The Collin County Observer™

A few eye-opening Collin County facts:

• 63,370 people who are below the poverty level in the county. (0.81%), 2010 census
• 122,964 have no health insurance (15.6%), 2010 census
• 10.2% of our children under 18 live in poverty, 2010 census
• 7.7% are unemployed (August, 2011)

The Healthcare Committee Collin County will hold a educational forum Tuesday Oct. 18th.

HCCC Educational Forum - Poverty in Collin County and its Consequences.

Date: Tuesday October 18th, 2011
Time: 6:30 - 9:00 p.m.
Place: Collin College Conference Center - Spring Creek Campus
Room AA135 - Section DE, 2800 E. Spring Creek Pkwy, Plano, TX 75074

Speaker Panel:

• Rev. Janet Collinsworth – Director of Mission and Outreach, St. Andrews United Methodist Church and 7 Loaves Food Pantry. Under Rev. Janet’s leadership St. Andrew’s has reached out to provide many needed services in Plano including a Food Pantry, a Medical Clinic and School Programs. Through these efforts, the data they have collected shows Collin County and those in poverty in a very eye-opening way.

• Dr. Richard Adams – is a developmental-behavioral pediatrician and will speak on the topic of children in Texas and their health and well-being. Dr. Adams has researched and is published widely on issues related to children with special needs. Food insecurities can play an important role in childhood health and behavior issues.

• Cara Mendelsohn – Chairman of Collin County Homeless Coalition. The results of the most recent homeless point in time count and what it means for our community will be addressed along with upcoming awareness events planned for National Homeless and Hunger Awareness Week.

• Lynne Sipiora - Executive Director of the Samaritan Inn, McKinney. Lynne will give firsthand experience with homelessness in Collin County and where they see the need.

Bill

Link: http://www.dallasnews.com/news/politics/texas-legislature/headlines/20110202-texas-businesses-serving-frail-warn-cuts-would-close-their-doors.ece

By ROBERT T. GARRETT / The Dallas Morning News - Austin Bureau
February 2, 2011

read this story at DallasNews.com (registration may be required)

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The needs of thousands of children and adults living with mental and physical disabilities are about to collide with the limitations of the Texas state budget.

Here in the wealthiest county in the state, where some folks would prefer to ignore the unpleasantness of mental or physical challenges, it will be interesting to see how this issue is prioritized by our legislators (including Senator Florence Shapiro who sits on the Finance Committee referenced below)and dealt with on the local level by our county leaders.

angellsmith

Link: http://www.dallasnews.com/sharedcontent/dws/news/city/collin/plano/stories/DN-plgrants_20met.ART0.State.Edition1.4364ddb.html

December 20, 2010
By THEODORE KIM / The Dallas Morning News

read this story at DallasNews.com

Link: http://www.dallasnews.com/sharedcontent/dws/news/city/collin/stories/DN-housecol_19met.ART.East.Edition1.4375173.html

December 19, 2010
by ED HOUSEWRIGHT/The Dallas Morning News

read the article at DallasNews.com

From a Collin County press release. Flu vaccination includes protection from both H1N1, and influenza A and B:

Collin County

HEALTH CARE ADVISORY: Nov. 30, 2010

Free flu vaccine for children available; adult doses for $10

(McKINNEY, Texas) - Collin County Health Care will be offering free flu vaccinations for children and discounted flu shots for adults during National Influenza Week, Dec. 5-11.

Flu shots will be administered at 825 N. McDonald Street, Suite 130, in McKinney, from 7:30 11 a.m. and 1 to 4 p.m. all week. Adult doses are $10 each, and cash or check is accepted.

The 2010–2011 flu vaccine will protect against an influenza A H3N2 virus, an influenza B virus and the 2009 H1N1 virus (swine flu) that caused so much illness last season.

If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)

National Influenza Vaccination Week was established to highlight the importance of continuing influenza vaccination, as well as fostering greater use of flu vaccine after the holiday season into January and beyond. The flu is a serious contagious disease that can lead to hospitalization and even death.

Flu-like symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu, and have respiratory symptoms without a fever.

People at high risk of serious flu complications include young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older. Vaccination of high risk persons is especially important to decrease their risk of severe flu illness.

Vaccination also is important for health care workers, and other people who live with or care for high risk people to keep from spreading flu to high risk people.

Children younger than 6 months are at high risk of serious flu illness, but are too young to be vaccinated. People who care for them should be vaccinated instead. For more information regarding the flu please visit http://www.cdc.gov/flu/NIVW/index.htm.

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Nonprofit clinic to treat the poor opens today in West Plano

October 6, 2010
By ED HOUSEWRIGHT / The Dallas Morning News

link to this article at The Dallas Morning News....

Collin County commissioners' vote not to include vision, dental care services in '11 grants

September 25, 2010
ED HOUSEWRIGHT / The Dallas Morning News

A

link to this article at The Dallas Morning News....

Intellectual and Developmental Disabilities - Panel Discussion

Tuesday, August 3rd – 7pm
Collin College McKinney Conference Center
2200 W. University Drive McKinney TX 75070

On Tuesday night, August 3rd at 7 pm, The Healthcare Committee of Collin County will host a Panel Discussion on Intellectual and Developmental Disabilities. This Educational Forum will provide some of the latest information and services for those needing support with Autism Spectrum Disorders (including Asperger’s Syndrome), intellectual disabilities and related conditions.

The panel includes:

• Gary Moore - President and Co-founder, nonPareil Institute
• Clay Boatright - President, ARC of Dallas and Vice President, ARC of Texas
• Nagla Moussa - President, Collin County Chapter of the National Autism Association (formerly Autism Society of Collin County)
• Charmaine Solomon - Chairman of the Board and Co-founder, My Possibilities
• Randy Routon - President, LifePath? Systems, MR Authority in Collin County

The Healthcare Committee of Collin County (HCCC) is a nonpartisan grassroots organization focused on ensuring access to quality healthcare for all residents in Collin County. Anyone with concerns about healthcare in this community is welcome to join and learn more about what services are available in Collin County and where we need to advocate for more.

This is the, I believe 4th in a series of panel discussions on the healthcare needs of Collin County residents. Previous discussions have focused on mental healthcare, mental illness in Collin County jails, and the role/future of the non-profit indigent clinics in the county. These discussions have all been very informative and have been well attended.

All meetings and presentations of the HCCC are free and open to the public.

Bill

Full disclosure: I am a member of the Leadership Team of the HCCC.

As aging baby boomers head to suburbs, Collin County to feel impact

Saturday, July 24, 2010
By JESSICA MEYERS / The Dallas Morning News

Tim Montgomery built his own retirement home.

In a land of McMansions, he limited his Celina house to one story. He widened bathroom doors to fit wheelchairs. He planned a spare bedroom for elderly parents. He designed his kitchen table to hold at least eight hungry grandchildren.

An Air Force vet turned teacher, the 54-year-old settled in Frisco a decade ago among other young working parents and their school-age children. Now these empty nesters and retired homeowners are uprooting the suburban stereotype.

Affordable living, jobs and a Sun Belt climate have made Texas one of the most attractive states for baby boomers. As America's "first suburban generation" ages, cities are scrambling to accommodate them.

Collin County will feel one of the greatest effects in the region, with its senior population more than doubling in the next decade. But the county – known for its youth rather than its elderly – already struggles with transportation, health care and affordable housing for its seniors. Cities that fail to reshuffle priorities, experts say, face strapped social services, budget pitfalls, disgruntled residents and tarnished images.

"For the most part, communities are not planning as well as they should be," said Doni Van Ryswyk, aging program manager at the North Central Texas Council of Governments' Area Agency on Aging. "There's a whole host of challenges in terms of infrastructure, livable communities and adequate transportation providers for people who are no longer able to drive.

"Even though Collin and Denton counties are relatively wealthy, there are portions that are already designated health professional shortages. That's only going to get worse as the population ages."

Unlike their Florida-bound parents, this generation doesn't want to move. Many deal with their own graying relatives and plan to work for years to come. Demographers have coined a term for this behavior: aging in place.

"[Leaving] would take me away from sons and grandsons," said 63-year-old Susie Reukema, a social worker who moved to Plano from Wisconsin three decades ago. "And at this point in life, family is a very big plus in the community."

Texas a hot spot

Such communities developed in Texas faster than anywhere else this decade. The Austin suburbs saw the highest growth rate in people 45 and older from 2000 to 2008, according to a recent Brookings report on the state of metropolitan America. The suburbs of three other Texas cities made the top 10, including Dallas'.

"Texas is a peek at the future of the suburbs," said William Frey, who wrote the report's section on aging. Most senior growth in the coming years will take place in bedroom communities, he said. Young minority and immigrant families may help offset the state's graying suburbs, but that won't happen for years to come.

Baby boomers, Frey said, "are people who are going to need social services at various times, and if it doesn't happen it will spill over to the image of the suburbs and quality of life."

He said, "One thing about the baby boomers and elderly is that they vote in large numbers and make their views known very loudly."

The number of Collin County residents 60 and older will increase by 118 percent between 2011 and 2020, estimates the Texas Health and Human Services Commission. Dallas County's will move up 25 percent.

Plano already sees this shift in wait lists for subsidized senior housing and complaints about limited Medicaid providers. With a visibly aging population, it has taken the most focused approach to the impending growth. Officials charted a plan three years ago to provide taxi vouchers for senior citizens and match them with requested services.

"We were looking at it in the context of Plano in a period of transition," said Kate Perry, the city's senior planner. "It used to be the city had only families and young children. That changed and continues to change, and a major component is seniors."

Much of the region has yet to catch up, said Lee Stark, transportation services director at the Geriatric Wellness Center of Collin County. "Folks at the county level are really more concerned with addressing the needs of a growing county," he said.

Developing communities like Frisco and Allen have made some provisions for seniors, Stark said, but affordable housing and convenient transportation remain less of a priority.

John Lettelleir, Frisco's director of development services, said the city has anticipated its aging boomers. Frisco's senior center is in walking distance of the downtown square, near residences and restaurants.

"It wasn't big until two years ago, and then people started to panic," he said about the aging boomers. "Now it's happening and we have to do something about it."

Lettelleir said city officials want to update zoning ordinances to allow for flexibility in housing developments. This way, he said, empty nesters can relocate to apartments down the block or grandparents can settle in duplexes up the street.

But wary developers make such transitions challenging, he said. "They say, 'Change is good. You first.' "

Revamping services

Most cities realize they must address this shift, said Karen Walz, project manager for Vision North Texas, a public-private partnership that plans for the region's future. They're talking about mixed-use developments or revitalizing areas so they're in walking distance of amenities. They're considering transit options and weighing housing costs.

"Right now there isn't a regionwide plan to say 'how are we going to deal with that,' but a recognition that cities need to be thinking differently," she said.

They need to do it quickly.

read the rest of this article at The Dallas Morning News....

Sheriff Terry Box has asked the commissioners court to ratify a grant application for Bureau of Justice Assistance grant valued at up to $50,000.

The grant funds would be used by the Sheriff's Department, in collaboration with LifePath Systems, to design a "strategic collaberative plan to initiate systemic change for the identification and treatment of system-involved individuals with mental illness or co-occurring mental health or substance abuse problems."

According to Box, the end result of the planning process would be a "comprehensive jail diversion program that would include all facets of the criminal justice system and local mental healthcare providers".

The county would be expected to contribute $12,500 in matching funds.

The planning process is scheduled to be complete in September of 2011, and will allow the county to apply for and participate in another $450,000 of grant funds for implementation of a diversion system.

The costs of incarceration for mentally ill individuals is enormous. At any given time, a large percentage of the inmates in the county jail are receiving mental health medication or need to be. In fact, the Collin County jail is the largest provider of mental health service in the county.

LifePath Systems, the co-collaborator in the grant is a community-based, non-profit organization created specifically to help individuals and their families dealing with mental illnesses, intellectual disabilities and developmental delays. LifePath with funding from the NorthStar program provides much of the mental illness services to the county jail.

The Dallas Morning News published a story this weekend on Dallas' mental health diversion program. It's an interesting read.

The county is already funding a seperate study by the University of North Texas on the delivery of indigent mental healthcare services in Collin County.

Bill

On Monday night, the Collin County Commissioners Court is scheduled to discuss and pass a "Resolution In Support of the Texas Attorney General and Texas Legislature in opposition to the Federal Healthcare Reform Bill."

Seeing the resolution as political posturing, David Smith, the Democratic candidate for County Judge questions, "Why is the Collin County Commissioners Court spending their time on a national issue? Why not focus on the county business [they] were elected to handle?"

In a "Talking Points" email sent to supporters, Smith, argues that the Healthcare Reform Act is in the best interest of the county since it will shift the burden of indigent healthcare from the county to federally funded Medicaid. He writes that, "The national bill recently signed into law will raise the Medicaid eligibility threshold to 133% of FPL If we can get them enrolled in Medicaid quickly enough, EVERYBODY in the county indigent health care program can have their care paid by Medicaid rather than the county."

In his email, Smith makes these points:
"- The current threshold for Medicaid eligibility is 26% of federal poverty level (FPL) income.
- The current threshold for Collin County indigent health care eligibility is 100% of FPL income.
- Collin County currently picks up health care costs for people in the 26-100% range
(as well as below 26% pending Medicaid enrollment - but that's another story.)
- The national bill recently signed into law will raise the Medicaid eligibility threshold to 133% of FPL."

The commissioners resolution reads:

Resolution In Support of the Texas Attorney General and Texas Legislature in opposition to the Federal Healthcare Reform Bill (HR 3590)

Whereas the Federal Healthcare Reform Bill would place the federal government at the center of our nation’s healthcare system at the expense of individual choice and liberty, free enterprise and competition; and

Whereas, the Collin County Collin County Commissioners Court steadfastly stands and defends the freedoms enjoyed by states and individual citizens guaranteed by the United States and Texas Constitutions; and

Whereas, the Commissioners Court believes Texas residents have the right to choose their own health insurance plan freely without imposition or threat of penalties from federal or state government; and

Whereas, the Commissioners Court asserts the healthcare reform legislation is wrong for Texas because it would result in healthcare rationing, higher taxes, massive increases in federal and state spending and increased healthcare bureaucracy; and

Whereas, the Commissioners Court challenges Congress’ right to impose health insurance mandates which overrule fundamental freedoms of individuals, businesses and states; and

Whereas, the Commissioners Court specifically protests the unprecedented breach of state sovereignty in the form of unfunded Medicaid standards, which are projected to cost Texas taxpayers $24.3 billion over the next ten years;

Now, therefore, be it resolved that the Collin County Commissioners Court unanimously and unequivocally supports Texas Attorney General Greg Abbott’s efforts, and the efforts of the Texas Legislature, to resist this federal healthcare bill on constitutional grounds. In witness thereof, we hereunto set our hands this fifth day of April, in the year of our Lord two thousand ten.

Collin County spends millions each year on indigent health care, which is funded with moneys held in the county's Healthcare Trust Fund. The Trust Fund, was originally funded in 1983, with the proceeds from the sale of the county's public hospital. Current projections are that the Trust Fund will run out of money in 2014. At that time, without federal help, all indigent care will have to be paid for with county tax dollars.

Smith, who does not take a position in support of the Healthcare Reform Act, charges that, "The Collin County Commissioners Court would rather play national partisan politics than tend to county business. Any commissioner support of AG Abbott's initiative is a blatant example of ideological impairment, preventing them from realizing that Abbott is actually seeking to cement in millions of dollars of future county costs that will otherwise go away."

The commissioners court will meet at 6:00 PM this Monday evening at the Prosper Municipal Chambers, Prosper City Hall, 121 W. Broadway, Prosper, Tx. The public is invited attend and to comment.

Bill

======================

The Observer comments:

It seems to me to be both ironic and a bit unseemly for bureaucrats, who are recipients of a lush taxpayer supported health insurance plan to be fighting so hard to deny a much less generous policy to those who can not afford health insurance.

For $10/month, commissioners are granted a plan with only a $500 annual deductible. A majority of the sitting commissioners have received taxpayer supported health benefits for most of their adult lives.

Yet, over 20% of Collin County residents are uninsured. Many work for employers who in the past would have offered group coverage, but most low wage jobs no longer offer insurance, or when it is offered, it is too expensive and comes with huge deductibles.

I read an interesting article this week on the opposition to the federal plan. A local civic leader (and McKinney City Councilman) was complaining about the new law. This so called 'leader' went on to state that he employed over 125 people in the 8 companies he owned, but only offered insurance benefits to a "few key employees".

The rest of his employees are a missed paycheck or two from needing public assistance if they need any medical help. I imagine that one of them could afford healthcare in the event of catastrophic illness.

Those who are loudly opposing the Healthcare Reform Act have insurance. Some are paid for by you, the taxpayers.

The commissioners resolution is mere pandering. They have insurance. The less privileged can "eat cake", while their taxes pay for the commissioners' healthcare.

Bill

Collin County at bottom of federal funds distribution

Wednesday, March 10, 2010
By JESSICA MEYERS / The Dallas Morning News

Collin County, known for its corporate headquarters and explosive growth, has a new distinction: The county reportedly receives the smallest amount of federal funds per person among the country's 200 largest counties.

A Brookings Institution report released this week looked at 2008 federal spending tied to the census in an effort to understand how the upcoming count will affect the distribution of more than $400 billion from federal programs. The bulk of federal assistance goes to states through grants for low-income households and highway infrastructure. States' per-capita funding is tied to income inequalities of high pay and high poverty, Medicaid income limits and the percentage of rural population.

Collin County didn't receive much federal money largely because it doesn't have an income disparity that pulls those funds, said Andrew Reamer, who authored the report. The county got $182 per person in 2008. Suffolk County, Mass., which includes Boston, received the most funding per person at $6,032.

"In wealthier counties, people don't use Medicaid, so they aren't likely to benefit," Reamer said.

Medicaid alone makes up almost 60 percent of federal assistance spending. The low-income health program accounts for most of Collin County's funding, as well. But these services are less utilized than in Texas counties of similar size, said Stephanie Goodman, a spokeswoman for the state's health and human services commission.

Collin County, which has a 6 percent poverty rate, has 31,064 people enrolled in Medicaid. El Paso County, with roughly the same population, has 133,079 in the program. Hidalgo County has 195,559.

That doesn't mean residents can slough off the upcoming census, Reamer said. "If Collin County is undercounted, it may not get its fair share from the state of Texas," he said, pointing to both fiscal and political ramifications. Businesses uses census data to identify markets, and an inaccurate count could lead to mistakes in investment, he said. The data will also be used to draw new legislative boundaries.

The 2010 census may also reveal just how short-lived the county's current distinction is, said Terry Clower, director of economic development and research at the University of North Texas. The county is becoming "more income diverse," he said.

Link to article and more at The Dallas Morning News....

HCCC Healthcare Candidate Forum
February 16, 2010
7:00 - 9:00 pm
Collin College Spring Creek Campus, Rm. C104

The Healthcare Committee of Collin County (HCCC) will hold its Healthcare Candidate Forum for the Collin County Commissioners Court at the Spring Creek Campus of Collin College Convention Center Room C104. The Candidate Forum will start at 7:00pm.

We encourage all members and friends to attend and get to know the perspective on Healthcare/Mental Healthcare issues of those that may be in leadership for the next four years. The County Commissioners are responsible for Indigent Healthcare and Mental Healthcare in Collin County.

The public is invited. Please invite your friends and associates. Questions will be healthcare related.

Invited Candidates:

Candidates for Collin County Judge
Keith Self (I) Republican
John Muns Republican
David M. Smith Democrat

Candidates for Collin County Commissioner, Precinct 2
Jerry Hoagland (I) Republican
Karl Voigtsberger Republican
Rick Koster Democrat
Cheryl Williams Republican

Candidates for Collin County Commissioner, Precinct 4
Kathy Ward (I) Republican
Duncan Webb Republican

About the Healthcare Committee of Collin County
Healthcare Committee of Collin County (HCCC) is a voluntary, non-profit, unincorporated committee of residents and healthcare service providers of Collin County, Texas and others, and is not affiliated with any political party.

The Committee is an independent, autonomous organization, and is not a branch or subsidiary of any national or other political action committee. It is focused on ensuring adequate, quality healthcare for all residents in Collin County.
www.collinhealthcare.org • E-mail: collinhealthcare@earthlink.net

Disclaimer: I am proud to serve on the Leadership Team of the HCCC.
Bill

Free H1N1 shots are being offered at Plano clinic

The Collin County Adult Clinic in Plano is offering free H1N1 shots to anyone 6 months or older. There are no residency or income restrictions.

The vaccinations are being offered in cooperation with the Collin County Health Department through at least the end of February.

Collin County Adult Clinic is at 2520 Ave. K, at the northeast corner of Avenue K and Park Boulevard.

Vaccination times are:
• Monday and Wednesday, 4 to 7:30 p.m.
• Saturday, 9 a.m. to 4:30 p.m.
• Feb. 1, 3, 8, 10, 15 and 17, 4 to 7:30 p.m.
• Feb. 6, 13 and 20, 9 a.m. to 4:30 p.m.

You might be surprised to learn that the Collin County Jail is the largest provider of mental health services in Collin County.

The cost to our taxpayers and our society is enormous - and growing. What is the cost to our communities? What can be done to reduce recidivism, prevent offenses and keep our neighborhoods safe? What resources are available to see that treatment is available when appropriate?

The HealthCare Committee of Collin County (HCCC) is sponsoring a panel discussion on issues of mental illness in Collin County Jails.

Panelists for the discussion will be:

• Hon. Jerry Madden – District 67 TX House of Representatives; Vice Chair, House Committee on Corrections
• Hon. Chris Oldner – Judge, 416th District Court; Administrative Judge, Collin County District Courts
• Assistant Chief Deputy Randy Clark – Collin County Sheriff’s Office
• Dr. Xiaoyan Wu – Contracted Psychiatrist, Collin County Jail
• Janie Metzinger – Mental Health America (serving an 11 county area including Collin County)
• Jane O'Brian – Collin County Adult Probation
• Lynda Wynn Drain - local defense attorney, Master-Substitute Judge for Mental Commitment Hearings since 2008

The meeting will be held Tuesday, January 5, 2010 from 7:00-9:00 p.m. at the Spring Creek Campus of Collin College, 2800 E. Spring Creek Parkway, Plano, TX 75074 in Room C103. There is no cost, and the public is invited to attend and ask questions.

This will be the fourth major panel discussion hosted by the HCCC. Previous expert panels discussed the role and financing of non-profit clinics, the need and government resources for mental health care, and the county indigent health care program. These well attended panel discussions have featured expert panelists from state and local government, elected officials and private and non-profit care givers.

