each clinic to report the name, address, last 4 digits of the Social Security number and a diagnosis code for each patient for whom the clinic is asking for county funding.

Most nonprofits strenuously objected to the 2007 changes, citing increased workload and patient confidentiality. Two of the clinics subsequently refused county funding because of patient confidentiality concerns.

Presently, the nonprofit clinics set their own admission and fee schedules. Most require that patients seeking low cost care only be uninsured, and not eligible for public health care assistance. The 2010 county proposal would force the clinics to change their admission criteria and to document income.

Supporters of the clinics note that the nonprofits provide the most economical health care service available to uninsured residents. While the county pays $210 to PrimaCare? for each patient visit, it only gives the nonprofit clinics between $35 and $50 for each visit.

In 2005, the Commissioners Court appointed a 25 member citizen task force to study the need for indigent health care programs. That committee met for over 18 months and issued its report in 2006. One key recommendation by the task force was to increase the grants program to nonprofits to between $500,000 and $800,000. The task force noted that while the CIHCP attempted to serve the hard core indigent, the clinics were serving the 'working poor' - those who because of the rising cost of insurance were not able to afford health care, even though they worked.

Also on the court's agenda for tonight is a request by Catholic Charities to open a "Homeless Prevention" office in Collin County. The office would attempt to help those recently unemployed, underemployed and families who were in imminent danger of becoming homeless. The Catholic Charity operation would be run at no cost to the county or taxpayers as it is funded by the United Way and federal and state grants. The program would provide over $1 million in benefits to the 9 county region.

State funding through the Texas Department of Housing requires that the local counties served give formal approval to allow the opening of the local office. Twice now, the commissioners' court has declined to approve the Catholic Charities request. Instead the court has asked for more information.

Some on the court have, in the past, expressed reservations on allowing federal, state or charitable funds to be spent on the poor in the county fearing that as The Dallas Morning News reported in 2005 on Commissioner Hoagland's concern, "he worries the grants will cause more homeless people to move to Plano. He said many problems in Dallas and other cities can be attributed to the homeless population." The DMN also reported that "he said the goal of trying to end homelessness is too large. He said the homeless have always been around and always will be."

In 2005 the issue was using federal dollars to fund apartments and a case manager for up to 8 mentally ill patients who would otherwise be homeless and unsupervised.

I hope that attitude is not what is holding up the Catholic Charities request.

The third item on tonight's agenda is to consider moving the alignment of the south-eastern leg of the Outer Loop. The part of the loop in question is between SH 6 and the Rockwall county line. The county staff sand consultants are recommending that a section be moved to avoid impacting the High Meadow Estates project in Josephine. The proposed realignment will reduce the number of residential properties that would be lost to the new road.

Both the proposal and the current alignment will adversely impact a number of homes.

Bill