The Healthcare Committee of Collin County is a nonpartisan grassroots organization focused on ensuring adequate healthcare for all residents of Collin County. The purpose of the Committee is to encourage members and others to be educated on all aspects of healthcare as it pertains to Collin County residents. All are welcome.

More information can be found on their web site, www.collinhealthcare.org

Bill

In the interest of full disclosure: I serve on the Leadership Team of the HCCC.

I hear it's tough to be in commercial real estate right now.

Tenants are seeking rent concessions from landlords. In fact two tenants of property owned by the county's Health Care Trust Fund have already sought and been granted rent reductions. Of the 4 lease agreements signed for Health Care Trust Fund tenants this year, 3 got reduced rent, and one stayed the same:

* In January, the Trustees (the county commissioners are also the Trustees of the Health Care Trust Fund) approved free rent of Trust Fund property for the county's own Bio-Terrorism team.
* In July, a one year lease renewal was signed with Mary Safi Associates. The lease payments remained the same.
* In August, Estimates, Unlimited negotiated a one year 30% reduction in rent from $1,029 to $735 per month.
* In September, CADET Center negotiated a 4 year rent reduction - from $781 to $734.

Collin County is very willing to renegotiate rents for tenants, especially when the money is due to the Trust Fund. However, they don't seem to be as good negotiators when tax dollars are at stake.

On Monday the court is scheduled to approve another lease renewal. This time the county is the tenant. The 3 year lease for the Constables' office in Frisco with Avventure Properties will renew at $13,005 per month.

That is the same as the county paid last year. The request to the commissioners notes that there is "no price increase". There is no decrease either.

Bill

UPDATE:
Nov. 16, 2009

At today's Commissioners Court, Matt Shaheen asked that a comparative rent survey be presented to the court before final action was taken on the lease renewal. The court agreed and the lease approval was put on hold pending the survey.

Bill

Collin County's Department of Homeland Security is responsible for running court house security, The Fire Marshall's office, the North Central Texas Fusion Center, and terrorism and disaster response.

On its web page, the Homeland Security Department lists another core function, "Developing and managing state and federal grant funding for emergency management, homeland security and bioterrorism programs."

It is in gaining and spending grant money, or as I'll call it OPM (Other People's Money) that the Homeland Security folks are masters.

According to a presentation given to the commissioners court earlier this year the DHS has managed to garner over $13 million in grant funds (OPM) since 2003.

UASI (Urban Area Security Initiative), SHSG (State Homeland Security Grant), and LETPP (Law Enforcement Terrorism Prevention) grants were used for construction of the Fusion Center, law enforcement radios, phones and communication systems, and disaster preparedness programs.

The PHEP (Public Health Emergency Preparedness)is a grant from the Centers for Disease Control for Bio Terrorism and epidemiology. In 2006,2007 and 2008, the PHEP grant included a total of about $1 million for pandemic flu planning.

The PHER (Public Health Emergency Response) grant is a state grant for pandemic H1N1 flu response. This year, Collin County has already received a PHER grant of $707,309 to be used to plan for mass H1N1 immunizations. The commissioners court is expected to approve another PHER grant request for an additional $1,166,545 to be used to distribute the flu vaccine to targeted populations.

Collin County has applied for 15,500 H1N1 flu vaccine doses, 2,500 will be for critical response and infrastructure such as police and emergency workers. The balance is planned for distribution to uninsured, high risk citizens. To date, the county has only recieved 500 doses of the H1N1 flu vaccine. It is likely that the county will only receive about 6,000 doses before the end of the flu season.

Homeland Security had already been awarded over $1 million from 2006-2008 to plan for a flu pandemic. In addition, it received another $700 thousand dollars this year, and it says it need yet another $1.16 million in order to distribute the vaccine.

Since the federal and state government bear the cost of the vaccine itself, the county will spend no money to actually acquire the H1N1 flu vaccine. It will however spend almost $3 million in overhead costs to plan and execute the distribution of the flu shots.

That $3 million is all grant money or OPM.

If the county were to receive ALL the doses it has asked for, the OPM overhead cost of planning is over $190 per dose for distribution. If, as is the more likely scenario, it only gets 6,000 doses, the cost in OPM per dose will be $500.

So how complicated is the distribution?

Well, so far the county plans to send some doses to area hospitals for their staff, but most of the available vaccine would be allocated to the county's own health clinic and to other area clinics. The county has already made an agreement with the Collin County Adult Clinic to distribute up to 2,600 doses at a cost of $19.20 each. The county plans similar agreements with other local clinics.

Most of us in Collin county will get the vaccination from our personal physician. Your doctor will also get the dose for free from the federal government, and he will only be able to charge the insurance company somewhat less than $50. My doctor will offer the shot for a flat $20 fee. Collin County will be responsible for vaccinating critical staff as well as the indigent and uninsured.

Its only the flagrant use of OPM that permits this normally frugal county government to spend $500 on something that will cost it less than $20.

Collin County prides itself on its efficient use of taxpayers dollars. It has no similar attitude when it comes to spending OPM... even if that OPM is taxpayer's dollars.

The county's Homeland Security Department is expert at finding and spending huge sums of OPM grant funds, often with little result.

Bill

DMN - Mental services under huge strain in North Texas

Tuesday, September 15, 2009
By KIM HORNER / The Dallas Morning News

The number of North Texans seeking taxpayer-funded mental health care has increased dramatically as people have lost their jobs and health insurance, but the company that runs the program for the state is planning to cut its budget.

The demand has climbed by about 4,000 people, or 17 percent, since July 2008 – and 30 percent since January 2008 – in the seven-county metropolitan area, according to ValueOptions of Texas Inc., a for-profit company that runs the region's mental health program.

ValueOptions plans to cut $10 million from the $146 million-a-year program after being denied additional funds from the state. Officials say the program, which serves the area's homeless and poorer residents, was already stretched thin before the increase of people seeking help.

Area mental health providers, who receive money from ValueOptions, said the cuts will force them to lay off employees and reduce services to some of the most ill people in the community.

"We'll be saying, 'No more room at the inn,' " said Liam Mulvaney, president and chief executive of LifeNet Community Behavioral Healthcare, a mental health provider. He and others voiced their concerns last week to the North Texas Behavioral Health Authority [NTBHA], a board that oversees the region's mental health system, called NorthStar.

Mulvaney said LifeNet spends about $300 a month per patient, but that will be cut to $140 per person soon under the new rate structure.

Higher costs in end?

Janie Metzinger, public policy director of Mental Health America in Dallas, said her agency is concerned that the lack of treatment will cause more people to get sicker and that they will end up in emergency psychiatric care or jail – which would cost taxpayers more money.

"It also occurs to me that we would not be having this discussion if the disease was cancer, heart failure or H1N1 [swine flu]," Metzinger said.

Dallas Police Senior Cpl. Herbert Cotner, who has trained hundreds of officers on how to deal with people with mental illnesses, said mental health care should be a higher priority, much like public safety.

"Police are always funded. It's time to start fighting so that mental health is always funded," he said.

ValueOptions says that mental health referrals from police, who are working to better target those in need, have fueled some of the increase in patients.

Jack Szczepanowski, chief executive of ValueOptions, said the changes will be less onerous than other alternatives.

"That's what we felt was the only viable solution at this time," he told the board at last week's meeting. "We have reached a critical mass."

Officials said they are seeking up to $7 million in relief from federal stimulus funds, but no decisions will be made for months.

Little input

The state's Department of State Health Services, which administers a contract with ValueOptions, agreed to the changes. But several members of the North Texas Behavioral Health Authority expressed frustration at having little input and no power to change the budget-cutting plans.

read more....

========================

Bill comments:

On Monday, the Collin County Commissioners Court approved a contract with The University of North Texas. UNT will undertake a study that will look at the delivery of mental health services in the county.

A few weeks ago I was at a seminar on mental health. Participants included the State of Texas, the NTBHA, ValueOptions, and some mental health care treatment providers, like LifePath Systems (Collin county's largest provider). What I learned was frightening. According to statistics kept by the providers, 75% of the people who come to ValueOptions seeking help are denied coverage. Three out of four people with mental health issues who can not afford treatment are turned aw

The cost in human misery is enormous - and some who are denied service end up in our jails and emergency rooms, costing taxpayers many times the cost of effective treatment. Some like Dena Schlosser (who did go to a Collin County treatment provider and ask for help, but was denied) go on to commit desperate, sick acts and become wards of the court or serve long prison sentances.

Texas ranks 49th of the 50 states in per capita public spending on mental health. Collin County ranks near the bottom of the 254 counties in Texas in per capita mental health spending. We are very near the bottom of the bottom in the nation in helping those who can not afford mental illness treatment.

There simply isn't enough money given to NorthStar to adequately address the needs.

Collin County is part of the 7 county NorthStar region. NorthStar operates like a private insurance HMO, with ValueOptions being the insurance company.

Except that in NorthStar, there is no competition among insurers - ValueOptions, which is guaranteed 12% of all the money it spends has no competition, It has an exclusive contract. It has become a privately held, for profit monopoly.

Last week, one of our Collin County representatives to NorthStar's board of directors (the North Texas Behavioral Health Authority) asked ValueOptions how much it was going to trim its budget to meet the shortfall described in the Dallas Morning News article above. After all, local providers would be receiving a 30% - 60% cut, probably 220 health care workers will be laid off, and client services will be cut... it seemed reasonable to ask, "Where are you cutting staff?".

ValueOption's reply? "That is proprietary information."

As I noted, there simply isn't enough money given to NorthStar to adequately address the needs, but it certainly doesn't help when ValueOptions takes its cut off of the top.

You see, the way the contracts are written, the less ValueOptions spends on the needy, the more profitable it is. ValueOptions gets to keep up to 12% of all funds given to it by the State and Federal governments. If it doesn't spend the money of patient care, it gets to keep it - up to the 12% limit. Over the last 21 months, ValueOptions share was over $28 million.

Last week's NTBHA board meeting with providers has caused a huge concern and subsequent furor among providers and those who care about the delivery of mental illness services to the poor.

NTBHA scheduled a meeting for this Thursday to discuss, "contract negotiations", in an effort to try to control and contain any dissension. No providers were invited, and the meeting was only posted on an obscure web page on the Texas Secretary of State's web site.

After word of the meeting got out, it was canceled, then rescheduled for this Friday. I called the Executive Director of the NTBHA to ask if there was a meeting, and if it was closed or (as the Texas Open Meetings Act requires) open to the public.

It was explained to me that, "of course the meeting was open", and it was posted on the NTBHA web site, but that the meeting was a (can you believe this?) simple "work session" designed to educate the board members on the vocabulary words that would be used in contract negotiations. That's right, it's billed as a vocabulary lesson for board members.

Two hours after my call, an agenda for a "work session" was posted on the NTBHA web site.

The meeting will be held this Friday, September 18, 2009 @ 10:00 AM at the NTBHA offices at 1201 Richardson Dr., Suite 210 in Richardson, Texas.

Providers and the public are welcome to attend. It could be very interesting.

Bill

Thursday, the Collin County Health Care Advisory Board met to consider their recommendations for the "fee for service" (formerly "grant") health care agreements for fiscal 2010.

The board had received 8 applications. They approved all at at requested funding levels.

The recipients are:

• Allen Community Outreach, $17,400 for vision and prescription services.
• Assistance Center of Collin County, $10,590 for prescription drugs.
• Children's Medical Center, $24,900 for 415 sick child visits.
• Collin County Adult Clinic, $49,980 for 1,428 clinic visits.
• Community Lifeline of McKinney, $4,500 for prescriptions and medical supplies.
• Frisco Family Services, $4,500 for prescriptions.
• Geriatric Wellness Center, $16,600 for 750 clinic visits and 25 homebound visits.
• Samaritan Inn, $20,100 for clinic visits and referrals.

The board also voted to keep $53,000 in reserve for additional applications from non-profit agencies.

Fiscal 2010 will be the first time the county has funded programs with the Samaritan Inn and with Children's Medical Center. Both agencies have applied for funding in past years, but their requests were not approved. The Samaritan Inn is Collin County's only homeless shelter. They plan to use the funding for co-pay, referrals and prescriptions for their clients to use at community clinics.

Children's Medical Center is a large non-profit hospital in Dallas. It has opened clinics in Collin County, and the county funds will be used to provide visits to poor, uninsured children in Collin County.

While the county's total outlay will not go up, most of the non-profit agencies that are recommended for funding will see a substantial increase from their 2009 funding since fewer agencies applied and were approved.

Noticeably absent from the list of applications are the Collin County Committee on Aging, which received $45,000 last year for its Meals on Wheels program. According to the Health Department's Michelle Patrick, the Committee on Aging missed the application deadline due to confusion caused by a turnover in personnel.

Also missing from the list of applications was the Plano Children's Medical Clinic. The Children's Clinic was the first non-profit to receive county grant funds in 2005. Last year it was granted $21,000 down dramatically from the $50,000 awarded to it in prior 2 years. This year, the clinic chose not to apply for an agreement, citing the burdensome restrictions and paperwork imposed on it by the county. In 2008, two other charitable clinics declined the county grant money, citing privacy concerns with the newly required paperwork.

The Bridge Breast Network, which received $37,500 last year also did not file an application. The reason for the omission was not clear.

The Commissioners Court will consider the board's recommendations when it makes the final awards later this month. The county had budgeted $200,000 for the program, and the advisory board is asking that the $53,000 not awarded be held in reserve and that the application process be re-opened so that the missing agencies would have another opportunity to file their request. The board was particularly concerned that the Meals on Wheels program not miss out on funding for 2010.

The Health Care Advisory Board is a volunteer, citizen advisory board; members serve without pay. Each County Commissioner and the County Judge appoint 2 citizens to serve a term on the board. The board can only make recommendations. The Commissioners Court will make the final decisions.

All awarded funding is dependent on county approval on each client or patient served. Funding is only allowed for clients who are county residents, US citizens, with incomes below 100% of the Federal Poverty Level.

Bill

From Congressman Johnson's web page:

On Monday, August 31st at 7:00 p.m., U.S. Congressmen Joe Barton (6th Dist.-Texas), Jeb Hensarling (5th Dist.-Texas), Sam Johnson (3rd Dist.-Texas), and Pete Sessions (32nd Dist.-Texas) will host a congressional field hearing on healthcare solutions at the Eisemann Center in Richardson. The free event will be open to the public and the media. There will be parking but people are encouraged to take DART.

Congressional hearing panelists include:

1. Eddie McBride?, President, Lubbock Chamber of Commerce; the Lubbock Chamber of Commerce works to make health care coverage more affordable for employers and their employees through both advocacy and the award-winning Lubbock Chamber Employer Health Plan;

2. Christopher Crow, MD, Village Health Partners, Plano, TX; Village Health Partners is a nationally recognized family medical practice located in Plano, serving patients throughout Dallas and Collin County;

3. Joel Allison, President and CEO, Baylor Health Care System; For the 17th consecutive year, U.S News has listed Baylor University Medical Center at Dallas (Baylor Dallas) in its America’s Best Hospitals issue. Baylor Dallas is the only North Texas hospital to achieve this distinction; and

4. Tarrant County Judge Glen Whitley, First Vice President of the National Association of Counties, to discuss local prescription drug card plans.

John Goodman, President and CEO of the National Center for Policy Analysis, of Dallas, will serve as the moderator of the event. Barbara Herteg of Richardson will perform the National Anthem. Richardson's Boy Scout Troop 1001 with Trinity Baptist Church will present the colors.

The Eisemann Center’s location, just south of the intersection of Central Expressway (US 75) and the President George Bush Turnpike (Hwy. 190), is easily accessible by car. Just a few hundred feet from the Eisemann Center’s front doors is the DART Rail’s Galatyn Park Station on the Red Line.

For the safety of all attendees, the Center prohibits large signs, posters or banners and any placard affixed to sticks or other sharp objects from being brought into the Center. In the event the Hill Performance Hall reaches capacity, attendees will be directed and seated in over-flow rooms where they may watch the event via a live video feed.

Monday, August 31st
7:00 p.m.
Doors open at 5:00 p.m.

Congressional field hearing on healthcare solutions:
U.S. Congressman Joe Barton (6th Dist.-Texas)
U.S. Congressman Jeb Hensarling (5th Dist.-Texas)
U.S. Congressman Sam Johnson (3rd Dist.-Texas)
U.S. Congressman Pete Sessions (32nd Dist.-Texas)

Charles W. Eisemann Center for Performing Arts and Corporate Presentations
Hill Performance Hall
2351 Performance Drive
Richardson

Plano children's clinic refuses county funds because of reporting requirements

Sunday, August 16, 2009
By ED HOUSEWRIGHT / The Dallas Morning News

The Plano Children's Medical Clinic has survived on donations since its founding 18 years ago.

The nonprofit center is now seeing a record number of poor families with no health insurance.

But when the clinic needs money the most, it's refusing Collin County funding for the first time. Why?

Too many reporting requirements jeopardize patient confidentiality and overburden a thin staff, said Susan Shuler, executive director.

"It's very time-consuming to assemble everything required by the county," she said. "It's not the best use of our time."

The county Commissioners Court recently added an income limit on patients at nonprofits clinics that receive county funding. In addition, clinics have to verify that patients are legal residents and submit their names, addresses, the last four digits of their Social Security numbers and medical diagnoses to the county.

Commissioners, who set the county budget, say they're being responsible stewards of taxpayer money. They want to ensure that illegal immigrants don't receive services and that all patients are truly needy.

"We're trying to balance the county's need to treat our indigent citizens with the nonprofits' desire to treat whoever they wish," said County Judge Keith Self, who heads the Commissioners Court.

But the commissioners were sharply divided on the new income requirement.

Starting next fiscal year, patients at county funded clinics can't earn more than the federal poverty guidelines. That translates to annual income of $10,830 for a single person and $22,050 for a family of four.

The Commissioners Court voted 3-2 in June to add the income measure. Commissioners Joe Jaynes and Kathy Ward, who opposed it, said clinics already were struggling to comply with the county's record-keeping requirements.

"I think we're putting so many restrictions on the money that agencies won't apply anymore," Jaynes said.

But those supporting the income ceiling – Self and Commissioners Jerry Hoagland and Matt Shaheen – said it shouldn't be an administrative burden on clinics.

"It's not onerous at all," Shaheen said.

No public hospital

Collin County, unlike neighboring Dallas County, doesn't have a publicly funded hospital. It farms out much of its indigent health care to small private clinics, which provide services at little or no cost. This year, eight agencies, including the Plano Children's Medical Clinic, shared a total of $200,000 in county funds.

The county also treats poor people at its clinic in McKinney and at PrimaCare clinics throughout the county.

County funding of nonprofit clinics has dropped from a high of $300,000 a year, in part because fewer agencies are requesting the money.

For instance, the Children and Community Health Center of McKinney dropped out of the grant program this year after receiving $105,000 since 2005. The clinic said it didn't want to turn over patient medical records, which the county says it needs to track health trends.

Allen Community Outreach received $11,400 in county funds this year. It has requested $17,400 for the fiscal year beginning Oct. 1, although it dislikes the county's restrictions, said executive director Glenda May.

"We're not in business to screen people whether they're U.S. citizens," she said.

John Ernst of the Collin County Adult Clinic spoke against the new patient income ceiling at the June Commissioners Court. He complained of "administrative drudgery" associated with the grants.

Yet the clinic in Plano is seeking $50,000 next year.

"I'd be foolish not to apply," said Ernst, the clinic's executive director. "I have to get money from as many groups as possible."

read more....

The Healthcare Committee of Collin County(HCCC) will to host an evening panel discussion on Mental Illness in Collin County on Tuesday, August 3, at 7PM at the Collin College McKinney Campus Conference Center.

This meeting is open to the public, and the public is encouraged to ask questions of the panelists.

The HCCC has assembled a panel of local experts in the delivery of mental health care services to indigent Collin County citizens.

The discussion panel will include:

• Matthew Ferrera - Special Initiatives and NorthSTAR Unit Department of State Health Services (DSHS) Austin, TX
• Sharon DeBlanc - Manager of Prevention, Education and Outreach for Value Options NorthSTAR Coppell, TX (also, current President of NAMI Collin County)
• Sherry Cusumano - Past President of NAMI Collin County (National Assoc. of Mental Illness)
• Dr. Randy Routon, PhD, Executive Director of LifePath Systems a major provider of Mental Illness services in Collin County.
• Hon. Weldon Copeland - Judge of Collin County Probate Court 1 - and judge of the mental illness court.

Most Collin County residents are unaware of the scarcity of resources available to those who suffer from mental health issues. Texas is ranked 48 of the 50 states in per capita spending for mental health services, and the NE Texas region is near the bottom of the list in Texas. Collin County receives the least amount of funding in the NE Texas region.

One result of the lack of dollars for treatment is that the Collin County jail has become the largest provider of mental health treatment services in the county.

Collin County's mental health care needs are serviced by a network of providers who are paid by an HMO-like entity named NorthStar which is controlled by a private company, Value Options.

The Collin County Commissioners Court has been pressuring NorthStar to release additional resources and funding to Collin County citizens, but with only limited success. The Commissioners Court is expected to commission a study by the University of North Texas on the present system. It is widely believed that the county wants to back out of the NorthStar system.

What would replace it is unknown.

Tuesday's symposium will allow interested citizens and consumers an opportunity to gain an understanding of the present system of mental health care services.

The discussion is second in a series hosted by the non-partisan Health Care Committee of Collin County. In June, the HCCC hosted a discussion on indigent health care that drew a crowd of over 100 people.

The Healthcare Committee of Collin County is a non-profit grassroots movement concerned about health care accessibility for the indigent and/or uninsured.

The meeting will be held on Tuesday, August 3 at 7:00 PM in the Collin College McKinney Campus Conference Center (Look for the main entrance across from the Clock Tower on Campus) - Room D106 Section B

The college is located at 2200 West University Drive, McKinney, TX 75070.

Bill

In the interests of full disclosure, I add that I serve on the board of the HCCC.

This from the Dallas Morning News' Ed Housewright writing in the McKinney Blog:

State preservationists love old courthouse

I had a story today on the Texas Historical Commission trying to save the recently abandoned Collin County Courthouse.

Many consider the 1979 building generic and boring.

The historical commissioner head, however, says the six-story cube is a "good example of a modern form of architecture known as Brutalism which is gaining notoriety and appreciation among architects and historic preservationists."

"Brutalism", eh? I think that term accurately describes a whole lot of what I observed in the 6th floor commissioners courtroom there over the last several years.

Bill

After the health care debate last night where every single county commissioner used his or her definition of 'conservative' to justify their vote either for or against restricting health care grants to nonprofit clinics who serve our poorer neighbors, I spent a few moments reflecting on what 'conservative' means to me.

I'm old enough to remember many constructions of conservative, from Eisenhower to Bush.

I listened closely as the citizens and commissioners debated what level of empathy for the uninsured was appropriate for county government. I listened to debates about using tax dollars to fund charitable organizations. To some it mattered not that the charities were cost effective.

Three commissioners believed that they were the best judge of community needs, The other two argued that the charitable clinics were the best judges of the needs of the community. All the clinics needed was assistance in carrying out what they saw as their mission to the poor, they said.

Now I believe that basic human values, such as a work ethic, respect for the individual and compassion for the least among us transcend narrow definitions of conservative and liberal.

But I'm a citizen and a taxpayer. To me a conservative government takes care of the community's needs in an economical manner. I expect my leaders to do all they can to conserve taxpayers' dollars and to spend them wisely.

As I said I'm a taxpayer - a Wylie taxpayer. Last night I saw conservative leadership, but I saw that leadership not in the front of the room where the commissioners sat, but in the far back corner.

Let me explain.

Last night's meeting lasted over 3 hours. Wylie City Hall is usually closed that late at night, but doors were open and lights were on to accommodate the 100+ citizens who attended the commissioners' court session.

As the meeting wound down, I noticed Mindy Manson, Wylie's City Manager, sitting in the back of the room. She was patiently waiting for the room to clear so she could turn out the lights and lock the doors.

The City Manager, the highest paid official in the city was waiting to close up city hall. By doing it herself, no overtime was incurred by the city, and as she told me, she didn't have to ask an employee to stay late away from his family.

That's conservative leadership.

Bill

Collin County Defines Who's Poor Enough For Care

By RANDY MCILWAIN / NBC 5 TV News
Tuesday, Jun 16, 2009

LINK TO VIDEO REPORT

How would you like a job paying $22,600 dollars a year? It's not a lot for one person, but for a family of four it's a struggle just thinking how to survive on it in this economy.

In Collin County, though, $22,600 means you're rich -- too wealthy for your family to receive taxpayer-funded health care services at any of the county's non-profit health care clinics.

Collin County's Commissioners, who double as the county's health care foundation board of trustees, voted 3-2 in favor of defining indigent patients as those at 100 percent of the federal poverty level.

Earn $22,050 dollars in that same family of four and you qualify for the tax subsidized health care services offered by the clinics -- a difference of only $550 dollars in annual income.

Trustees who supported the restrictions on funding say it's all about fiscal responsibility and watching out for taxpayers. They also restrict any tax dollars from being used to pay for the health care of undocumented or illegal immigrants.

Critics claim, before the vote, clinics were free to use the grants to treat "the most vulnerable, low income" patients at their discretion. Many of Collin County's non-profit health care clinics cater to children and elderly but lately they've seen a rise in patients due to the economy.

Several supporters of the county's non-profit clinics, including health care professionals, clergy and patients, all told trustees stories of need. In the end, cost prevailed over need as some trustees say to continue undefined funding of indigent health care would cost more money than the trust has at its disposal annually without raising taxes.

Leaders of non-profit clinics vowed to continue to push for more funding and say the trustees decision only insures that more poor and working poor people will have less access to health care.

link to article and video report on Channel 5....

Collin County commissioners approve income cap for those seeking health care from nonprofit agencies

Tuesday, June 16, 2009
By ED HOUSEWRIGHT / The Dallas Morning News

WYLIE – Collin County commissioners voted 3-2 on Monday to set income limits for people who seek health care from nonprofit agencies that receive county funds.

Individuals will not be allowed to earn more than $10,830 annually, while the cap for families of four was set at $22,050. The new policy will take effect in October with the start of the next fiscal year.

Nine nonprofit agencies now receive a total of almost $200,000 to treat the indigent. Currently, the county does not require the clinics to ask patients to state their incomes.

A standing-room-only crowd of more than 100 people packed the emotional meeting at Wylie City Hall. County Judge Keith Self and commissioners Jerry Hoagland and Matt Shaheen voted in favor of the income guidelines. Commissioners Joe Jaynes and Kathy Ward voted against the requirements.

"We're required by law to take care of poor people," Hoagland said. "I believe we're more than adequately doing it now."

However, Jaynes said commissioners were placing too many restrictions on the nonprofit agencies.

"We're tightening restrictions on a program that gives us some of the biggest bang for our buck," he said.

Shaheen said commissioners were simply making the income requirements consistent across the board.

The county also provides indigent health care at a publicly run clinic in McKinney? and PrimaCare? medical centers throughout the county. Both use the same income guidelines that were adopted for nonprofits Monday.

"I don't think this reflects a lack of compassion," Shaheen said.

More than two dozen people spoke either for or against the income guidelines.

Opponents said Collin County, one of the most affluent counties in the state, was being hard-hearted in these tough economic times by adopting the limits.

"We feel this is a moral issue for commissioners as well as a fiscal one," said the Rev. Patrick Price of Community Unitarian Universalist Church in Plano.

Supporters of the caps said commissioners should limit health-care spending and encourage charities to provide the care.

link to article on the DMN....

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.

read more....

Budget crunch forces Collin County agency to scale back Meals on Wheels for seniors

Thursday, June 11, 2009
By VALERIE WIGGLESWORTH / The Dallas Morning News

Evening and weekend deliveries of Meals on Wheels will be eliminated and transportation services for seniors will be scaled back as the Collin County Committee on Aging copes with a $1 million budget deficit.

"If people would just give up one latte a week, there'd be more than enough money to reinstate the programs,"
Terry Dougherty, Meals on Wheels volunteer

The McKinney-based nonprofit will continue delivering meals at lunchtime but restrict the service to those seniors most in need. Specific changes to the agency's bus service are still being worked out but will probably mean fewer trips until at least Oct. 1.

"It was the most difficult decision we have ever been forced to make," board chairman Mark Heidenheimer said in a written statement.

The nonprofit's president and chief executive officer, Marilyn Stidham, said the financial problems snuck up on the agency, which operates on an annual budget of $5.5 million.

"It was a perfect storm," she said, citing the increasing demand for services coupled with higher prices for food and gasoline and the slowing of donations and other funds. "The need outstripped our funding."

Stidham said she kept hoping the agency's cash flow problems would work themselves out as they have in the past. But they didn't.

"If there were any way we could provide the services, we would," she said.

Stidham said the agency is still evaluating the number of clients affected. As of Monday, 112 seniors were cut from the lunchtime deliveries. The 85 to 90 meals delivered in the evenings have been reduced to six to eight meals that are paid for through a specific state program.

And for the first time, the agency has started a waiting list for its meals program. Clients with the greatest needs will be served first. That means that a new referral with a greater need could bump someone already receiving meals to the waiting list. More than 20 people are on the list, which will be reviewed weekly.

Seniors will still be able to get meals at area senior centers, but for some, the problem will be in getting to a center. Most of the agency's clients are homebound and can't drive.

A meal costs $5.25. Any senior able to pay that full price will be able to stay with Meals on Wheels. Stidham said families and churches are stepping in to pay the cost for some. The agency's volunteers are also sending in donations.

read more....

Health Care Crisis In Collin County?

Tuesday, June 2, 2009
McKinneyNews.net / Brett Ryder

"We’re not talking about affording medical care, even the rich can’t afford medical care. We’re talking about affording medical insurance. The only people who pay retail are the indigent – because they have to."
John Ernst, Director of the Plano Adult Clinic

Representatives from a half-dozen area non-profit medical organizations convened Tuesday evening to discuss the growing need for indigent health care services in one of the state’s wealthiest counties.

Hosted by the Healthcare Committee of Collin County, a non-profit grassroots movement concerned about health care accessibility for the indigent and/or uninsured, the two-hour meeting at Plano’s Parr Library produced a unified opinion from its six person panel: Collin County indigent clinics are in desperate need.

Without exception, representatives from the clinics – most of whom operate within the confines of a severely limited budget and staff -- appealed for more cash, more in-kind donations, and more volunteers to meet increasing demand for services for those – both documented and undocumented – in need of medical assistance.

If the representatives were of one mind with regard to the dire need of fiscal assistance, they, too, were unanimous in their general lack of enthusiasm for myriad stipulations and restrictions placed on those clinics that accept county funding.

"I have a problem with the stipulations," said Cathy Reynolds, chairman of Frisco Cares Children's Clinic. "There are a lot of strings."

For fiscal year 2009, the Collin County Commissioners’ Court provided $199,954 of the more than $380,000 requested by roughly 12 clinics in the county.

County Judge, Keith Self, who heads the commission, has stated publicly that he would like to see the county grant program end.

HCCC has been meeting once a month at various Plano libraries since December. Barbara Walters, HCCC board member, said the meetings are open to anyone – county commissioners included. The Court has yet to send a representative, Walters said.

“I just feel like they don’t really believe there’s an indigent problem in Collin County, despite the growth,” said Sandy Dickey, executive director of the Children and Community Health Center of McKinney, an organization that stopped applying for county grant dollars because of what she considers over-zealous qualifying stipulations.

Even at 200-percent of the federal poverty guidelines, health care is untenable, Dickey said. “How are you going to buy health insurance on $20,000 a year?” she asked.

“We’re not talking about affording medical care,” said John Ernst, director of the Plano Adult Clinic, “even the rich can’t afford medical care. We’re talking about affording medical insurance. The only people who pay retail are the indigent – because they have to.”

Those who aren’t seen at the clinics eventually make it to area emergency rooms, a trip, the panel agreed, whose tab is ultimately passed on to the taxpayer.

read more....

The newly formed non-partisan Healthcare Committee of Collin County (HCCC) is hosting a panel discussion Tuesday night, June 2 on the capabilities and role of the non-profit, charitable clinics in offering health care to the poor and uninsured.

Members of the panel include, John Ernst, Executive Director of the Collin County Adult Clinic, Sandy Dickey, Clinic Administrator - Children & Community Health Center, Bea Vallejo, Clinic Administrator - Frisco Children's Clinic, Carolyn Rice, Executive Director - Geriatric Wellness Center of Collin County, and Jackie Hall, Executive Director - Assistance Center of Collin County.

Every year, thousands of poor, uninsured Collin County residents receive low cost health care and services from non-profit clinics and organizations manned with volunteer doctors and staff. With the rising cost of insurance and frequently the unavailability of getting family coverage, the charitable clinics have served to provide a critical safety net for our working poor.

For the last several years, Collin County has provided some grant funds to help these clinics and social service organizations. The County's grant or 'fee for service' program is currently under review for renewal. The commissioners court has scheduled public discussion of the grant process later this month.

The HCCC program will be held at Plano's Parr Library, 6200 Windhaven Parkway Tuesday (tonight) from 7 PM to 9 PM. The meeting is free and the public is invited.

The Healthcare Committee of Collin County is a nonpartisan grassroots organization focused on improving healthcare for everyone in Collin County.

Bill

Full disclosure requires that I inform my readers that I serve on the board of the HCCC.

Collin County's State House Representative Jodie Laubenberg serves on three legislative committees. Most committees meet in the morning. Texas House records show that this session, she has missed morning committee recorded quorum calls over 85% of the time, including over 60% of the meetings of the House Public Health Committee.

Most of the 8:00 AM Public Health Committee meetings were recessed after the House was called into session and met again later in the day. Rep. Laubenberg did show up for most of the afternoon sessions of the committee.

Of the 11 meetings of the Public Health Committee held since February 24 and for which minutes are posted on the Legislature's web site, Rep. Laubenberg was absent for 2 and missed the morning session on 5 more.

Because of her attendance, Ms. Laubenberg was marked "absent" for 60% of the roll call votes in the committee. Since the legislative session began, the Public Health Committee has voted to pass 70 bills to the full House. Laubenberg was marked "absent" on all but 28 of those 70 roll call votes.

Rep. Laubenberg also sits on the Natural Resources and on the Local & Consent Calendars Committees.

The Natural Resources Committee has posted minutes on 10 meetings, 6 of them began at 8:00 AM. Ms. Laubenberg missed 6 of the 10 quorum calls, including all but one of the 8:00 AM calls. However, since she did eventually make it to most of the committee meetings, she was marked "absent" in only 13 of the 85 roll call votes on bills.

The Local & Consent Calendars Committee has met 4 times this session. Ms. Laubenberg was marked absent in 2 of the 4. In those 2 absences, she also missed the recorded votes to pass bills to the House floor.

I have sent the following email to Representative Jodie Laubenberg:

Rep. Laubenberg,

I have noticed that you seem to have a hard time making roll calls in the morning.

In the three committees on which you serve, I note that the minutes show you missing 12 out of 14 morning quorum calls.

Like most of your constituents, I work for a living. In order to pay my bills and taxes, I must wake up and be on my way early every morning.

If you would send me your phone number, I would be happy to offer you wake up calls at 6:00 AM. Perhaps that would help you better represent our district.

Sincerely,

Bill Baumbach
The Collin County Observer

Rep. Laubenberg (R-Parker), who is serving her 4th term as representative from District 89 in south-eastern Collin County, was the past chair of the Public Health Committee. After the previous chair, Dianne Delisi decided not to run for re-election, then Speaker Tom Craddick appointed Laubenberg chair in July of 2008 after the 80th Session ended.

When the current session began, new Speaker Joe Straus demoted her and appointed Rep. Lois Kolkhorst (R-Brenham) as the new committee chair.

The Collin County Observer has criticized Ms. Laubenberg for not issuing a report to the legislature on regional health care.

Last session, Laubenberg authored HB 3154 , which called for a series of public hearings on regional approaches to public health. She held only one meeting, which was highly orchestrated and allowed no public testimony. No public hearings were ever held, and the committee report that her bill mandated to be submitted to the legislature by September 1, 2008 has still not been released.

Bill

Critics say Collin County not being a team player; officials cite rapid growth for tough decisions

April 5, 2009
By ED HOUSEWRIGHT / The Dallas Morning News

If Dallas County could be likened to a senior citizen living on a fixed income, then Collin County might be the energetic teen with a fast car and a trust fund.

It's envied by other North Texas counties and is well-known as one of the most affluent, fastest-growing counties in the nation.

"This is not the time to raise taxes."
Collin County Judge Keith Self

"I think you should honor your county's agreements."
Denton County Judge Mary Horn

"It's really tragic that this is sign of the future leadership of the community."
State Sen. John Carona (R-Richardson)

In recent months, however, some say Collin County is earning a new reputation, and not an enviable one.

"I don't think Collin County plays nice lately," said state Sen. John Carona, R-Dallas. "I don't think they have a regional concern, but only for provincial Collin County."

The comments, made during a recent Senate hearing in Austin, are striking a chord with some who accuse the county of acting in its own interest at the expense of others. County officials have sparred with regional leaders as of late, mostly on transportation and health care issues.

Collin County officials reject the criticism, saying they're willing to help forge solutions to common problems. But they also make no apologies for putting Collin County first, citing rapid growth.

Since 2000, the county's population has swelled by almost 50 percent, and officials say that's forcing them to make tough decisions.

"We've changed more in the last five years than we had in the previous 20," Commissioner Joe Jaynes said.

Transportation bill

If there is grumbling about Collin County from its neighbors, it occurs quietly, and on a local level. But Carona's high-profile statements on March 18, directed at County Judge Keith Self, brought negative sentiments out in the open.

Self attended the Senate Transportation Committee hearing to speak against a bill that could establish new taxes to expand regional rail service.

More than 40 area cities and five counties passed resolutions in support of the measure, but Collin County did not.

Self said the county believed the bill would burden constituents with unnecessary taxes for rail service that would benefit few. (Collin County Commissioner Jerry Hoagland later spoke in favor of the bill.)

"This is not the time to raise taxes," Self said.

Carona railed against Self at the public hearing, saying he was not providing constructive input.

"You do a disservice to your community by sending missives out [to anti-tax groups] before you even understood what the bill was about," Carona said.
"It's really tragic that this is sign of the future leadership of the community."

The county's opposition to the rail bill is only the latest action on transportation to upset elected officials.

For instance, county commissioners recently backed out of a written agreement with Denton County to support a Dallas North Tollway extension along their joint border. They now want an alignment entirely in Collin County to receive taxes from development along the corridor.

That decision irked Denton County Judge Mary Horn, who said the county was reneging on a promise it made years ago.

"I think you should honor your county's agreements," she said.

In addition, the county angered the North Texas Tollway Authority by creating its own toll road agency. Commissioners have defended themselves by saying the need for a proposed 53-mile highway called the Outer Loop is so great that they can't wait on NTTA to build it.

Parkland hospital

County officials also continue to generate friction with Dallas County over Parkland Memorial Hospital, a sticking point in the past.

Collin County commissioners snubbed Dallas County's request to support a bill that would create a new hospital tax in suburban counties to help pay for using the Dallas hospital.

"I don't think our residents would ever support something like that," said Hoagland, the Collin commissioner. "Why should they? We don't have that many people going down there."

Collin County commissioners have irked officials in surrounding counties in the past year:

March 30 – Collin County Commissioner Kathy Ward testifies against a bill that could tax suburban counties for using Parkland Memorial Hospital in Dallas.

March 18 – State Sen. John Carona, R-Dallas, publicly chastises Collin County Judge Keith Self for not having a "regional concern."

September 2008 – Collin commissioners create a county toll road authority, separate from North Texas Tollway Authority.

May 2008 – Collin commissioners rescind a 2005 agreement with Denton County to support a Dallas North Tollway extension along a joint border.

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Late Monday evening, the Texas House County Affairs Committee held a hearing on HB515.

HB515 was introduced by Reps. Allen Vaught and Carol Kent, both Dallas Democrats. The bill would allow citizens to file a petition forcing an election to merge the Dallas County Hospital District (Parkland) with a contiguous county. Elections would have to be held in both the petitioning county and in Dallas County, and voters in both would have to approve it for the merger to take place.

The Collin County Commissioners Court vehemently opposes the bill. Merging with Parkland is one of their worst fears.

Dallas County Judge Jim Foster and Parkland President Dr. Ron Anderson both testified that the merger was to the benefit of all counties, and might be needed so that Parkland could remain a level 1 Trauma center. If Parkland were to give up their level one status, the closest level one center would be in Houston. It was pointed out that when a traffic accident in Collin or Rockwall Counties results in a horrific trauma, the patient is almost always airlifted to Parkland - whether or not the victim is insured. Loss of access to Parkland would inevitably cost the lives of some suburban residents.

Dr. Anderson and members of the committee pointed out that Parkland not only served the poor and indigent, but also insured Dallas and suburban residents with the region's premier trauma center, burn unit and 24 hour psychiatric center.

Parkland's indigent care covers uninsured citizens who earn up to 200% of the federal poverty level (FPL). Judge Foster testified that last year, Parkland absorbed over $20 million in unpaid bills from suburban residents. Collin county covers up to 100$ of FPL, but also subjects applicants to an asset test that disqualifies more poor folks than the income level does. Other counties have more stringent income qualifications.

At one point during his testimony, Dr. Anderson quoted the Ellis County Judge as telling him, "Why buy the cow, if I can get the milk for free."

While County Judge Keith Self attended the hearing, he wisely (after the drubbing he got the last time he appeared before the County Affairs committee) did not testify. Commissioner Kathy Ward and the County's Health director, Candy Blair spoke on behalf of the commissioners court.

Commissioner Ward was closely questioned by several members of the committee, especially Chairman Garnet Coleman and Rep. Valinda Bolton. The Chair, in particular was inclined to lecturing on the history of health care benefits and legislation in Texas. Commissioner Ward, however remained poised and gracious, and the committee reciprocated. Her reception was in stark contrast to the last two legislative appearances by our county officials.

Ward testified that the county was willing to explore new ideas in indigent care, but that they were opposed to HB515 because the election would be too expensive and because it wasn't clear how much of Parkland's debt Collin County residents would have to assume.

Ward also stated that Collin County paid its bills. She noted that last year, the county paid Parkland on 143 invoices for 'qualified' Collin County indigents. What she did not list was the number of bills that went unpaid, because the county would not grant benefits because of income or asset tests.

Ward noted that an election would cost the county over $400,000. She rightly stated that HB515 would allow only 50 voters to file a petition to force an election. Ward pointed out that Collin County had any number of political activists who could go to any 7-11 and get 50 signatures before lunch.

Ward's $400,000 figure would be correct if the referendum was the only item on a county-wide ballot. However, HB515 does not mandate a special election. Nothing in the bill would prevent the commissioners from scheduling the election at the next regular election date. Combining the referendum with normally scheduled elections would drastically reduce the cost.

Ward also objected to a provision in the bill which would grant Dallas County commissioners the right to appoint the Hospital district's representatives from the annexed county. She stated that there was no way Collin County Commissioners would agree to that. She is right on target with that - in order to be fair to all sides, that provision of the bill needs to be reworked.

As to the debt issue, it is addressed in the bill, "If the district has outstanding debts or taxes, the voters in the election to approve the annexation must also determine if the annexed territory will assume its proportion of the debts or taxes if added to the district."

Candy Blair told the committee that according to Parkland's own statements during its last bond election, 90% of patients from suburban counties were insured and their bills were paid at a much higher percentage than patients from Dallas County.

With both HB515 and the Local Option Transportation Bill (SB855) asking local voters to take control over their own destinies by using the ballot box to decide if they want to support mass transit or improved health care. The 81st legislature is blazing a new trail in proposing innovative approaches to some of the most difficult political problems we face in suburban Collin County.

The legislature is not dictating new taxes, instead it asks the voters, "Is a mass transit system worth paying higher taxes?" and "Is improving health care access worth paying a hospital district tax?"

The county would do well to negotiate with the legislature to remove the more objectionable provisions of these bills - and then let the voters decide.

Bill

The recording of the March 30 House County Affairs Committee is at the Legislature's web site, here (requires RealPlayer).

The hearing on HB515 begins at time stamp 4:26:25.

Kathy Ward's testimony begins at time stamp 4:55:33.

1. DA John Roach standing in court with his shirt tails hanging out, telling a judge, "I knew about Sue and Tom the whole time, neener neener."
2. Judge Keith Self and Commissioner Jerry Hoagland featured on a Friday night WWE match, with proceeds benefiting the Plano Children's Clinic.
3. The NTTA declaring "Warrantless Wednesdays" and "Toll Free Fridays".
4. TxDOT giving the SH121 money back after the Collin County legislative delegation threatens to kick their ass if they don't.
5. The Fusion Center actually doing something useful.
6. Sam Johnson bringing a nice fat transportation grant check to Collin County.
7. The opening of a new highway that doesn't charge by the mile.
8. Sheriff Box giving NTTA their 12,000 warrants back with a note, "Do it yourself."
9. The County buying a software package that actually works and saves money.
10. Jerry Hoagland caught in an airport restroom with an unnamed US Senator.

Bill

The news today is that Tom Craddick will not be re-elected Speaker of the Texas House of Representatives.

The election of a new speaker will affect many state house committee assignments, and especially committee chair appointments. Craddick is well known for freezing out those that displease him and rewarding his faithful with powerful committee assignments.

Following the election of a new speaker, two Collin County legislators may loose their powerful committee chairmanships.

Plano's Jerry Madden, [unfortunately] a loyal Craddick supporter, has become a highly respected expert in prison and criminal justice reform. He was the chair of the Corrections Committee, Co-chair of the committee for oversight of the Operations and Management of the Texas Youth Commission, and co-presiding officer of the joint Criminal Justice Oversight Committee.

Rep. Madden earned high marks for his handling of the TYC scandals that broke onto the news as the last legislature was just beginning. I hope the new speaker will recognize Mr. Madden's work and expertise. Texas needs substantial prison and criminal justice reform. Jerry Madden has proven that he can build consensus, and look beyond rhetoric in seeking innovative approaches to making our state safer on a limited budget.

Rep. Jodie Laubenberg, another Craddick sycophant, is chair of the Public Health committee. Frankly, I hope the new speaker recognizes that she is utterly unqualified and is ill-suited for such an important position.

I first met Ms. Laubenberg shortly after the 79th legislature killed much of the CHIP program. I attended a town hall meeting she had called. We listened to her read from a Craddick playbook and blame all budget cuts on prior democratic rule (even though the last legislature had left a huge surplus). Answering my question, she asserted that, "not one Texas child would loose benefits" under the stripped down CHIPs appropriation she voted for.

In fact, over that year and the next, more than 100,000 Texas children lost their medical benefits.

The Dallas Morning News is currently publishing an investigative series that, in part, details the horrific effects of Craddick's policy to privatize public health benefits. Ms. Laubenberg has not the intellectual heft, independence, nor the imagination that will be required to reform a broken healthcare system.

An example of her handling of difficult issues: In the last legislature, Ms. Laubenberg authored HB 3154, a bill that called for a task force to hold public hearings on seeking a regional solution to indigent public health care. As I detailed in "Laubenberg throttles regional health care committee", there were no public hearings, the committee only met once, and the report which was due on September 1st has still not been written.

The whole process was a sham, as is Jodie Laubenberg's concern for the millions of Texas' uninsured.

Plano's Brian McCall is not a committee chair - he made the mistake of challenging Speaker Craddick a few years ago for the speakership. McCall presently serves on the Financial Institutions committee and is vice chair of the Education Committee. Rep. McCall is a seasoned legislator and is highly regarded by his peers.

He is well positioned for advancement after being one of the "Gang of 11" Republican legislators who chose and pledged support for Joe Straus of San Antonio to be the next Speaker. Look to see his star ascend in the upcoming legislative session. My guess is that he will pick up a very important committee chairmanship.

Rep. Ken Paxton has shown little to recommend himself to either the past or future leadership. He currently is Vice Chair of the State Affairs committee and Vice Chair of the Property Tax relief and Appraisal reform committee.

Now if just one of these guys could get back our SH 121 billions.....

Bill

Former Commissioner Phyllis Cole has left her mark on Collin County

Wednesday, December 31, 2008
By ED HOUSEWRIGHT / The Dallas Morning News

Susan Shuler hates to see Collin County Commissioner Phyllis Cole leave office.

Shuler, executive director of Plano Children's Medical Clinic, credits Cole with increasing county funding of nonprofit health care agencies.

"She totally understands the health care needs of the county," Shuler said.

Cole left office Wednesday after 18 years as commissioner. She is being replaced by Matt Shaheen, who defeated her in a Republican primary runoff last spring. Shaheen, a first-time officeholder, will be sworn in Friday morning at the courthouse, along with seven other elected officials.

Cole, 61, said she has no hard feelings toward Shaheen, who defeated her by 30 votes in a hotly contested campaign. She said she plans to travel and spend time with her two daughters and three grandchildren, who live in Collin County.

"I'm excited about moving into something new and different," Cole said. "Every time a change comes about in my life, something good comes of it."

Cole said improving health care for children and the poor became a passion. During her tenure, commissioners began awarding annual grants to nonprofit organizations. They also raised the income ceiling for people to qualify for free care at the county clinic. In addition, commissioners began a partnership with PrimaCare? to allow low-income residents to receive care for a $20 co-pay.

"We've done some groundbreaking things in health care," Cole said.

Her colleagues on the five-member Commissioners Court applaud her commitment to health care.

read more....

Bill Comments:

I'll miss Phyllis Cole's presence on the commissioner's court. She and I have sparred more than a bit, but I've always respected her commitment and intelligence - and her concern for those who really needed health care services.

Good Luck, Mrs. Cole, in whatever you chose to do.

The Dallas Morning News reported today that "One third of Dallas area nursing homes get lowest possible medicare rating."

After reading the article, I was curious to see how Collin County's nursing homes fared. So I went online to the Medicare site, and looked them all up.

I can report that we did just a little better than the rest of the metroplex, however 27% of our nursing facilities received Medicare's lowest rating - one star, described as "much below average".

All told, more than half of the nursing homes in Collin County are rated as "below average" or "much below average" according to the rating system used by Medicare.

I know how bad some of these places can get. My father died in one of these local "one star" Medicare/Medicaid homes after a short stay when he was discharged from the VA system. The whole building smelled like urine, and on the faces of the patients was the look of hopelessness and despair.

Medicare rated 15 of the 18 nursing homes listed in Collin County. Of those 15:

1 (7%) was rated at the highest overall rating of 5 stars described as "much above average

5 (33%) were rated 4 stars for "above average"

1 (7%) got 3 stars or an "average" rating

4 (27%) earned only 2 stars, a "below average" rating

4 (27%) received the lowest, one star rating, described as "much below average".

The lowest 4 are the McKinney Healthcare and Rehabilitation Center, The Collinwood, the Baybrook Village Care and Rehab Center, both in Plano, and Hillcrest Nursing and Rehabilitation LP in Wylie.

The 4 listed as "below average" are, North Park Health and Rehabilitation Center in McKinney, Prairie Estates in Frisco, Prestonwood Rehabilitation & Nursing Center in Plano, and Settlers Ridge Care Center in Celina.

Only one nursing home, The Park in Plano, was rated as "average".

The 5 above average were Victoria Gardens of Frisco, Victoria Gardens of Allen, Life Care Center of Plano, Hinton Home, Inc. in Farmersville, and Heritage Manor Healthcare Center in Plano.

The highest rated nursing home in the county, and the only one 5 star rated is Homestead of McKinney.

The ratings averaged the scores for health inspections, staffing and quality measurements.

The ratings can be found at Medicare's Nursing Home Compare website.

Bill

Frisco council sends unused social services fund back to Housing Trust Fund Board

By Ann Marie Shambaugh, Staff Writer / Frisco Enterprise
Tuesday, October 21, 2008

The Housing Trust Fund Board will have more money to allocate to local service agencies after the city council unanimously approved the rollover of remaining funds from fiscal year 2008 for similar purposes in fiscal year 2009. Normally unused funds are sent to the city’s general fund.

About $56,000 remained unspent at the end of the fiscal year. Frisco Housing Coordinator Stacy Brown said that the Collin County Committee on Aging had about $31,000 because of miscalculated cost estimates, CASA had about $1,900 in funds it could not use, and the Frisco Cares Clinic was not able to use about $23,000 because it did not move into a new building as anticipated.

The council agenda stated that the rollover funds could be used for other service organizations, but Mayor Maher Maso said that he wanted to be sure that the same organizations that did not use the funds last year would be eligible for them this year.

“I’m OK with them being reallocated to the same services agencies to fill their needs because that’s what they were meant for and those agencies, at least the ones I’m aware of, fill a very basic need,” Maso said.

The city appropriates $1 per capita for social service organizations, and with the extra $56,000 the total will be near $160,000 for the upcoming fiscal year.

Brown said that other service organizations could use the funding, such as Frisco Family Services Center, which has seen an increase in clients with the recent downturn in the economy.

Council member Jeff Cheney said he believes it is important to keep the funds in the social service sector.

“We have many social services needs, and the game has changed,” Cheney said. “We actually made these allocations and there’s a lot of need.”

read more....

Breast cancer is one of the leading causes of death in women. Getting checked regularly is important in the fight against this disease. Learn about breast cancer risk factors and the preventative measures you can take.

This summer I've had to learn more than I ever expected to about breast cancer. I've been astounded at the numbers of brave women who have faced this disease.

You women, get your mammogram. Men encourage your wife to get checked every year. Trust me, you do not want to hear a doctor tell someone you love that she has advanced cancer.

Low income or uninsured women can qualify for free or reduced rate mammograms.

Collin County and the Susan Komen Foundation offer free or low cost mammograms to low income and uninsured women in the county. For an appointment, contact Lena Decker at 972-548-5524.

The Planned Parenthood clinic in McKinney or Plano can also help low income women get mammogram screenings.

More information on mammograms and breast cancer is available:

Cancerinfo.net is a good resource for information on all kinds of cancer.

The Susan Komen Foundation offers support and a way to donate to breast cancer research

Johns Hopkins has a great site for support and information.

National Breast Cancer Awareness month

The National Breast Cancer Foundation

Bill

Here are the latest updates on a couple of the subjects covered in the Collin County Observer:

Collin County vs Collin County Auditor - expect much more writing from me on this.

On the 22nd, visiting Judge Calhoun ruled in favor of the auditor. This is the second time Judge Calhoun has granted summary judgments against the Commissioners Court. His final written ruling is expected in a few days.

While the ruling may be final, the turf war is most certainly not.

Laubenberg and HB 3154 - The report on regional healthcare was due on the first of September. I contacted Rep. Laubenberg's office about getting a copy and was told that the report was "running late", and not withstanding the statutory deadline, to expect it in about 30 days.

Bill

In 2007, the Texas legislature passed HB 3154. Written by Rep. Jodi Laubenberg of Parker, HB 3154 called for the creation of a "Review Committee" or task force to, "to conduct public hearings regarding, and to study the implications of, implementing regional health care service to address indigent health care in the region.".

The committee was charged specifically to:

• "(1) examine whether a regional system to provide indigent health care should be offered throughout the region;
• (2) examine whether there should be a mechanism for additional counties to participate in the regional health care system;
• (3) perform a review of funding and financing options, including a review of funding indigent health care in the region."

In simple English - many counties, including Collin, are deathly afraid that public hospitals, such as Parkland will try to expand and regionalize their reach into suburbia. Yet simply because of where they live, thousands of Texans are denied decent health care due to lack of access to these public hospitals. The committee was to bring together institutional stakeholders to discuss and propose solutions.

From the beginning, HB 3154 was criticized because while its membership included all State Representatives, all County Commissioners and all Hospital CEOs in 19 county North Texas Health Region 3, only 2 of its members represented public hospitals. There were no representatives from the charitable clinics, nor from the public itself. The committee was a stacked deck in favor of the status quo.

Laubenberg's bill required that, "The initial meeting of the committee must take place before September 30, 2007. At the initial meeting the committee shall:

• (1) adopt rules governing the committee; and
• (2) establish a work plan and schedule for future meetings."

With much media attention the committee did hold its first meeting at UTD on September 20, 2007. I was there, so was the media.

The conversations were interesting and diverse opinions were heard, but no conclusions reached. Rather, the tone of the discussions seemed to be more in the nature of opening statements. I'm sure everyone present believed there would be more meetings - just as the law required.

While there was discussion among the members of the committee, the public was not permitted to speak. I wrote Ms. Laubenberg after the meeting:

Rep. Laubenberg's response was terse:

Since I had asked to be informed of future meetings, and since I knew that the committee report was due by September 1, 2008, I recently asked Suzanne Bowers, the Chief of Staff for Ms. Laubenberg why I had not received notice of any other meetings. "There were no other meetings", she told me, "but the committee was working hard on getting the report done by the deadline".

Wow!

Laubenberg's bill calls for the committee to:
"issue a report on indigent health care that summarizes:

• (1) hearings conducted by the committee;
• (2) studies conducted by the committee;
• (3) any legislation proposed by the committee; and
• (4) any other findings or recommendations of the committee."

It will be interesting to see what a committee that only met once, and never held hearings will write in the report since:

• The Committee never held hearings.
• They never conducted studies.
• They never proposed legislation.
• They never proposed recommendations.

The committee existed only to obfuscate the real issue of access to public hospitals that beg for real answers. This is old fashioned "Good ol' boy politics" at its worst.

So I ask, Who is writing this report? There's nothing to write unless Laubenberg's staff simply writes her opinion.

It is becoming obvious that this committee existed only to further the agenda of those who do not want indigent health care to be debated in the public forum.

Any report issued in the name of this committee must be presumed discredited. The committee was a sham, and because of that, any real discussion on the need to improve the indigent health care system has been stifled.

In an editorial today, the Dallas Morning News noted that Speaker Tom Craddick just appointed Rep. Laubenberg chair of the House Public Health Committee. Her actions in throttling the North Texas review committee does not bode well for the plight of the millions of indigent and uninsured in Texas.

The fox is in charge of the hen house.

Bill

Notes:

Apres Delisi, le deluge - Bukablog, Texas Monthly August 10, 2008

Editorial: Laubenberg's new assignment - The Dallas Morning News Aug. 10, 2008

Laubenberg: Citizen input not allowed - CCO Sept. 27, 2007

Regional Healthcare & HB 3154 - CCO Sept. 5, 2007 (also published in the Dallas Morning News as A healthy discussion)

HB 3154 - Text of Enrolled bill

HB 3154 - Bill analysis State of Texas Senate Research Center May 16, 2007

Editorial: Laubenberg's new assignment

Sunday, August 10, 2008
The Dallas Morning News Editorial Board

State Rep. Jodie Laubenberg has reflected the political philosophy of her high-wealth, high-growth Collin-Rockwall County district during three terms in the Texas House. Her voting record last session earned her a 96 percent approval rating from the conservative Heritage Alliance, the highest score among 150 state representatives.

But Ms. Laubenberg has just been assigned a new constituency – the entire state of Texas. Speaker Tom Craddick last week promoted her from vice chair to chair of the House Public Health Committee, a job that broadens her responsibilities.

Ms. Laubenberg must adjust if she is to effectively mold public policy for a state with chronically high levels of poverty and children without health insurance.

In a column published in this newspaper last year, Ms. Laubenberg accused Dallas' Parkland Hospital of having an "insatiable appetite for more taxpayer dollars" and a goal of "socialized medicine."

Parkland, in fact, is not the enemy. It is the foundational public health provider for much of the region and often struggles financially to fulfill its mandate. If anything, the Legislature must find a way to ensure that surrounding counties pay a fair share when their residents receive treatment at Parkland. Another Republican committee member, Jim Jackson of Dallas, advocates that kind of regional approach; if Ms. Laubenberg keeps the chair next year, she should help him shape that concept.

For her part, Ms. Laubenberg tells us she knows her new role requires openness to all viewpoints, and she pledges that approach – a positive sign.

Another lawmaker from North Texas, Lewisville Republican Jane Nelson, has shown it is possible to stick to conservative principles while molding compassionate health policy. As chairwoman of the Senate Health and Human Services Committee, Ms. Nelson has developed into a reformer with a grasp of the complexity of health law and finance.

The job takes zeal for the subject matter and the willingness to govern with the interests of more than 24 million Texans in mind.

Charity clinics cropping up to serve Dallas-area immigrant workers

Monday, July 14, 2008
By DIANNE SOLÍS / The Dallas Morning News

PLANO – Alfredo Rivera winced slightly as Julia Grenier examined the stitches in his finger.

"It's beautiful and it's healed," the nurse said.


The carpet layer was lucky, she said, that his boss brought him for treatment. Around her, more men in construction boots waited in her crowded clinic, tucked inside the Plano Day Labor Center. Some needed a bee stinger removed or salve for a rash. Others were heart attacks waiting to happen.

Charity clinics like this one are appearing all over the area. Over the last decade, there's been a tenfold increase in the number of such clinics identified by an association formed by the Dallas County Medical Society. The clinics, now numbering more than 40, are among the only option for growing numbers of people without health insurance, especially illegal immigrants who are fearful to use government-affiliated clinics or hospitals.

A few of the clinics have funding restrictions tied to immigration status. But doctors, nurses and clinic support staffers say checking for disease and injuries – not immigration documents – is their mission.

The need for these services is great. Texas leads the nation in its percentage of residents without health insurance. Nationally, legal and illegal immigrants make up about a fifth of the uninsured, according to the health-focused Kaiser Family Foundation.

The growth in charity clinics "really shows the alarming situation in our community of the uninsured growing," said Connie Webster, community health director for the Dallas County Medical Society.

There are as many as 2,000 charity clinics around the country.

"Free clinics are the best-kept secret in America," said Nicole Lamoureux, executive director of the National Association of Free Clinics. "Instead of waiting for the problem to be solved, free clinics are offering a solution right now," she said, noting the fierce political debate over health insurance fixes.

Curbing emergencies

The for-profit medical system needs paying customers, and Parkland Health & Hospital System is financially strained. So more and more doctors, nurses, social workers and translators are quietly volunteering at the free clinics, even as a crackdown on illegal immigrants continues.

"The hospitals totally ignore that we are saving their bottom line," Mrs. Grenier said as she bags supplies at her clinic. "Every visit here is a potential emergency room visit there. We stop problems from growing here."

Mrs. Grenier, a 72-year-old, Louisiana-born public health nurse who uses a cane and buys supplies at dollar stores, runs the clinic on Wednesdays at the Plano Day Labor Center.

She started her practice a decade ago from the back of a Ford pickup, performing what might be called guerrilla nursing. Now she runs the 5-year-old Collin County Adult Clinic as well, with about 25 volunteers.

Patients without documents "are just people who need our help."
Dr. Paul Piper, Collin county Adult Clinic

Construction worker Rodolfo Ibañez arrived at the Labor Center clinic with an earache. In his homeland of Mexico, he'd self-medicate with a pharmacist's counsel. But, in the U.S., with only rudimentary English, "I don't want to because you can harm yourself," Mr. Ibañez said.

Another patient, Daniel Rodriguez, got some numbing salve for the gums near a sore tooth and the address of a dental school where charges are as little as $16. Soon, a fuss started A stocky, 64-year-old man had high blood pressure: 182 over 114. As he left, Mrs. Grenier muttered, "He thinks he's above the law."

Whose law? Her law of cutting salt and fried foods from the diet, the nurse said.

Proof of residency

About half of the budget of the Collin County Adult Clinic comes from the county, with the stipulation that each patient show a Social Security number as proof of legal U.S. residency. The rest of the budget comes from the donations of individuals and churches, and that is used for patients without Social Security numbers.

County officials "want to make sure everyone we serve is documented and they know darn well that some of our people aren't," Mrs. Grenier said.

Added Dr. Paul Piper, one of the volunteer physicians at the adult clinic: Patients without documents "are just people who need our help."

Every Monday, Jerry Weis, the president of the board and a retired business manager, organizes the records and makes note of Social Security numbers for reports to funding agencies. "We are never short of patients, and the demand gets higher," Mr. Weis said.

All over North Texas, clinic activity is up. In some cases, the volunteer clinics are on overload and regularly turn away patients.

read more....

FFSC adjusts services to meet changing needs

By Ann Marie Shambaugh, Frisco Enterprise
Thursday, June 26, 2008

Frisco Family Services Center supporters and board members heard an update and presentation of future goals for the center at the annual “State of the Agency” address Thursday night at the Senior Center at Frisco Square.

"[some] who were previously donors to the food bank have had to learn how to become clients."
Jill Cumnock

Executive Director Jill Cumnock addressed the crowd of about 50 on changes that have occurred as the economy has declined. She said that some clients who were previously donors to the food bank have had to learn how to become clients. She said many of them are from the housing industry.

“We are definitely seeing a different clientele,” Cumnock said.

She also said that the agency has seen a spike in its gasoline voucher program as oil prices have surged, and FFSC is planning to begin distributing child-care vouchers in a similar program that would allow parents to leave their children in safe hands as they work until a first paycheck hits the bank.

read more....

Monday, the county commissioners, meeting as the Health Care Foundation Trust Fund trustees, approved a $3,607 budget amendment for meals for health department employees attending a training seminar on "Customer Service".

However, after an objection was raised by Commissioner Joe Jaynes, Candy Blair, manager of the Health Department promised to find the funds from a budget item that would not impact patient care. Jaynes stated he would vote against the funding if it came out of the in-patient hospitalization budget.

The original proposal called for the funds to be transfered from the patient hospital account. (see Taking from the poor, again!, Collin County Observer, June 20, 2008).

Ms. Blair acknowledged that there had been some criticism of sending the entire Health Care department to a customer service training class, but stated that they were trying to serve "so many people, and trying to be efficient".

Ms. Blair also promised that, "at the end of the day, I can assure you that no one will go untreated. (because of the training)"

After Ms. Blair promised that the funds would not come from the hospital account, the commissioners approved the budget transfer unanimously.

Bill

ASNT looks to help more of Collin County
By Phoebe Wu, Staff Writer / Plano Star Courier
Saturday, June 21, 2008

After just kicking off its capital campaign, AIDS Services of North Texas is $20,000 and a few steps closer to building its new facility.

The new location will serve Collin County and replace ASNT’s Plano office. By building its own space, ASNT is hoping to use the funds spent on rent to serve more clients.

ASNT, which has offices in Denton, Plano, and Greenville, is the only non-profit HIV clinic directly serving North Texas. Since there are no public hospitals and a lack of indigent health care in Collin County, ASNT has seen the number of Plano clients grow in recent years. Because of this shift in numbers, ASNT is moving part of its administration from Denton to the new facility.

The agency hopes to raise $2 million for the campaign to cover the purchase of land, site development, building construction, and furnishings.

“These are needy people who desperately need our help and resources,” said Ronald Aldridge, executive director for ASNT.

Aldridge, who has been with the agency since 2000, has helped it grow from 1,800 to 16,000 clients during his leadership. Founded in Denton in 1988, ASNT, then called AIDenton, was formed by a group of physicians, pastors, social workers, and public citizens to provide a counseling and care for people dying from AIDS. The focus was to help people die with dignity. When medicine became available to help treat HIV, ASNT began helping people with the disease live as positively as possible.

“It’s easy to get depressed,” said Aldridge. “Our clients get mad at us sometimes because they have no one else to get mad at.”

To help combat depression, ASNT also is including mental health services in addition to treatment rooms in its new facility.

Described as a “one stop shop” atmosphere, the Plano location will provide more comprehensive services, including prescription and insurance payment assistance, housing assistance, transportation, HIV testing, and a food pantry where clients can shop for groceries.

In Denton, ASNT also offers a guardianship program, which is funded through the county probate court. This program entrusts ASNT to look after people who are incapable of taking care of themselves, such as clients with Alzheimer’s and the mentally retarded.

The average income of the agency’s clients is $6600, so most are unemployed or the working poor.

“It’s hard to hold a job sometimes, because you have this disease,” Aldridge said. “Many don’t want to tell their employer.”

According to a 2007 report by the Joint United Nations Programme on HIV/AIDS, the disease afflicts 33.2 million people around the world. According to ASNT, approximately one in every 700 Plano residents is HIV positive. Since 2000, the number of HIV positive people increased by 340 percent.

A common misconception, Aldridge said, is that HIV/AIDS is a homosexual disease. Although over half of new HIV infections are in people under the age of 25, nearly 15 percent of new infections are from people over the age of 50.

read more....

With the size budgets that the County and its Health Care Trust Fund manage, $7,961 may not seem to be a lot of money.

But in my family, and in the families of those who rely on the trust fund for their care, $7,961 might seem a princely sum.

This year, we have watched the "off-budget" expenditures of the Health Care Trust Fund; what we've seen continues to demonstrate the disdain the County Commissioners Court treats those who live in poverty and need medical services.

Grants to the charitable clinics that serve the needs of hundreds of our residents have been restyled as "Service Agreements" and the funds distributed have been radically cut.

A few months ago, the Collin County Observer noted and protested the loss of rent revenue to the Trust Fund when the commissioners approved giving free rent to the Bio-terrorism squad. Rent revenue that were from Trust Fund property.

This time, the court is planning to approve transferring $3,607 from the patient hospital account to "Staff Training", "food", and "books" so health department employees can attend conferences and training. This is on top of the $4,354 that was transfered from the same patient hospital account at the last meeting on June 3.

You see, the Health Department wants to send all its employees to a training class on, "Good Customer Service, and Positive Response to Change." (I'm not joking!) To learn this stuff, they need lunch and books.

Maybe the training is important (but is sure looks like bureaucratic fluff).

I don't understand why if it is so important that it wasn't budgeted for during the annual budget hearings. I don't understand why the health department didn't get the dollar amount right when they sought approval for the training on June 3. And I really don't understand why staff food and books should come out of the funds budgeted for patient care.

If Health Department employees require the training and food, then the funds should be transfered from another administrative account, not from patient services.

Sure, in the entire scheme of things, $7,961 is not a tremendous amount of money - unless you are the patient who has no other means of affording medical treatment.

Bill

The Health Care Trust Fund Trustees (Commissioners) will meet this Monday, June 23 at 1:30 PM. The meeting immediately precedes the Commissioners Court meeting and is held on the 6th floor of the County Courthouse at 210 S. McDonald St. in McKinney.

Citizens may express their opinions to the Trustees after filling out a request to speak that will be available before the meeting. The budget amendment to move $3,607 from hospital patient services to "Education and Conference" is Agenda item HCF2d.

Planned Parenthood premieres with prayer protest

BY DANNY GALLAGHER, McKinney Courier-Gazette
Wednesday, June 4, 2008

Planned Parenthood officials cut the opening ribbon on their new clinic while a group of pro-life supporters stood aside and prayed in hushed voices in spiritual protest.

The clinic, located in a shopping center on the northeast corner of Eldorado Parkway and Medical Center Drive, held a grand opening Tuesday making it the first Planned Parenthood clinic in the city of McKinney.

Holly Morgan, director of media and communications for Planned Parenthood of North Texas, said Planned Parenthood aims to provide reproductive health services to a rapidly growing community.

“[This clinic] is important to us because we know what an incredibly fast growing city this is,” Morgan said. “McKinney has been named by the nation’s census twice as the fastest growing city this size in the entire country, so obviously there are people here [who] need us.”

Jim Roderick, president and chief executive officer of Planned Parenthood of North Texas, estimated the new McKinney clinic and the two Plano clinics will provide services and referrals to 8,000 to 10,000 patients in the Collin County area.

“We believe the growing community really needs our service,” Roderick said. “There are about 50 million Americans without health care, so our focus is to provide affordable health care to as many uninsured people as we can.”

Morgan said the McKinney clinic will provide a number of “Express” services including health screenings, sexually transmitted disease testing, contraception options, family planning education and other appropriate medical referrals.

“We provide the full range of women’s GYN services and we become a referral source in our clinic to other providers for problems we detect in our clinic from cancer to infections and the like,” Roderick said. “We become a vehicle for other people who enter the health care system for more acute problems that they may encounter.”

Some citizens weren’t as pleased with the opening of the clinic. A small group of protesters culled from several area churches voiced their opposition to the clinic through quiet, soft-spoken prayer. They stood a few feet away from the clinic’s main entrance clutching rosaries and praying together in quiet unison.

“We believe prayer is the best weapon we have against abortion,” protester Melaine Gutierrez said. “We’re here to pray for an end to abortion, to pray for people who work for Planned Parenthood that they have a change of heart and to see that life is not an option, life is not a choice and that everyone has a chance at life.”

read more....

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Note:

Planned Parenthood does not offer abortion services at the McKinney location. It does offer low cost healthcare for those who are uninsured. No one is turned away for inability to pay.

Bill

Planned Parenthood ‘Express’ opens here: Open house will include information on services

By Paul Gosling, McKinney Courier-Gazette
Thursday, May 29, 2008

The recently opened McKinney branch of Planned Parenthood will be have an open house from 10:30 a.m. to 12:30 p.m. Tuesday to give area residents the opportunity to tour the clinic and ask questions about available services

The McKinney clinic, which opened on April 22, has already become known as the Planned Parenthood Express. The “express” portion of the name reflects two of the services it offers. The H.O.P.E program [Hormonal Option without Pelvic Examination] means women can have access to oral contraceptives without undergoing a pelvic examination. The clinic still recommends that women have a yearly “Well-Woman” exam that includes a pelvic examination.

The “Pills Now, Pay Later” program means patients who qualify for a prescription can receive a year’s supply of oral contraceptive pills and be billed monthly through either credit or debit cards.

“It’s just a lot more convenient for a lot of women,” said Holly Morgan, director of public relations and communication.

Other services offered include pap smears, screenings for cancer, diabetes and high blood pressure. The clinic also provides testing for sexual transmitted diseases. Hormone replacement therapy is also available for women going through menopause.

The clinic also provides family planning education and counseling, “Patients can schedule a discussion to talk about their options,“ said Morgan.

Discussion of those options is one of the reasons Planned Parenthood is a target of many opponents of abortion. They believe that the organization encourages the practice above other choices, and they dislike the fact that many Planned Parenthood clinics do perform the procedure.

Also provided is an emergency contraception option. Commonly known as the “morning-after pill,” the pill can be used to prevent pregnancy for up to 72 after having unprotected sex.

Men can also receive screenings for sexually transmitted diseases, discuss birth-control options and receive referrals for vasectomy procedures.

Morgan said that payment for services is on a sliding scale dependent upon finances and circumstance but added Planned Parenthood’s philosophy is that they will, “never turn anyone away because they cannot pay.”

read more....

Unfinished Plano children's shelter being torn down after storm damage

Thursday, May 22, 2008
By ANNETTE NEVINS / Special Contributor, The Dallas Morning News

Workers began dismantling the twisted framework of My Friend's House on Thursday, six weeks after major storm damage forced construction of the children's shelter to stop before it was completed.

The demolition of the structure – the latest slowdown in a project already plagued by delays – means the 24-bed, short-term shelter won't open until at least early next year.

But officials with CITY House Inc., the nonprofit overseeing My Friend's House, say they've been encouraged by an outpouring of donations and support. They also learned this week that insurance will pay for the teardown and rebuilding of the shelter.

"We appreciate so much the continued generous outpouring of the community," said Kathy Blank, director of outreach and volunteer services for CITY House.

High winds from an early-morning April 10 storm caused irreparable damage to the shelter, which was about midway through construction.

read more....

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

In an article published today in the Dallas Morning News, a spokesperson for the State of Texas' Health and Human Services Commission admitted that problems with the State's privatization of the welfare system caused children in Plano to not receive Medicaid benefits.

Rick Perry's efforts to slash the HHS budget and privatize the welfare administration has caused serious errors and backlogs. According to lawmakers quoted in the article, the system is so damaged it may not be salvageable.

The Governor and the legislature share the blame for the starvation of the HHS. Their insistence in trying to outsource the state government has caused a failure in the basic safety net needed by our most vulnerable children.

Bill

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Texas' welfare privatization efforts snagged

Lost paperwork, other glitches often block help to needy Texans

11:24 PM CDT on Sunday, April 6, 2008
By ROBERT T. GARRETT / The Dallas Morning News


AUSTIN – Lawmakers are worried that a partly privatized system for determining who receives public assistance is still shaky and may not be salvageable.

Paperwork for applicants has been lost. Needy Texans have received little help from state workers when they've complained of mistakes. And all too often, Texans who should qualify for state-paid health care and other benefits have been refused because of such errors.

When one closely watched measure of the state's performance on aid requests plunged recently, lawmakers sharply questioned Health and Human Services Commissioner Albert Hawkins. He has announced several new initiatives this year to lure and retain state eligibility workers – and to train more of them on a computer system causing most of the delays.

But those steps haven't calmed lawmakers' nerves. They and advocates for the poor are skeptical he can quickly fix a system that's been in crisis for most of the five years since the Legislature and Gov. Rick Perry slashed the payroll of the state's welfare offices and ordered a shift of many screening duties to four privately run call centers.

State leaders acknowledge that promised cost savings haven't materialized and mistakes are common. Now, the system could be headed for more severe problems, as a jittery economy means more Texans may soon apply for public assistance.

As policymakers and experts in Austin bicker, needy Texans continue to report problems. When they complain, poorly trained state and contractor employees respond inadequately, they say.

Plano housewife Cecilia Davidson is one such person, baffled – and frustrated – by the sputtering system.

Ms. Davidson, whose husband got laid off from a construction job and struggled to find work, got her two sons on Medicaid. When their six months of coverage ended last April, she applied for renewal, but state workers' errors left the family without coverage until December.

Ms. Davidson abandoned hope of getting help from the state. Despite her own chronic medical condition, she took a job last summer, hoping it would be the ticket to private family coverage. It wasn't.

She said that by September, her 16-year-old son, Leth, who has a mild form of autism known as Asperger's, needed care. So she applied again to get government coverage for him and his brother Scott, 8.

In December, Ms. Davidson rushed Leth to the emergency room because he had seizure-like "twitching and jerking." Hit with a $3,000 tab, she redoubled efforts to get coverage for the boys. On some days, she recounted, she spent up to five hours on the phone.

"You get run around so much," she said. "My application had so much weighing on it."

Ms. Goodman acknowledged that Ms. Davidson provided all information requested of her, and the boys should have had continuous coverage.

Under Medicaid, a child's bills from the last three months can be paid when they enroll – so Leth's ER visit is covered. Ms. Davidson said she winces, though, when state workers tell her that millions more Texans eventually will have their records pulled into TIERS.

"Everybody's going to be on it," she said. "God help everybody."

read more (lots more)....

Most Collin County citizens like the idea that they live in one of the most affluent counties in the nation. We like to point to our high average incomes and low unemployment.

But Collin County does have a less glamorous side. According to the State of Texas, Collin County has over 55,000 uninsured, of which more than 12,000 are children. More babies die here every year as our infant mortality rates continue to climb.

Now, recent data from the State of Texas shows that Collin County's need for children's health coverage is growing at a far larger rate than Dallas or the State of Texas as a whole.

CHIP (Children's Health Insurance Program)
Texas Health and Human Services Commission recently released data that shows CHIP enrollment by low income children in Collin grew at almost 3 times the statewide average.

From February, 2007 to February, 2008 the number of kids in Collin County's CHIP program grew almost 30%. During the same year, Dallas' enrollment grew 12% and Texas' by 10%.

While other programs are designed for the very poor, the unemployed or disabled, the CHIP program provides healthcare coverage for children of working poor and low income parents.

According to the Texas H&HS website, "CHIP is health insurance designed for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private health insurance. CHIP enrollment fees and co-payments are based on the family’s income. Enrollment fees are $50 or less per family for each 12 month term of eligibility and most co-payments for doctor visits and prescription drugs range from $3 to $10."

PERINATAL CHIP
The reported data did not include mothers and infants enrolled in the CHIP perinatal coverage program. Perinatal coverage provides prenatal care for the unborn children of low-income women who do not qualify for Medicaid.

Once born, the child will receive CHIP benefits for the duration of the 12-month coverage period. The perinatal program began in January of 2007 and the number of mothers covered has increased dramatically every month.

As perinatal enrollments soared, Dallas and statewide figures grew at 20X, while Collin County saw "only" a ten fold increase - from 65 to 672 mothers covered.

MEDICAID
In most of the State, the CHIP enrollment increases were, in large part, offset by a decline in Medicaid enrollment for children. Not so in Collin County.

While Dallas saw a 15% drop and the state saw a 13% decline in children's Medicaid, Collin County's enrollment actually grew slightly.

Collin County may be rich, but not all share in her affluence.

There are still many adults and even children who still fall "between the cracks" in getting adequate healthcare coverage. As our nation enters what many believe to be a recession year, it will increasingly fall on local government to do what it can to help fill in the gaps.

Bill

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Further reading:
The Dallas Morning News, March 11, 2008 - Texas enrollment in Children's Health Insurance program surges 7%

Texas Health & Human Services - CHIP Enrollment Statistics

Collin County Observer, Dec. 2, 2007 - Collin Infant Mortality rates grow

The region's hospital

Counties should pay fair share to Parkland
Dallas Morning News Editorial Board
Sunday, January 27, 2008

When you look at maps showing the income and education of residents across our region, you can see why the taxpayers of Denton and Collin counties believe they need no county hospitals. Everyone around them seems to hold down a good job and enjoy the benefit of private health care.

Those maps don't tell the whole story.

Yes, there's plenty of wealth and a solid professional class in those counties, but many of their citizens rely on Parkland Hospital, or its clinics, for care.

The latest data show that 10 percent of Parkland's hospital admissions come from outside the county. Many require expensive trauma care, and Dallas County taxpayers sometimes foot the bill.

Moreover, every out-of-county patient makes it that much more difficult for Dallas County patients to be seen.

Dallas County Commissioner Maurine Dickey's constituents regularly express concern about this situation, so she's taking action. She'll brief commissioners this week about hiring a lobbying team – including an economist – to help find a solution.

The numbers guy would detail who in the suburbs is using Parkland services and why. A lobbying firm with expertise in health care could then provide context for Dallas County taxpayers, suburban North Texans and state legislators.

We're not wild about hiring lobbyists or consultants. But unless commissioners have a better idea, they should approve the plan. Especially given that Dallas County officials and their staffs clearly have never been able to persuade our suburbs or the folks in Austin – who must approve any revenue-sharing agreement – that Parkland deserves more dollars from its neighbors.

The facts are on Dallas County's side. A better presentation will help.

Link to editorial

Over the last few years, I have come to meet an awful lot of people in Collin County. Some I like, some I respect and a few I simply can't abide. But only on a very few, rare occasions have I run into a person who I hold in complete awe.

On the front page of today's Dallas Morning News there was a picture of a woman whose compassion for those who have little has moved her to accomplish a great deal.

Nurse Julia Grenier runs a makeshift clinic at the Plano Day Labor Center and says she's not concerned whether those who see her are in the U.S. legally.

Nurse Julia Grenier is one of the founders of the Collin County Adult Clinic. The clinic is one of only a very few in our county that offer free or low cost healthcare to the poor and uninsured.

The Dallas Morning News wrote of her, "Every Wednesday for the past seven years, Ms. Grenier, 71, has run a makeshift clinic out of the Plano Day Labor Center off Central Expressway...

From a closet-size room, she treats illegal immigrant workers, tending to everything from sore throats to beer-bottle lacerations.

Ms. Grenier, a nurse for 49 years, walks with a cane. She uses over-the-counter medicines and bandages she buys with her own money, mostly from dollar stores."

In affluent Collin County there is at least one person who looks past the issues that rage around us to see those who are desperate for help, and who then offers that help. A true hero of Collin County.

Bill

My message to the commissioners court, "Fix this while you still can!"

The debate over indigent health care grants is heating up and may soon be played out on a national stage.

The county is pushing too hard. They need to help these charities do what the county should have been doing all along... providing a decent level of indigent care. The grant money needs to be freed up now, and the clinics should be reassured that the county is not playing politics with the poor.

There must be a compromise between the court and the clinics...one that is reasonable and just. One that is swift.

My fear is that if this confrontation continues to escalate into the election year, some local candidates will seek allies from large national pressure groups. Both sides might then stake out more extreme positions designed to further their own cause - and not to the benefit of our county.

The commissioners court needs to heal the rift with the clinics. They need to do it now, while they still can.

Bill

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Groups criticize Collin County's patient data rule
Rights advocates say county's limits on clinic funds break laws

Thursday, December 6, 2007
By ED HOUSEWRIGHT / The Dallas Morning News

Two national civil rights organizations are criticizing Collin County commissioners for prohibiting nonprofit clinics from treating illegal immigrants with county funds.

Officials with the League of United Latin American Citizens and the Mexican American Legal Defense and Educational Fund say they think commissioners are violating federal privacy and health care laws.

"There's no constitutional basis to limit these kinds of programs to U.S. citizens," said Nina Perales, regional counsel for MALDEF in San Antonio.

Commissioners maintain they can legally ask nonprofit clinics that receive county grants to report each patient's name, age, address, medical diagnosis and the last four digits of his or her Social Security number.

"To me, it's not a racial situation," Commissioner Jerry Hoagland said. "It's an economic situation. If you don't want to abide by the rules, don't take the money."

Several clinics have complained about the new reporting requirements, saying the policy forces them to violate patient confidentiality laws and play the role of immigration officer.

Clinics can still treat illegal immigrants, as long as they use other funds, commissioners have stressed. The county is not seeking personal information on patients treated with other funds.

One clinic, Children and Community Health Center of McKinney, has said it will reject its $30,000 grant rather than comply with the reporting requirements. Another, Frisco Cares Children's Clinic, says it may refuse its $11,000 grant.

"We're planning on telling them they are violating federal law," said Dr. Paul Reyes, medical director of Frisco Cares. "Every kid deserves to be treated."

read more....

Is Collin County about to become the next Farmers Branch - another battleground over illegal immigration?

I sure hope not.

Jerry Hoagland seems to be on a mission to outdo Farmers Branch councilman Tim O'Hare in attacking immigrants. (See the Channel 11 video here)

The stage is set for a confrontation - is it inevitable?

Commissioner Hoagland, speaking about a possible battle, says,"I'm willing to take that on.".

On the other side, Latino activist, Carlo Quintanilla, appears to be equally ready for a fight, calling the dispute, "immigrant bashing".

The truth is, the battle is political, and is about the role of county government in health care access for the uninsured.

Commissioner Hoagland has always opposed any and every grant proposal to the charitable clinics. In a commissioners court discussion last year, he very clearly stated that it was wrong for tax dollars to go to charity... no matter the purpose. He has very publicly stated his opposition to all county health care spending not mandated by law. He has a long-standing philosophical stand against government assistance.

Immigration is a red herring. Hoagland first brought up the subject of illegals during the campaign last year. His position was embraced by many who are frustrated with the national immigration policy, and who wrongly believe that illegals do not pay county taxes. (They do - they live in houses or apartments that pay the same property tax as you or I - they shop and pay the same sales taxes the rest of us do.)

Sadly, the discussion of the needs of the 19% of Collin County residents who are uninsured never could not be heard over the shouting about illegals.

According to the State of Texas, Collin County has over 55,000 uninsured, of which more than 12,000 are children. These numbers are growing.

The total health care grants awarded by the county come to less than $6 per year to care for each person who can't afford health insurance. That's $6 per year per person for medical expenses.

As health insurance becomes more and more unaffordable for working families, the closing of the clinics will divert thousands of people to the county's emergency rooms, further raising medical costs for all citizens in the county.

According to statistics compiled by the Access Project, most uninsured work for a living and are US citizens. In fact, in Texas 4 out of 5 uninsured are citizens. Collin County's ratio would be much higher.

What causes people to be uninsured is that they work on jobs where health insurance is not offered, or is priced beyond their means.

The debate needs to be returned to the real issue, "Does requiring personal information help or hinder the clinics in their attempts to help our poor get care?"

There are three major issues that need to be resolved:

1. Diagnosis codes - The county's new reimbursement policy requires listing of diagnosis codes. The county will only allow diagnosis codes that describe an illness. "Well baby" and preventive care are thus excluded from the grants.

It it generally agreed that the best way to limit health care expenses is to invest in preventive care. With infant mortality on the rise, it does seem that the county's insistence on illness is short-sighted.

2. Privacy - The county's new forms require name, address, city and zip for all patients.

Why? Several of the clinics balk at this, calling it an invasion of privacy. The county has replied by saying that insurance companies require this information every day. True, but the county is not paying on thousands of different insurance policies. Why does it need the data, other than to screen for citizenship, and what is it going to do with it. And what is going to prevent the county from turning over the clinics records to another government agency?

Because they are gathering personal identifying data, the clinics now must fill out a HIPPA release form and get it signed. The paperwork is becoming burdensome and requires additional volunteers.

3. Exclusion - The new county policy requires that the last 4 numbers of the patients Social Security number be reported. The county then runs the number against the name and address using commercial database software to attempt to verify citizenship.

How accurate is that software? How many false hits will it report? What will the County do with the reports?

What about the children of illegal immigrants? Most of these kids are US born and are US citizens, yet they do not have a social security number. Does the county intend to deny care to these vulnerable American citizens?

Over the next 2 weeks, the clinics and the county plan to hold a series of meetings that will, I hope, lead to a fair and just policy. Yesterday, Commissioner Phyllis Cole was quoted as saying that perhaps the county needs to reassess it's reporting policy. We need to hear more of the commissioners talking in that rational tone.

If the court can act with wisdom and compassion, the hot heads on both sides will never get to have their battle.

And our community will be the winner.

Bill

Collin County health grants linked to immigration status

Watch Video

Tuesday, December 4, 2007
By BOB GREENE / WFAA-TV

They applied and were granted money to help continue their operations.

But several non-profit clinics in Collin County are now frustrated.

They say the terms of their agreement with the county changed after they signed on the dotted line.

Plano Children's Medical Center applies for county grant money annually.

This year, the clinic got $50,000.

"It helps us purchase medicine, it helps with medical supplies," said Susan Shuler, from the center.

And this year, it means an extra $50 per patient visit.

But there's a catch.

The clinic will only be paid for legal residents of Collin County.

"It concerns us," Shuler said.

And it concerns several other non-profit clinics that were caught off guard when they signed on the dotted line, only to find out when the money came, so did new stipulations.

read more....

While our commissioners court plays hardball with the charitable clinics over indigent health care grants, statistics show that babies in the county are dying at an ever increasing rate.

Statistics gathered by The Center for Public Policy Priorities in its annual State of Texas Children Report, show that the rate of Infant mortality grew from 3.5 per 1,000 in 2000 to 5.1 in 2004 (the last year reported).

Actual infant deaths almost doubled from 30 in 2000 to 53 in 2004.

Collin County Infant Mortality Rate 2000-2004

click on graph to download larger image

Collin County Infant Mortality Numbers 2000-2004

click on graph to download larger image

Collin County has one of the nation's highest per capita incomes, but we still have many poor who suffer with little or no health care.

In 2004, over 11,000 children in Collin County were living below the federal poverty level, and over 30,000 were living without health insurance.

According to CIA, statistics, Collin County's infant mortality rate is higher than 20 countries (including Canada, Australia, Japan and France). The lowest infant mortality rate is enjoyed by Hong Kong, which at 2.97 is a little more than half of Collin County's.

Yet instead of being shocked into action by these numbers of infant deaths, the focus of the Commissioners Court is on reporting diagnosis codes and social security numbers.

Shame on us all!

Bill

Collin County grants require some data on patients
Collin tells clinics grant funds can't be spent on illegal immigrants

Saturday, December 1, 2007
By ED HOUSEWRIGHT / The Dallas Morning News

When Collin County commissioners awarded almost $300,000 in grants to nonprofit health care agencies this year, the money came with strings attached.

Clinics were told they can't spend the money to treat illegal immigrants. They also were ordered to report patients' personal information, such as name, age, address, medical diagnosis and the last four digits of each person's Social Security number.

Now, some clinics are balking, saying the requirements – a first in the five-year history of the grant program – are forcing them to violate patient confidentiality rules and play the role of immigration officer.

One recipient, the Children and Community Health Center of McKinney, already has rejected its $30,000 grant, and others may follow.

"We are not going to release information that will tie patients directly to a diagnosis code or the clinic," board member Michael Mixson recently told county commissioners. "That's protected health information."

read more ....

State forfeits health foundation’s charter
By Brandi Hart, McKinney Courier-Gazette
Wednesday, November 28, 2007

The Collin County Health Care Foundation is still operational even though its state charter has been forfeited by the State Comptrollers of Public Accounts Office in Austin.

The foundation’s charter was forfeited Aug. 22 of this year because the comptroller’s office did not receive a periodic report from the foundation this year, said Jana Watts, who works in the franchise tax office of the comptroller’s office. The registered agent was listed as former county judge Ron Harris on the comptroller’s Web site http://ecpa.cpa.state.tx.us/coa/servlet/cpa.app.coa under the corporation search tool. The foundation’s status with the comptroller’s office was also listed as “not in good standing.”

Collin County Auditor Don Cozad said after the commissioners’ court meeting Tuesday that he approved a payment last month to have the charter reinstated. He said he would look into getting the registered agent for the foundation changed from Harris to Keith Self, the current county judge.

The foundation is tax-exempt and once the charter is reinstated, the foundation’s status with the comptroller’s office should once again be listed as in good standing.

Tuesday's Commissioners Court meeting never seemed like it would end.

The meeting began at 1:30 PM, with a full house but it was after 6:00 PM before they finally adjourned before an empty gallery.

Most of the attendees were county employees there to see the debate over longevity pay. (See "Collin County workers' longevity pay cut back")

But many were there to hear how the court would deal with the growing discontent with the county's indigent health care grants. Last week, I reported on the McKinney Children's Clinic's refusal to accept the county's grant reporting requirements.

The McKinney clinic objected to the county changing the rules after the grants were awarded - specifically the requirements that the clinics report the full name, address, diagnosis code and last 4 digits of the social security number for each patient served. The clinic also protested the new policy of reimbursing for illness, not for "well-patient" visits.

In a surprising development, Candy Blair, the county health care administrator, told the commissioners that she had received a legal opinion that cast doubt on whether the grant program was legal.

After a protracted debate on immigrants, social security numbers, diagnosis codes and HIPPA, the commissioners seemed to agree that they wanted to insure that none of the grant funds were spent on illegal aliens. The court then agreed to go into executive session with their lawyer to discuss the legal aspects of the grant process.

At 6 PM, the court reconvened and the court voted on revising the grants -

1. Require only the 2007 documentation for the period from October 1 to December 31, 2007

2. Void and rewrite all grants for calendar year 2008, changing them from a "fee for performance" grant to a provider agreement contract. The contracts would redefine the grants to be more like an insurance system type "fee for service" arrangement. The contracts, called "Business Associates Agreements" would include the reporting requirements, and a HIPPA disclosure form be submitted for for each patient visit.

Left unanswered was the suggestion of a committee made up of clinic leaders and county officials that would try to resolve the clinic's concerns.

In one long meeting, the county commissioners managed to screw up their employee benefit package, without addressing the underlying morale issues, and screw up the indigent grant program, again without addressing the underlying dissatisfaction with the program.

The employees came out losers.
The charitable clinics and their volunteers were losers.
The poor and sick children were big losers.

Bill

the bio-terrorism squad?

Our County Commissioners occasionally let us see exactly what they think of poor folks and their health care in Collin County.

Tuesday, the Commissioners (meeting as the Health Care Trust Fund Trustees) will vote on a proposal to require the trust fund to grant free rent to the county's bio-terrorism department.

It seems the bio-terrorism folks lost their grant, and instead of budgeting some of the hundreds of millions of dollars in county surplus, the commissioners want the poor to pay their rent through December, 2008.

The rent payments for the 14 months are approximately $10,000.

I've always wondered about conflicts of interests between the trust fund and the county. The trust fund was created from the sale of the county's public hospital 24 years ago, and is dedicated to providing funds to support indigent health care. The trustees of the fund are the county commissioners, and the trust fund owns buildings the county rents.

The lease between the Bio-Terrorism Department and the Trust Fund is signed by Keith Self as lessor, and Keith Self as lessee.

Lease Amendment between Bio-Terrorism & The Trust Fund
(click to download pdf)

Last year, the commissioners refused to allow a private passport expediting company to renew their lease on the fund's Plano building, because the county has a passport service there. They claimed the public found 2 passport operations in the same building confusing, but made no mention that the county's operation was run by Commissioner Hoagland's wife. So to keep the County Passport office and staff happy, the trust fund gave up the lease payments from the private firm.

Now this year, we have the bio-terrorism department wanting $10,000 free rent. Who's next?

The county has allowed federal and state grants to finance a huge growth in the Homeland Security and Bio-Terrorism departments. Bio-Terrorism alone budgeted and employed 12 people last year. In fiscal 2007, these 2 operations spent millions of dollars in grant money. As the grants wind down, who is going to pay the bills?

In this case, it could be the Health Care Trust Fund...and that is just plain wrong!

Bill

Sometimes, Ed Housewright gets it right. I was at the NTBHA's town hall meeting, so were 3 readers of this blog, so was Ed. That was it, folks.

Indigent mental healthcare in Collin County, and for that matter, in Texas is in great need of state dollars. Texas ranks 48th of the states in per capita public mental health spending, and the North Texas region ranks near the lowest in Texas. Our commitment to those who need care is among the lowest of the low.

"Fortunately, a lot of people with mental problems have families that help them access the system... For those who do not, I don't know how they survive. If they are not on their medication, those are probably the people who end up in jails."
Commissioner Phyllis Cole

Those poor in our county who need mental health services are likely to end up in jail or homeless - or possibly hurt themselves or others.

The effects of our inability to provide decent care are profound for our community, and for those who suffer.

Bill

------------------------------------------

Collin County's mental health care merits public debate

Sunday, November 25, 2007
Ed Housewright/The Dallas Morning News

Ross Galvan made straight A's in high school, quarterbacked the football team and never got in trouble.

Now Mr. Galvan, who is 21, sits in the Collin County Jail. He's become a frequent guest over the past 18 months – thanks to three felony charges and three misdemeanors.

His mother, Jill Galvan of Plano, doesn't make excuses for Ross. He did the crimes, and he deserves the time, she says.

But Ms. Galvan thinks she knows why Ross' life took a dizzying nosedive: mental illness. Two years ago, Ross was diagnosed with bipolar disorder, a condition marked by extreme highs and devastating lows.

He's been in and out of jail since then, and he's never consistently taken medication that could smooth out his moods and his behavior, Ms. Galvan said.

"It's been a nightmare," she said.

Medical treatment has become a front-and-center issue in Collin County. County commissioners get lambasted by some for not spending more to treat the poor.

But at least a debate has begun.

Mental health care – that's a whole other story. I've covered Collin County government for almost five years, and I've heard mental illness mentioned at a public forum maybe two or three times.

Indigent medical care, by contrast, has drawn hundreds to rowdy town hall meetings.

What's the deal?

Experts will tell you severe mental illness can be just as debilitating as physical illness. And yet publicly funded treatment never seems to merit discussion.

Here's an example. I attended a public hearing last week on accessing mental health treatment – the first I can remember.

The meeting took place at 6 p.m. at the courts building on University Drive in McKinney – a convenient time and place.

A grand total of four people attended. Well, I made five.

Talk about apathy.

Two officials with the publicly funded North Texas Behavioral Health Authority were prepared with several handouts. Despite the abysmal turnout, they spoke for more than an hour. They talked about the provider network and the different types of care that are available.

It's too bad more people didn't hear the information.

Collin County Commissioner Phyllis Cole, a longtime advocate for better medical care, thinks mental health care deserves more attention and funding.

"Fortunately, a lot of people with mental problems have families that help them access the system," she said. "For those who do not, I don't know how they survive. If they are not on their medication, those are probably the people who end up in jails."

read more....

If they gave a prize for the most misleading headline, The McKinney Courier-Gazette would win it, "hands down" for its Saturday coverage of healthcare in Collin County.

Courier-Gazette reporter, Stefanie White wrote the article headlined, Collin bests state in child healthcare, which covered the annual "State of Texas Children" report issued by the Austin think tank, The Center for Public Policy Priorities

The CPPP's report states that Collin County has the lowest poverty rate and the highest median income in Texas - not that it has the best "in child healthcare" as the Courier-Gazette's headline touts.

According to the CPPP, in Collin County:

* The poverty rate is up, with 36,000 poor in 2004

* The child poverty rate is up, with over 11,000 in 2004

* Unemployment is up

* While teen births are down, births to unmarried teens is on the increase

* Infant mortality is up.

* Low birth weight babies are more common

* Child abuse rates are up, with the number of confirmed cases over 1,000 in 2006

* the number of children living in battered women's shelters is up

The CPPP's report does clearly show that Collin County is Texas' richest, yet it has a long, long way to go to meet the needs of our most vulnerable citizens.

The McKinney Courier-Gazette article, "Collin bests state in child healthcare" is here.

The Collin County fact sheet from the CPPP's The State of Texas Children 2007 report is here.

The entire The State of Texas Children 2007 report is here.

The Center for Public Policy Priorities homepage is here.

Bill

McKinney Children's Clinic refuses county grant
Court plays power games - several other charitable clinics upset

"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 Children & Community Health Center of McKinney has declined to accept a $30,000 grant from the Collin County Health Care Trust Fund. In a letter to the county dated November 5, CCHC President Mary Cummins wrote, "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."

The CCHC accuses the county of changing the rules after the grants were awarded. Specifically, the CCHC objected to the county's position that they would reimburse only for sick visits not for 'well patient visits'. The CCHC letter also objects to the county requiring the clinic report social security numbers and illness diagnosis codes for all visits.

Ms. Cummins wrote that, "it is not clinic policy to require social security numbers." and "that patient confidentiality is irreparably broken by ... submitting patient diagnosis codes.".

click on image to download the letter from Mary Cummins or memo from Candy Blair

In a memo to the Commissioners, Collin County Health Care Services Manager, Candy Blair wrote that, "Comments and concerns have also been expressed by Frisco Cares, Plano Children’s Medical Clinic, the Assistance Center of Collin County and the Adult Clinic."

Ms Blair also revealed that, "As of November 13, 2007, we have not received signed contracts from Frisco Cares and the Assistance Center of Collin County.". It is unclear what the reasons are why Frisco Cares and the AACC have not completed the grant acceptance paperwork.

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 - one, The Children & Community Health Clinic of McKinney, has refused the grants, and 4 have expressed concerns over the increased reporting requirements. Two of those 4 have yet to accept the grants.

Last year, the Commissioners did increase the reporting required by the clinics. The new requirements include that each patient report the last 4 digits of their social security number.

The new guidelines acted to discourage block grants, substituting a "pay for service" grant system whereby the charities would be reimbursed for each client served. The requirement that social security numbers be reported effectively limits grant money to documented, legal residents old enough to have a social security card and who have the card.

The CCHC letter and other documents were enclosed in the Commissioners packet distributed to them in anticipation of the Health Care Trust Fund Board meeting on Tuesday, November 27.

While the court fiddles, children still get sick and clinics go broke.

Bill

The North Texas Behavioral Health Authority (NTBHA) is the Local Behavioral Health Authority for Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall Counties.

NTBHA was created by the Commissioners Courts of each of the seven counties to oversee the managed behavioral (mental health and chemical dependency) healthcare service delivery system which serves persons eligible for Medicaid and/or public behavioral health funds in the NorthSTAR Region.

Town Hall Meetings
Town Hall meetings focus on stakeholder input for regional planning. Join us to learn about efforts to improve mental health and chemical dependency services. Your input is greatly needed on the following:

What is working now?
What can be improved?
Your community needs?
Ideas to improve the mental health and chemical dependency system of care.

Local Planning Town Hall Meeting, November 19, 2007
Collin County
University Drive Courts Facility
Location: 1800 N. Graves St., Suite 300, McKinney?, Texas 75069
Time: 6:00 p.m. to 8:00 p.m.

I'll be there. If you care about the mental healthcare system for the poorer and uninsured in Collin County, then you should be there too.

Bill

The article doesn't mention that Vermont, under the leadership of Gov. Howard Dean, enacted a sweeping program that guaranteed medical insurance for all of Vermont's children. Is that investment paying off?

Will Texas ever figure it out?

Read the 2007 American Health Rankings here

Bill

--------------------------

DMN - Vermont residents are healthiest, Texas ranks 37th
Monday, November 5, 2007
The Associated Press/ The Dallas Morning News

Texas came in 37th in the 2007 America's Health Rankings, which lists the nation's states from the most to least healthiest when it comes to people and medical-related issues.

The United Health Foundation produces the annual report in partnership with the American Public Health Association and Partnership for Prevention. Texas held the same spot in last year's report.

Vermont topped the list as the healthiest state in this year's report. Minnesota, Hawaii, New Hampshire and Connecticuted round out the top five.

Mississippi, Louisiana, Arkansas, Oklahoma and Tennessee ranked as the least healthy states.

The report states that the nation's overall health declined over the past year, despite modest gains in reducing the rates of cancer and cardiovascular mortality.

Campaign would help insure 92,000 Texas children

Thursday, November 1, 2007
By SHERRY JACOBSON / The Dallas Morning News

State Rep. Helen Giddings and a band of Dallas County officials launched a campaign Thursday to find 92,000 Texas children to fill in the ranks of the state's Children's Health Insurance Program or CHIP.

The Texas Legislature expanded CHIP by 127,000 children in the last session along with removing some of the controversial restrictions imposed from a previous session.

"The goal is to enroll all the eligible children in the area in CHIP," Ms. Giddings, a Dallas Democrat, said at a news conference announcing the Insure Every Kid campaign.

The state-federal program is designed to help working poor families that make too much money to qualify for Medicaid but not enough to afford private insurance

Link to story

Workers facing higher '08 health costs
Tuesday, October 30, 2007
By JASON ROBERSON / The Dallas Morning News

This year's open enrollment season will come with yet another jump in health care costs for Dallas-area companies – and another shift of more of those costs to employees.

Employees at companies from American Airlines to Wal-Mart should brace themselves for greater costs and higher deductibles.

In a new twist, some employers are even veering from the tradition of extending coverage to employees' spouses if those spouses are covered by their own employer's plans. An increasing number is either denying such spouses coverage or charging extra.

Dealing with the effect of higher health care costs is driving companies to make such changes. While the two big consulting companies that study health costs differ on specifics, both agree rates are bumping up again in 2008.

read more....

THIS IS GOING TO HURT

* 7% 2008 increase in employer health care plan costs
* 45% Increase in employer health care plan costs, 2003-2008
* 59% Increase in employee-paid portion, 2003-2008
* $9,312 Average cost, 2008 employer health care plans
* $2,040 Employee-paid portion, 2008 health care plans
* Under 4% Average expected 2008 employee raises
* 8% Rise in employee-paid portion of 2008 health care plans

SOURCE: Towers Perrin, Stamford, Conn.

Dallas Morning News reporter Ed Housewright doesn't get it.

Commissioner Jerry Hoagland certainly doesn't get it.

...and I'm starting to think that County Judge Keith Self doesn't get it.

So let me use simple words to explain it - Ed, Jerry, listen carefully, "There are poor people in Collin County"

In a Sunday article about the "AirCheck Texas" program, Ed Housewright wrote, "Good idea, but Collin County – the state's richest county by household income – doesn't have enough poor people."

The same article quotes Jerry Hoagland as saying, " "It's another Robin Hood-type program that's been implemented by the state of Texas.".

So Ed and Jerry here are some numbers for you (courtesy of the US Census Bureau):

22,000 families in Collin County have a gross income of less than $35,000. That's about 13% of the county's families. These families get by on less than 200% of the federal poverty level.

6% in Collin County live below the federal poverty level. These 28,000 people are the poorest of the poor. Of these, almost 12,000 are children.

We know from the Healthcare Task force study last year, that 20% of County residents don't have health insurance.

And we are now reading, in the Dallas Morning News, of horrendous living conditions, crime and government indifference to the plight of poor folks living at the Sugar Hill project in McKinney?.

So Ed and Jerry, What part of poor don't you understand?

Bill

Being the richest county in Texas does not mean that Collin County doesn't have poor and underpriviledged citizens.

Last year's healthcare task force brought this lesson home when it noted that over 6% of our residents live below the poverty level, and that 20% have no health insurance.

Thursday, the Plano Star Courier printed 2 articles by reporter Lynn Proctor Windle. The first, Graduates not guaranteed work told the story of a Plano resident and single mom who, despite a college education, has never earned more than $17,000 a year.

The second article, Just ‘getting a job’ doesn’t always change lives of low income describes the Family Self Sufficiency program at the Plano Housing Authority. The four-year-old program offers hope to its clients that their lives can get better with “lots of hard work".

Last week it was reported that The Samaritan Inn, Collin County's only homeless shelter, has been full (capacity is 120) for over six months.

While most of us here might be fortunate, we must not forget those among us who are not.

Bill

------------------------
link to Graduates not guaranteed work

link to Just ‘getting a job’ doesn’t always change lives of low income

Frisco Cares Children’s Clinic provides care for children without insurance

By Penny Rathbun, Staff writer/Frisco Enterprise
Friday, October 12, 2007

Four-month old Jessie Kennedy was not happy once she realized she was being stuck with needles, but she quickly recovered.

Her mom Kelly Kennedy of Little Elm had brought Jessie earlier this week to the Frisco Cares Children’s Clinic to receive free immunizations.

Every second Wednesday of every month the clinic provides free immunizations to children who do not have medical insurance.

In a separate effort the clinic provides free medical care to children without medical insurance who live in the Prosper, Celina or Frisco areas or who live in Plano or McKinney? and attend a Frisco school.

The clinic was started two years ago as a Frisco Leadership project. At first it was run in a van outside of the Acker Special Programs Center. The bus had so many mechanical problems the clinic had to be moved. Now the clinic is run from the Primera Iglesia Bautista church at 8581 5th Street in Frisco. The pastor’s wife, Ivette Ruiz, is the one who suggested the clinic use church space.

Patients and their parents start lining up in mid afternoon on Wednesdays to be seen by one of two doctors beginning at 6 p.m. In rooms that are otherwise offices or Sunday school rooms the two doctors have set up makeshift offices and treatment space. Doctors Paul Reyes and Beatrix Bansal are both M.D.s and pediatricians.

read more....

Study: Medical care for children often falls short
Doctors score low on preventive steps, tests for seriously ill infants

Thursday, October 11, 2007, The Dallas Morning News
From Wire Reports

MELVILLE, N.Y. – Children are not faring well in the health care system, a team of researchers reports today in the largest analysis of its kind.

The study, published in the New England Journal of Medicine, concludes that overall, doctors gave children the appropriate outpatient medical care only 47 percent of the time.

"They got an F," said Dr. Joseph Hagan, a Burlington, Vt., pediatrician. Dr. Hagan co-edited the American Academy of Pediatrics' latest update to its children's health guidelines, due out later this month.

"It's sad, but I think it reflects some unpleasant realities about our current health care system or, I might say, non-system," Dr. Hagan said.

The report, by the Seattle Children's Hospital Research Institute and the nonprofit Rand Corp. research group, is the first comprehensive look at children's health care quality. The findings are particularly troubling because nearly all the 1,536 children in the nationwide study had insurance.

Eighty-two percent were covered by private insurance. Three-quarters were white, and all lived in or near large or midsize cities.

Experts said minority children, those with more restrictive government insurance, and the millions with no insurance at all certainly fare even worse.

read more....

Following through on their July decision, yesterday the commissioners budgeted funds for grants to 11 charitable organizations and clinics.

These groups provide health care services to poor and indigent citizens of Collin County.

Budgeted were "fee for service" grants (these grants pay a predefined amount per patient or visit. The patients must be pre-qualified and the grant amount is the maximum total amount the county will reimburse):

Prescription assistance to low-income citizens:
$11,000 to the Assistance Center of Collin County
$6,000 to the Allen Community Outreach
$4,000 to the Community Lifeline Center
$6,000 to Frisco Family Services

Surgical Procedures and medication for breast cancer patients:
$47,233 to the Collin County Bridge Breast Network.

Health care visits for uninsured and low income citizens:
$30,000 to the Children and Community Health Clinic in McKinney?
$31,980 to the Collin County Adult Clinic
$50,000 to the Plano Children's Medical Clinic
$11,000 to the Frisco Cares Children’s Clinic

Post hospitalization monitoring and assistance for senior citizens:
$38,024.90 to the Maurice Barnett Geriatric Wellness Center, Inc.

Meals on Wheels:
$40,000 to the Collin County Committee on Aging.

Last July, the commissioners also approved a $24,750 grant to the Journey Home, a hospice center. Unfortunately, the Journey Home has ceased operations.

As usual, Jerry Hoagland cast the lone dissenting vote on all the grants. This year, he couldn't even blame illegal aliens, since the clinics agreed to only submit fee for service vouchers for citizens.

Bill

Immigration inaction is muddying waters of Parkland debate

Dallas Morning News
Tuesday, October 9, 2007

In the debate about Parkland Hospital picking up the tab to treat residents of nearby counties, there may not be a redder herring than illegal immigration.

And yet it was that topic more than any other that stalled a recent discussion among North Texas leaders on the subject. The longer Congress waits before passing a comprehensive immigration reform bill, the more times the immigration issue will muck up debates like this.

That's not to say that creating a regional safety net is simple. It's not. But there are steps counties could take toward a more equitable sharing of the public health care burden in North Texas.

For example, Collin County has made indigent care available to more people by raising its income limit to 100 percent of the federal poverty level. Shamefully, Texas requires counties only to define someone as indigent if that individual makes less than 21 percent of the poverty limit. Dallas County goes even further, defining indigent as 200 percent of the federal poverty level in order to maximize federal matching funds.

read more....

Collin is top hospital debtor
Parkland says counties outside Dallas owe $25M in indigent care

Saturday, October 6, 2007
By ED HOUSEWRIGHT / The Dallas Morning News
ehousewright@dallasnews.com

Parkland Memorial Hospital provided more than $25 million in unreimbursed care last year to residents outside Dallas County, and like in years past, Collin County rang up the largest unpaid tab, Parkland records show.

Collin County residents accounted for $5.7 million in care provided by Parkland. Tarrant and Denton counties together accounted for $6.2 million, statistics show.

Parkland officials said the numbers reinforce a need for counties to give more money to the hospital. But some officials, including those in Collin and Denton counties, said their constituents are not willing to pay more for health care.

read more....

This last Monday was the first meeting of a task force on regionalizing indigent health care in North Texas. The task force is made up of all the county commissioners, CEO's of non-profit hospitals and State Representatives in the 19 county Health Region 3.

The mission of the committee is to report to the legislature on region-wide approaches to providing indigent health care.

While much of the discussion at the first meeting was constructive (and enlightening), I was put off by Rep. Jodie Laubenberg's opening statement that no members of the public would be permitted to address the committee.

I spoke to Ms. Laubenberg after the meeting and she repeated that there would be no opportunities for public input. I then wrote her the following letter. Her reply follows.

From: Bill Baumbach
Sent: Wednesday, September 26, 2007 1:03 AM
To: Jodie Laubenberg
Subject: Regional Health Care Task force

Ms. Laubenberg,

I want to revisit the conversation I had with you after the Task Force meeting on Monday.

I mentioned that I thought the Task Force had made some progress towards bringing together some of the different stakeholders in Health District 3. I asked you to have your office update me on future meeting schedules and agendas.

When I said that I was looking forward to the public hearing phase of the Task Force meetings, you replied that there would be no public hearings - that the purpose of the Task Force was to allow only "policy makers" to participate.

You further asserted that HB 3154 made no provision for public hearings.

I must respectfully disagree and protest.

First, Section 1 (b) of HB 31254 (as signed by the Governor) contains the following language - "(b) The regional health care systems review committee is created to conduct public hearings regarding, and to study the implications of, implementing regional health care service to address indigent health care in the region."

Section 1 (d) begins with the following -
"(d) In conducting hearings and studies,..."

The "Bill Analysis", written by the Senate Research Center re-states the language of the bill - "(b) Provides that the regional health care systems review committee is created to conduct public hearings regarding, and to study the implications of, implementing regional health care service to address indigent health care in the region."

I think the meaning of the Act is clear. The Task Force is to hold public hearings. In fact, by being listed first, I would maintain that holding hearings is it's PRIMARY purpose.

Second, You stated that only policy makers would be allowed to participate. I believe that creates a fundamental unfairness. Notably absent on the Task Force are 3 major stake holders who should be included in the discussion:

1. the indigent

2. private and charitable clinics already providing care

3. the taxpayer who will ultimately pay for any changes or lack of changes.

Rep. Laubenberg, I ask you to reconsider your position on holding open meetings, and I ask you to publicly publish schedules and agenda for the Task Force.

I look forward to your reply,

Respectfully,

Bill Baumbach

From: Jodie Laubenberg
Sent: Thursday, September 27, 2007 3:06 PM
To: Bill Baumbach
Subject: RE: Regional Health Care Task force

Bill,

Thank you for your email. Please let me clarify the issue. I was the author of HB 3154. I know the intent and purpose of this legislation. All meetings are open to the public. However, because there is no specific legislation filed, there will not be outside testimony beyond the parameters of those participants as outlined in HB 3154.

Sincerely,

Jodie Laubenberg

Laubenberg is wanting to use tired old "good old boys" tactics to solve the real human issues of health care for our poor and uninsured. These meetings need to be advertised and they need to allow for public input.

Bill

EDITORIAL

Dialogue on health care for indigents will help reconcile differences in view

12:00 AM CDT on Thursday, September 27, 2007
Dallas Morning News - Collin County Edition

Monday's meeting of health care officials and elected leaders could have easily devolved into a Parkland vs. Collin County battle. That it didn't says a lot about Collin County Commissioners Phyllis Cole and Jerry Hoagland, County Judge Keith Self and Parkland Health & Hospital System CEO Dr. Ron Anderson.

These people are among the major players in discussions about a regional solution to indigent health care in the future, and you get the sense from hearing their concerns that if they were locked in a room together for a weekend (or maybe a week), they would emerge with a solution.

But, alas, two major obstacles stand in their way:

• Politics. Although Collin County has stepped forward on the issue of indigent care, other North Texas counties seem oblivious to the growing problem. The Ellis County judge flat-out questioned whether indigent care is an issue at all. After all, his county has a charity clinic that seems to be doing pretty well, he says. That's nice, but Ellis County accounts for 11 percent of the $26 million that Parkland spends treating out-of-county people who don't pay to keep its lights on. Collin County, as we've noted before, accounts for 29 percent of that out-of-county cost.

But in Collin County, at least, officials worked closely with Parkland on reimbursing Dallas County taxpayers for treating people who qualify under Collin County's rules. What's more, they've changed those rules to expand the pool of people who can benefit. Collin County also has entered partnerships with nonprofits and other clinics to expand access to care within its own borders.

Dr. Anderson praises all these efforts and the fact that Collin County conducted a study to determine its needs. Others might be more likely to work with Parkland as Collin has if they understood the needs of their community better. But too many elected leaders in other counties see the shifting demographics of North Texas and the growing need for indigent care as little more than a Parkland problem.

• Differences. While others lag behind what Collin County has done and probably lack the political will to go even half as far, there remain serious differences between Parkland and Collin County.

These differences are fundamental: Parkland serves anyone in need. Collin County serves those who qualify, but focuses with a healthy dose of skepticism. Collin County leaders are suspect of anyone who would accept a handout. Where Parkland sees patients, Collin officials see potential for fraud and abuse.

There are other issues about who should qualify for care, what kinds of services should be offered and how the cost should be shared, but this fundamental difference in views is the major stumbling block. It's messy, it's wrapped up in the debate over immigration, and it won't be overcome easily.

But if both sides can find a way to unclog emergency rooms and steer people instead toward efficient, low-cost care, access to quality health care can improve for all North Texans. That's a worthy goal, and we look forward to the coming public hearings called for by the Legislature. If officials keep talking, we're confident they can find a solution.

DMN Suburban Editorial Board

Taxpayers foot Parkland AIDS bills for indigent nonresidents

Contract ties federal funding at hospital to HIV treatment for needy in 24 counties

11:38 PM CDT on Tuesday, September 25, 2007
By SHERRY JACOBSON / The Dallas Morning News

About 350 indigent AIDS patients who don't live in Dallas County left behind about $283,000 in unpaid medical bills at Parkland Memorial Hospital last year.

The hospital's board of managers was told Tuesday about Dallas County taxpayers footing the out-of-county bills.

"Can't we send those counties a bill?" asked board member Wendy Lopez.

Hospital officials said they could not, because Parkland had contracted with the federal government to provide AIDS-related care to indigent patients in a 24-county area of North Texas.

A majority of the 4,300 AIDS patients served by the program were from Dallas County. Roughly a third of the county's AIDS caseload is handled by Parkland.

Last year, the Dallas public hospital received $7.6 million in federal grants and $11 million in other payments, including Medicaid and Medicare, for providing HIV/AIDS care. Dallas County taxpayers kicked in $5.1 million.

Dr. Ron Anderson, Parkland's president and chief executive officer, noted that AIDS care has become another medical service that neighboring counties have shifted to Dallas County over the years.

"It is a regional issue, just like mental health and trauma," he said of Parkland's efforts to be recognized as a regional hospital that required broader tax support. "But we do get additional federal funds that make up some of the difference."

read more....

Lisa Virgoe of Lucas: Can we afford it?
Fewer families make enough to pay for the Collin lifestyle than you might think
Dallas Morning News Community Opinions
11:17 AM CDT on Friday, September 21, 2007

Can you afford to live in Collin County?

According to the Center for Public Policy Priorities, the minimum annual salary needed to sustain a family of four in North Texas is $43,723. Their study used averages across the metroplex, which is a large, economically diverse region. So I wondered what the minimum salary would be to sustain a family in our county. The results aren't pretty.

After making adjustments specific to Collin County and for increased taxes owed, I found that mom, dad and their two kids would be eking by on an income of $49,000, assuming they had employer-paid health benefits. If not, they needed to earn $59,000.

That's assuming, as the study did, that they lived in a two-bedroom apartment. CPPP allotted a paltry $404 for transportation costs. In our county, where the typical commute to work is about half an hour, that's not going to cover gas and insurance – or a loan payment.

Let's be clear. Families with income this low aren't living in houses with yards, taking annual vacations, or splurging at Gymboree. With a mere $334 a month to cover utilities, cleaning supplies and school expenses, they don't have those luxuries. Scariest of all, they're saving nothing. Nothing for retirement. Nothing for college. Nothing for emergencies.

But the median Collin County family income in 2005 was $75,709. Most families are doing fine, right? Wrong.

In our county, where few adults can rely on public transportation, most families have at least one car payment. If you add in minimum savings for retirement and college, and costs incurred by owning a modest home, required family income climbs to $86,000.

If the median income is $76,000, fewer than half of Collin County families earn enough to cover realistic expenses. And I based my estimate on a $150,000 house, a rare find, but doable. Consider this. In July 2007, the median selling price for a Collin County house was $207,200, and the average was $253,600.

But what if you don't pay for child care, budgeted at $927 in the study? It's difficult to imagine having no child care costs at all. Even when parents stay home, families pay for anything from Mother's Day Out to preschool to summer camp.

Experts also say that before one parent contemplates leaving a job, the family should have enough cash to cover at least six months of expenses in case of layoffs, illness, divorce or disability. That's in addition to retirement and college savings. According to my estimate, that's roughly $35,000.

Most families in our county can't afford to lose any extra wages, not when they need $86,000 to sustain a modest lifestyle – without luxuries like entertainment or dance classes. Certainly, it's possible to survive on less. For example, you can forgo saving for retirement or college. To skip saving for college, you need $20,000 per child invested at birth, $40,000 for two kids.

How many families have an extra $75,000 in assets during their childbearing years?

We live in the most expensive county in Texas. While there are many Collin County families doing well financially, my concern is for the people who aren't. Since our housing prices are up 5 percent over last year despite the subprime mortgage crisis, there's no reason to expect our county's status to change.

Each family has to make its own financial choices. But if being middle class means a house, two cars and kids dreaming about the University of Texas, more than half of Collin County residents are falling short.

Lisa M. Virgoe is a resident of Lucas and a Voices of Collin County volunteer columnist.

A healthy discussion
Dallas Morning News Community Opinions
Regional talks should focus on finding a just, fair solution, says BILL BAUMBACH of Wylie

12:00 AM CDT on Thursday, September 20, 2007

In the Bible, the devil's name is legion, but in the Collin County Commissioners courtroom, the evil one has a name – Dr. Ron J. Anderson.

He is no devil. What he is, to the chagrin of Collin County commissioners, is a doctor who treats the sick and injured people who come to his hospital. Dr. Anderson is the president and CEO of Parkland Hospital in Dallas.

Collin County Commissioners believe he is a demon who wants to swallow entire county budgets in a quest for a regional hospital district.

Unfortunately, many of those who do come to his hospital are the poor and uninsured from suburban counties, such as Collin. Dallas County taxpayers naturally do not want to pick up the tab for counties who won't pony up for a hospital. And Collin County commissioners shudder at the thought that they should pay the bills for their poor.

A few years ago, Commissioner Phyllis Cole told the Houston Chronicle, "Parkland believes anybody who shows up should get health care. It's not our problem they don't qualify patients before they admit them. I wish they would get off my back."

The sad fact is that often the uninsured and poor have nowhere else to go. So they show up at Parkland or other large public hospitals paid for by the citizens of those hospital districts. In 2006, Collin County residents left Parkland with more than $4.5 million in unpaid bills.

The public hospitals want help in meeting needs they believe are being shirked by suburban counties; the suburban counties live in terror of facing a bottomless pit of uncontrollable medical bills.

Last year the Legislature passed HB 3154 to begin a public discussion on the health care needs of those not served by a public hospital. In a statement filed with the bill, its author, Jodi Laubenberg of Parker wrote, "Much discussion of late has centered around the regionalization of indigent health care throughout the state. However, the discussion should include both public hospitals and local county officials.

"While regionalized health care is a possible solution to the state's indigent health care situation, all options should be explored. HB 3154 encourages such a study by establishing a regional health care systems review task force, which would include the local county governments and county hospitals."

HB 3154 calls for a regional conference made up of all county commissioners, county judges, state legislators and all public and private hospital administrators from the 19-county Texas Public Health Region 3. This committee will act as a task force, holding public hearings and then issuing a report by September 2008.

The first meeting of this committee is scheduled for Monday, from 8 to 11 a.m., at the McDermott? Suite on the UT-Dallas campus in Richardson

Of the hundreds of participants invited to be part of this, only two are from public hospitals – Dr. Anderson and Dr. David Cecero from John Peter Smith Hospital in Fort Worth.

Dr. Anderson is probably up for the job, though. He has been named one of the most "powerful people in health care" by several magazines and journals, has served on the executive committee of the State Task Force on Indigent Health Care and, in 1985, played a major role in the passage of landmark legislation concerning indigent health care in Texas.

I hope you can make plans to attend this historic first meeting of politicians and doctors. I'll be there, and I'll be praying the committee finds a path of compassion, wisdom and justice.

Bill Baumbach is a Wylie resident and was the Democratic candidate for Collin County Commissioners Court, Precinct 2, last year. His e-mail address is bill@baumbach.org.A version of this column appeared on Mr. Baumbach's blog, The Collin County Observer.

In the bible, the devil's name is Legion, but in the Collin County Commissioners courtroom, the evil one has a name - Ron J. Anderson, M.D.

He is no devil. What he is, to the chagrin of Collin County Commissioners, is a doctor who treats the sick and injured people come to his hospital. Dr. Anderson is the President and CEO of Parkland Hospital in Dallas.

Collin County Commissioners believe he is is a demon who wants to swallow entire county budgets in a quest for a regional hospital district.

Unfortunately, many of those who do come to his hospital are the poor and uninsured from suburban counties, such as Collin. Dallas County taxpayers naturally do not want to pick up the tab for counties who won't pony up for a hospital. And Collin County Commissioners shudder at the thought that they should pay the bills for their poor.

A few years ago, Commissioner Phyllis Cole was quoted saying,"Parkland believes anybody who shows up should get health care. It's not our problem they don't qualify patients before they admit them. I wish they would get off my back."

The sad fact is that often the uninsured and poor have no where else to go. So they show up at Parkland or other large public hospitals paid for by the citizens of those hospital districts. In 2006, Collin County residents left Parkland with more than $4.5 million in unpaid bills.

The public hospitals want help in meeting needs they believe are being shirked by suburban counties; the suburban counties live in terror of facing a bottomless pit of uncontrollable medical bills.

Last year the Texas Legislature passed HB 3154 to begin a public discussion on the health care needs of those not served by a public hospital. The bill's author, Jodi Laubenberg of Parker wrote, "Much discussion of late has centered around the regionalization of indigent health care throughout the state. However, the discussion should include both public hospitals and local county officials. While regionalized health care is a possible solution to the state's indigent health care situation, all options should be explored.

H.B. 3154 encourages such a study by establishing a regional health care systems review task force, which would include the local county governments and county hospitals."

HB 3154 calls for a regional conference made up of all county commissioners, county judges, state legislators and all public and private hospital administrators from the 19 county Texas Public Health Region 3. This committee will act as a task force, holding public hearings and then issuing a report by September, 2008.

The first meeting of this committee is scheduled for:

Monday, September 24, 2007
8:00 am to 11:00 am
at the McDermott? Suite
UT Dallas in Richardson

Of the hundreds of committee members, only 2 will be from public hospitals, Dr. Anderson and Dr. David Cecero from JPS in Ft. Worth.

Ron Anderson is probably up for the job. He has been named one of the most "Powerful people in Health Care", has served on the executive committee of the State Task Force on Indigent Health Care and in 1985 played a major role in the passage of landmark legislation concerning indigent health care in Texas.

I hope you can make plans to attend this first, historic meeting of politicians and doctors. I'll be there and I'll be praying the committee finds a path of compassion, wisdom and justice.

Bill

Link: http://www.baumbach.org/Prima_Care1.pdf

Last year, in response to the Indigent Healthcare Task Force Report, Commissioner Joe Jaynes suggested contracting with PrimaCare to provide emergency and acute care to any Collin County citizen who's income was below the federal poverty limit.

The court agreed and budgeted $400,000 for 2007.

The PrimaCare? program was envisioned as a way to reach the thousands of poor and uninsured residents who were not served by the county's indigent healthcare plan. While US Census figures show that over 40,000 people in the county lived in homes with income below the Federal Poverty Level, the county's indigent plan was only assisting a few hundred.

Gone were the 12 page application forms, notarized signatures and the involved asset verification process. Applicants would merely have to show citizenship and that their income met the guidelines in order to receive treatment. While the PrimaCare? program was not designed to meet the long-term and chronic needs of our poor, it could act as a part of a comprehensive health plan in treating acute injury and illness.

Seven months into the program, county records show that the program has begun to reach a larger share of our poor residents than the county indigent plan.

From January through July, the county paid PrimaCare? $110,170 for 958 patient visits at $115 each. The program was able to assist 882 people gain access to acute care. Children under 18 years old accounted for 282 visits, senior citizens for 24 - with the largest group served being adults between 19 and 62. Two thirds of those helped were female.

Only 46 claims were denied because of too high family income.

While the 958 patient visits is a dramatic improvement over the county indigent plan, it still dwarfs the over 15,000 patient visits to charity clinics in the county. It does not address chronic illness, hospitalization, prenatal or preventive care. But it is a good, solid step in the right direction, and should be continued.

The PrimaCare? program needs to be better publicized and referral procedures should be created to escalate those who need more care into the county indigent care plan.

I hope the county will budget to advertise and continue this program in fiscal year 2008.

Bill

The Primacare statistics are here

Link: http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/081007dnmetparkland.36ffe71.html

Parkland fights patients accused of lying about residency, income

220 patients under investigation for fraud

11:32 PM CDT on Thursday, August 9, 2007

By KIM BREEN and SHERRY JACOBSON / The Dallas Morning News
kbreen@dallasnews.com; sjacobson@dallasnews.com

Three hospitals in three counties turned Wendy Devineni away last year as she sought relief from the rare disorder that left her bedridden with headaches and vertigo.

Uninsured and desperate for spinal surgery, the Denton County woman lied about where she lived to qualify for charity care at Dallas' Parkland Memorial Hospital, whose primary mission is to provide indigent health care.

"When you're faced with the health problems that I was having and you're at the last straw, you're going to fight for your life," said Mrs. Devineni, who is 32.

But now that lie has come back to haunt her, and Parkland wants her to pay.

She is one of the first 220 patients under investigation on allegations of defrauding the hospital – and Dallas County taxpayers – by lying about where they lived or how much money they earned so they could get charity care.

After decades of having to look the other way, the hospital now has the tools to catch dishonest patients – including software that tracks financial information and addresses, and investigators who work full-time building fraud cases.

"The majority of it's a paper trail," said Lt. Rick Roebuck of the Dallas County Hospital District police force. "But there have been times when we've gone out, knocked on doors, and sat in the road and watched" to see where people lived and worked.

The first time the hospital used the technology to analyze patients enrolled in Parkland Health Plus, its charity care program, it flagged 12,000 cases of potential abuse.

Dallas County's elected leaders have been pressuring Parkland to do a better job of identifying patients who could afford to pay for their care; especially those who are middle-class and living in neighboring counties. Last year, local taxpayers were forced to pay about $25.2 million for out-of-county residents treated at Parkland.

Since last August, more than a dozen people have pleaded guilty to felony or misdemeanor charges, and agreed to pay their full hospital bills. Because most of the defendants have never been in trouble before, they received deferred adjudication. In such cases, a defendant doesn't have a conviction if probation is completed.

The hospital has received $228,535 in restitution payments so far from those and other pending cases. Full restitution on cleared and pending cases is expected to exceed $1.3 million.
Egregious deceit

Several are egregious examples of deceit, officials said, including a Southlake businessman who claimed to make just $8 an hour at a Subway sandwich shop, but in reality owned nine franchises. He also lived in a $500,000 house and drove a Mercedes, officials said.

He and his wife racked up $46,800 in charity care and paid it in full when caught. Neither could be reached for comment.

An Allen woman who owned a successful motel near Winstar Casinos in Oklahoma also claimed $119,000 worth of charity care, officials said. Her son said she was seeking treatment for breast cancer and had nowhere else to go. Officials said she wrote a check for $20,000 when she was caught.

"What we are trying to target are those people who demonstratively are defrauding the system because they have income and assets and businesses that they are not reporting," said Lincoln Monroe, a Dallas County assistant district attorney who is prosecuting the Parkland cases. He said the county is sending a message to people who might be tempted to deceive Dallas' charity hospital.

"To the residents of North Texas – if you defraud Dallas County, Dallas County will actively prosecute you," Mr. Monroe said.

"We do not want to make criminals out of noncriminals, but we do want people who have the ability to pay and are abusing the system to be held accountable."

Parkland does not turn away patients in need of immediate medical care, but it also must discern who is indigent and who is not. Along with finances and residency status, Parkland checks to see if patients wanting charity care have access to private health insurance.

Mr. Monroe noted that many small business owners choose not to provide insurance and instead direct employees to receive care at Parkland.

"There are businesses that do that, who openly make a choice, and that's not fair to the other citizens of Dallas County," he said.

Officials say the first patients who have been prosecuted share common backgrounds – most of them are middle-class, small business owners from Middle Eastern countries. They live in neighboring counties but claimed to live in Dallas County, sometimes using a business address as a home address. Several of the defendants are related or know each other, and investigators said they learned from their ethnic communities how to get into Parkland without paying.

"That is something that we have noticed," Lt. Roebuck said. "It is a lot of times a group of people or a certain community where they learn that this can occur."

An Allen businessman who spoke on the condition he not be identified said he and his wife went to Parkland because they had no insurance and a client told him he could get free care there. "I don't understand the American regulations," said the man, who was from Iran and was treated at Parkland for a brain tumor. His wife suffers from multiple sclerosis. Together, their hospital bills totaled more than $102,000.

They put a second mortgage on their house to pay the bill.

"Sometimes I go to Parkland now, but I pay cash," he said. He said he is now charged $140 to see a specialist, $1,750 for an MRI and up to $700 for lab work.
Nowhere else to go

Some of the targeted patients said they had nowhere in their own county to turn. In North Texas, only Tarrant and Dallas counties have tax-supported public hospitals, leaving few options for indigent and uninsured residents.

A Kaufman County woman, who also agreed to tell her story as long as she wasn't identified, said employees at a county clinic directed her to Parkland when she needed specialty care after a test indicated she could have ovarian cancer.

She provided a relative's Dallas County address as her own and was later caught. She said she is unemployed and uninsured and takes care of her disabled son. Cancer is common in her family, and her mother died from the disease.

"I'm sorry, but I did what I had to do to take care of my son," she said.

"I regret what I did, but any strong-willed mother would do this, I believe, in order to take care of her family."

She borrowed from her sister to pay the $3,537 bill.

About 80,000 patients are enrolled in Parkland Health Plus, which is paid for with county tax dollars. "We use the PHP as a payer of last resort," said Bob Reed, director of patient access at Parkland. Patients are also screened to see if they are eligible for other funding, such as Medicaid.

To qualify for PHP, patients can earn no more than 200 percent of the federal poverty level, or $41,300 a year for a family of four.

Patients are required to bring in documents to indicate where they live and how much they earn. In the past, it was difficult to detect dishonesty.

"What they showed us is what we believed," Mr. Reed said.
Better screening

But since 2005, patients seeking PHP enrollment are screened immediately during the application process using a national database. Addresses are verified, and if some parts of the application raise red flags, finances are checked as well.

"These tools give us the ability to ask reasonable questions," Mr. Reed said.

If someone claims to have no income, for example, a screener can now ask, "How do you have this auto loan?" said Beth Keating, financial counseling manager at Parkland.

Screening is now much more thorough, and people who are not eligible are prevented from getting into PHP, she said.

"I think we're doing a very good job of being responsible stewards of the county's taxpayers' dollars," Ms. Keating said.

Patients are also caught deceiving the system when they, for example, pay for a prescription with an out-of-county check. Sometimes, people are turned in by neighbors and exes, said Graciela Escobar, financial counseling supervisor.

That's how Wendy Devineni believes she was caught.

She said her saga at Parkland started last August, when she tried to get into the public hospital the legal way. But after admitting she lived in Denton County, hospital officials said she could only have the surgery if she paid for it, starting with a $20,000 down payment.

"It might as well have been a million dollars," said her husband, Hari Devineni, who last year earned about $25,000 running a Carrollton transmission shop. Mrs. Devineni is unemployed.

The surgery involved removing about four inches of her skull that was pressing on the top of Mrs. Devineni's spinal column. It could only be performed by a doctor specially trained in neurology and spinal surgery, and her research showed that there were two such doctors at Parkland.
Residency rule

The Devinenis recall that social workers told them repeatedly that she needed to be a Dallas County resident to qualify for care at Parkland.

"It was, 'Just get a residence, get a Dallas address,' " she said.

So they rented a house in Carrollton, paying an acquaintance $800 for one month, and turned on the utilities. Mrs. Devineni said she brought the lease agreement and utility receipt to Parkland, and within two months, doctors performed the surgery.

"After my surgery, I never went back to that hospital," she said. "I never had any prescription filled through them, I never went through any follow-up appointment, I didn't even go back to remove my stitches. I did not want to utilize anything other than what I had to, because we were afraid something like this might happen."

Mrs. Devineni said she wishes she had actually lived in the house, but never did, because it would have disrupted her family and she was too sick to handle the move.

Early this year, she got a call from an ex-husband saying Parkland was asking questions about where she lived. He told the hospital that she had never moved from Little Elm to Dallas County.

Later, Parkland informed Mrs. Devineni's lawyer that she owes $26,000. She has not yet been charged, but her case is under investigation. She hopes to avoid prosecution by setting up a payment plan.

Cases are not prosecuted when the patient has died, if the amount of care is less than $300, or if records provided clear the patient.

Lt. Roebuck said that for people who are charged with a crime, simply paying what they owe is only part of the equation. They also will be prosecuted, he said.

"We're not debt collectors," Lt. Roebuck said.

"They're taking away from the folks who really need it and are eligible to receive it," he said. "It's not a bottomless pit" of resources, he said.

The Collin County Commissioners Court has scheduled 2 public hearings to get citizen input into the fiscal 2008 county budget.

9:00 AM Tuesday, August 28
7:00 PM Tuesday, September 4

I'll be there.

Bill

FOR IMMEDIATE RELEASE
CONTACT: Michelle Patrick, Health Care Services, 972-548-5522
Tim Wyatt, Public Information, 972-548-4673

July 10, 2007

Commissioners Approve Health Care Grants to 12 Non-Profit Agencies

Collin County Commissioners agreed today to award funds to a dozen non-profit agencies to provide a variety of health care services to low-income residents.

Commissioners approved $299,987.90 in grants from the Collin County Health Care Foundation after reviewing recommendations from the foundation's advisory board, whose members selected the 12 agencies from a competitive application process.

The agencies picked to receive the grants were:

* The Assistance Center of Collin County: $27,000 in prescription assistance to be distributed among Allen Community Outreach, The Community Lifeline Center of McKinney?, and Frisco Family Services Center.
* The Bridge Breast Network: $47,233 for breast cancer surgeries and prescription assistance.
* Children and Community Health Center in McKinney?: $30,000 for 600 health care visits for children and adults not eligible for Medicaid.
* Collin County Adult Clinic in Plano: $31,980 for 1,066 limited primary health care visits for adults.
* Collin County Committee on Aging in McKinney?: $40,000 for Meals on Wheels program to help provide 39,000 evening and weekend meals.
* Frisco Cares Community Clinic: $11,000 for 200 health care visits and the rental of an immunization van for children in Frisco, Prosper and Celina school districts.
* Geriatric Wellness Center of Collin County: $38,025 for post-hospitalization assistance for homebound elderly with heart disease and diabetes.
* Journey Home, Inc.: $24,750 for 150 days of hospice care for eligible county residents.
* Plano Children's Clinic: $50,000 for 1,000 sick-child visits for low-income and uninsured children throughout the county.

Among the criteria used to award the grants were the agencies that targeted at-risk or vulnerable patients, had the means to get matching funds from additional sources, and that promoted volunteer and citizen involvement in their programs. Each agency also agreed to use grant funds for providing health care to Collin County residents who are U.S citizens or legal residents.

This is a quote from Collin County's 2007 grant application to the Susan G. Komen Breast Cancer Foundation.

The County sought and received a $90,000 grant for mammograms and screening of low-income women. (Jerry Hoagland voted AGAINST accepting the grant)

"Despite having seven, licensed general hospitals in Collin County, nearly one_third of the land area of Collin County has been designated Medically Underserved Areas (MUAs) by the U.S. Department of Health and Human Services. The entire eastern third of the county, two census tracks in McKinney?, two census tracks in Frisco and one census track in Plano have been designated MUAs based on their population over 65 years of age; the percent of population below lhe poverty level; the infant mortality rate; and the number of full time primary care physicians."

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.

Clinics offer low-cost care for poor

County to subsidize $20 office visits at a cost of $400,000

12:00 AM CST on Saturday, January 13, 2007

By ED HOUSEWRIGHT / The Dallas Morning News

For the poor and sick in Collin County, help may be just around the corner.

PrimaCare?, which has clinics in Frisco, Plano and McKinney?, has begun offering $20 office visits for people who meet strict income guidelines.

For instance, a family of four can't earn more than $20,000 a year, and a single person can't make more than $9,800.

County officials contracted with PrimaCare? to provide the low-cost care, which will be subsidized with $400,000 in public funds.

Officials are hoping the public-private partnership will be an effective piece of an expanded effort to provide health care to indigent adults and children.

"I think it's a unique approach," commissioner Phyllis Cole said. "This is just another idea we're going to try. I think it'll work really well."

People seeking care should encounter little red tape. They must sign an affidavit attesting that they meet the salary guidelines, but they don't have to provide income documentation or fill out lengthy forms.

"I think it'll be good for patients," said Candy Blair, Collin County health care administrator. "It doesn't give people the stigma of having to get health care at a county facility."

For more than two years, Collin County officials have wrestled with ways to offer cost-effective care to the growing poor population. Government leaders around the state and country are taking stabs at addressing the complex health care issue.

In November, Collin County commissioners voted 4-1 to adopt a package of measures to offer more care. The agreement with PrimaCare? Medical Centers, which went into effect Jan. 1, was a key component.

Commissioners also allocated $400,000 in grants to nonprofit clinics that serve low-income residents.

Commissioner Jerry Hoagland cast the opposing vote. He pointed out that the county already provided more indigent care than the state requires.

"I am opposed to spending money that we are not legally required to spend," Mr. Hoagland said.

County officials met with two other private clinics – CareNow? and E-Care Emergency Centers – before choosing PrimaCare?.

The company has more clinics and offered a broader range of services at a better price, said Bill Bilyeu, Collin County administrator.

PrimaCare? has no other contracts with government agencies, said Jennifer Stephenson, executive director. "It's a different model, but I think it's something we can work with," she said.

PrimaCare? visits are for non-emergencies. For more complicated medical conditions, PrimaCare? will refer patients to a specialist. Subsequent treatments may or may not be covered by county subsidies depending on the patient's income and assets.

PrimaCare? has two clinics in Plano, one in Frisco and one in McKinney?. They are open from 8 a.m. to 9 p.m. Monday through Friday, and from 8 a.m. to 5 p.m. Saturday and Sunday.

By contrast, the county-run clinic is open from 8 a.m. to 5 p.m. Monday through Friday. Some nonprofit clinics that receive county grants are open only one day a week.

Commissioners said they would rather contract with PrimaCare? than build another county clinic.

"PrimaCare has the brick and mortar in place, the staff and the accessibility," commissioner Joe Jaynes said. "I'm really looking forward to seeing the results."

People can visit PrimaCare? for a $20 co-pay that will cover X-rays and tests. Patients may receive free medication or be given a prescription that they can fill at a pharmacy at their own expense.

Commissioners said the $20 fee should be affordable for most people. By comparison, people receive free care at the county clinic and at some nonprofit agencies.

"People need to have some investment," Mr. Jaynes said. "You can't just have a government giveaway program. If you make it free, you open it up to abuse."

E-mail ehousewright@dallasnews.com

A Real Option for the Poor: Affordable PrimaCare? program will improve access to medical services

07:10 AM CST on Friday, January 12, 2007

Over the years, we've questioned Collin County's commitment to providing medical care for low-income residents. In November, for example, we criticized county commissioners for passing a scaled-down version of a health task force's recommendations to improve health care to uninsured, low-income residents in Collin County.

We wanted more, knowing that the county has the means and responsibility to do so much more, and we were disappointed when commissioners settled for less.

But in fairness, it's time to praise the county for doing something right. The county has contracted with PrimaCare? Medical Centers in Frisco, Plano and McKinney? to provide health care services to residents who fall below certain federal poverty guidelines and lack health insurance. The only stipulation is that patients will have to provide a $20 copayment, which makes the program affordable.

We're also pleased that there's little red tape to discourage patients. PrimaCare's registration form, for example, asks for household income, the number of people in the household and current employment information.

The one-page form does not ask for a list of assets. That's substantial, because even the working poor in this county often own a car, and that can disqualify them from receiving other public assistance. And unlike the county's indigent health care program, residents don't have to go through a comprehensive enrollment process to obtain treatment from PrimaCare?.

This is a wise way to extend medical services to Collin County residents who otherwise would be unable to afford medical care. Collin County is a growing county, and with that growth comes the responsibility to care for its most vulnerable residents.

Since Collin County sold its public hospital in the 1980s, the county population has more than doubled, and county lawmakers haven't dedicated a new revenue stream to take care of the medical needs of poor residents.

The result is that the poorest of the poor in Collin County either go without medical care or travel to the nearest public hospital, Parkland in Dallas, increasing its massive caseload. That's saddled Dallas County with more than $7 million in unreimbursed costs of treating Collin County residents.

As we said before, Collin County needs to do more to take care of its own. But we'll give credit where credit is due, and the PrimaCare? program deserves praise.

DMN Suburban Editorial Board

Indigent care receives healthy debate

10:19 AM CST on Sunday, November 26, 2006

Poor people have gained political power in Collin County.

Commissioners recently voted to spend about $500,000 more on indigent health care in 2007.

After 18 months of study and public hearings, commissioners decided that the richest county in Texas wasn't doing enough to help people who can't afford health insurance.

We saw a seismic shift in the county's attitude toward sick poor people. You may disagree with the commissioners' action – and many people do – but indigent health care has gained a place at the budgetary table.

The debate over taxpayer-provided medical care is likely to intensify next year and every year thereafter.

You can thank – or curse – a 25-member task force that commissioners appointed in spring 2005.

Unlike some citizen panels, this one took its charge seriously. With the help of the University of Texas at Dallas, members pored over poverty rates in Collin County and the number of people without health insurance. They visited nonprofit clinics overwhelmed with poor people.

The panel successfully persuaded commissioners to dig deeper than ever into county coffers to fund indigent care. Commissioners gave an additional $90,000 to nonprofit clinics that serve the needy, and they allocated $400,000 to let poor people get treatment at private clinics such as PrimaCare?.

Commissioner Jerry Hoagland, to no one's surprise, cast the only vote against the increased spending.

"This health care issue is a bottomless pit," he said at the meeting.

Many of his constituents share his view that private charity, not county government, should care for most poor sick people. In his re-election campaign earlier this month, indigent health care was a central issue. Mr. Hoagland opposed higher spending. His Democratic opponent, Bill Baumbach, favored it.

Mr. Hoagland won with 62 percent of the vote. He'll soon have a powerful ally on the five-member Commissioners Court: Keith Self, the incoming county judge.

On Jan. 1, Mr. Self takes over for Ron Harris, whom he defeated in last spring's Republican primary. The county judge heads the Commissioners Court.

Mr. Self hasn't assumed office, but he's made his views on indigent health care crystal clear: He doesn't think Collin County has an obligation to spend more on free care for the poor.

Mr. Self, like many other citizens, addressed commissioners the night they voted to increase indigent health care spending. He argued that the county should focus on its "core functions," such as improving transportation, prosecuting criminals and running a jail.

Mr. Self invoked the name of former President Ronald Reagan, a champion of limited government and an icon to many conservatives.

"President Reagan said, 'No government ever voluntarily reduces itself in size,' " Mr. Self told commissioners. "I urge you to find solutions to this and every issue that preserve individual freedom and limit government intrusion."

Look for clashes between Mr. Self and commissioners over funding indigent health care in future years. But that's not a bad thing.

Collin County officials, for the first time, are fully engaged in the difficult debate over public funding of medical care.

What obligation does the county have to less-fortunate citizens? What should its top priorities be?

As a resident, you can help drive the decisions.

Commissioners just demonstrated that they listen to the public. After all, they want to keep their jobs. They heard more sentiment to increase health care funding than to keep it flat, so that's what they did.

Collin County is one of the fastest-growing counties in the state and the richest. Each year, millions in additional tax revenue flows into the general fund. In 2007, for instance, tax revenue will rise from about $141 million to $151 million.

The county expects to spend about $1.8 million on indigent health care.

Is that enough? Too much?

By comparison, here are some other spending levels: $3.7 million for jail inmate health care; $3.1 million for vehicle maintenance; $739,720 for courthouse security; and $616,075 for the animal shelter.

Some people, such as Mr. Self, argue that providing more free medical care fosters dependence on government. Others, such as Commissioner Phyllis Cole, argue that helping people get well promotes self-sufficiency.

The answers aren't easy, but the questions must be asked.

The Collin County Commissioners Court today approved spending $250 million for the fiscal 2007 budget. As with any political process, there were both high and low points in the budget.

Some good stuff? Our law enforcement officers got a 14-17% raise that will put them about the midpoint in police salaries for the region. This was a critical need and the Court did well. Most other employees received an 8% raise in pay.

Longevity pay for elected officials (re-election bonus) is dead. Savings are almost $150,000.
Car allowances for elected officials and department heads is dead, saving the taxpayers over $190,000.

Also the tax rate was cut by 1/2 cent. I think this is a largely symbolic cut that should have been closer to 1 - 2 cents per $100 valuation. The county is growing too comfortable with the revenues generated from our growth. The reserves are too high. Right now the County budgets for a 180 day reserve... that's over $100 million dollars in excess taxes collected. A more prudent reserve would be in the 100 - 110 day range. Reducing the reserve would free up tax dollars that could have been used to finance a 10% tax cut.

The low point was hit when the Commissioners Court broke faith with the taxpayers over the elected officials salaries. First they voted themselves a 17% raise, and then when the citizens complained, the court froze their salaries. In what one citizen called "shenanigans" the court simply ignored its own salary freeze and then without public comment voted itself a 6% raise.

The Commissioners also broke faith with the taxpayers by refusing to take up the issue of the Health Care Task Force recommendations. After pledging to address the report during the budget hearings, the Court never placed it on their agenda. Rumored is the idea that the issue is on hold until after the November elections.

A CALL TO ACTION!

The Collin County Commissioners Court will hold a special meeting on Monday night, August 14 at 7:00 PM to receive the report of the Task Force on Indigent Health Care.

You need to be there. Let me explain why:

The Task Force was created by the Commissioners Court after many citizens complained that the county was not doing enough to meet the healthcare needs of our poorest citizens. The Task Force spent 18 months getting citizen input and they have made several recommendations which I support.

Jerry Hoagland is opposed to the proposal by the Task force and is sending emails throughout the County saying that the proposal is offering "free healthcare to illegals at county tax payers' expense". Hoagland is calling for all who are opposed to illegal immigration to "Let your voice be heard" by attending the Commissioners Court meeting on Monday night.

Lets look at the issues involved. First, the Task Force looked at many alternatives to funding a program that would provide basic, primary healthcare to more individuals than are presently eligible under the strict guidelines of the present County Indigent Health Care Program.
Over 20% of those living in Collin County are uninsured. Over 6% live below federal poverty guidelines. The county, however, only provided care for 83 residents in fiscal 2006. It is clear that the county is not meeting the needs of those working poor who can not afford insurance, or who fall through the federal and state safety nets.

The task force looked at many alternatives. Most were too expensive and would have raised taxes. The alternative chosen by the members of the Task Force was to leverage the tax dollars by increasing the grants to the nonprofit clinics that are already serving over 26,000 patients a year.

The proposed increases are modest - one half of one percent of the general fund budget. It is important to understand that the County can afford this increase WITHOUT RAISING TAXES. For a person who owns a $100,000 home, the Task Force recommendation would amount to $1.25 of existing tax money per year. That's about the price of a bottle of Coke.

We can afford these increases, in fact I think we can not afford to not increase our spending on indigent care. Public health affects us all, not just poor people. As good citizens, we should recognize that the health of our neighbors is both an economic issue and a moral issue that affects the entire community. When many of our neighbors do not have any options to meet their basic needs, we are all more vulnerable.

Jerry Hoagland would style the proposal as a give away to illegals. WRONG! It is a proposal to help all of our residents who need, but cannot afford basic, primary care. Hoagland's attitude is not only wrong, it is mean spirited and short sighted. It is a blatant appeal to emotion and anger.

For the price of a Coke, we can help children, old people and parents get better health care than they had before.

So, what's the fight about? The fight is about an election that Jerry Hoagland is afraid he is losing. I support the recommendations of the Task Force as a positive, conservative public response to a real need in Collin County. The immigration issue is a smoke screen - a desperate act by a politician who is afraid of losing in November.

This is why you need to be at the Commissioners Court meeting on Monday night. Hoagland is trying to pack the room with supporters in order to show the other commissioners that public opinion is on his side. Hoagland is wrong, and you can prove it by being at the County Courthouse annex (on the southside of the Courthouse grounds) at 7:00 P.M. on Monday night. The address is Central Jury Room, Courthouse Annex, 314 S. Chestnut St., McKinney? 75069.

If you can't be there, e-mail your commissioner and express your feelings on helping our communities and the least among us. Contact information for the commissioners is here.

For More information:
A copy of the Task Force report is here.
For the full (70pg) technical report, Go to www.collincountytx.gov/public_information. Click on the news releases link, then go to the 2006 section. Click on the Indigent Task Force Report.
A Dallas Morning News column by Ed Housewright on the Monday meeting is here.
Jerry's e-mail is here.

Even after watching him for years, I'm still sometimes surprised at the meanness, vindictiveness, and anger that seems to be Jerry Hoagland's political style.

At the commissioners court meeting last week, Jerry made a motion to kill the re-election bonus (longevity pay) for elected officials. After years of fighting to keep his cherished bonus, Jerry's campaign supporters forced him to throw in the towel. He wasn't happy about it.

He was so unhappy, that immediately after the motion was approved, Jerry asked that the next commissioners agenda include a proposal to kill the longevity pay for ALL county employees. His logic being, if he couldn't get a bonus on top of his $87,000/yr salary, then neither would the clerks who make $23,691/yr.

For the record, I believe that keeping experienced county employees is crucial to maintaining efficiency in county government. Longevity pay serves a good purpose when applied to staff positions. As in businesses, employees are the greatest asset the county has. They should NEVER be held hostage by vindictive politicians. Most of the other commissioners seem to agree with me.

Shame on you, Jerry! Shame on you!

And if his stand on longevity pay wasn't mean enough - Jerry, after voting against grants to charitable healthcare clinics, spent some time complaining that some of those clinics are actually giving food to poor people.

Food? Jerry, when was the last time you missed a meal?

Last weeks shenanigans only served to convince me more that Jerry Hoagland needs to retire.