The Galveston County Daily News

A top official at the University of Texas Medical Branch said Friday the medical branch had not canceled an agreement to provide health care to indigent people from Galveston County.

This week, county officials insisted the medical branch canceled the agreement.

But Dr. Ben Raimer, the medical branch’s senior vice president, said the county had failed to renew its contract at the end of an extension in November.

“They failed to renew the contract,” Raimer said. “We have sent them contracts. They refuse to sign the contracts. I have no way to make them do that.”

However, county officials point out that, when the extension expired in November, the medical branch was incapable of fulfilling its end of the agreement because of Hurricane Ike.

Stuck in the middle of the dispute are about 300 county residents whose advanced treatments for ailments have been delayed as the county tries to find doctors outside of the medical branch’s system to treat them.

Last summer as the county’s contract with the medical branch for secondary health care and hospital care for its small cluster of indigent patients was about to expire, County Judge Jim Yarbrough requested an extension.

Raimer said the medical branch’s executive board agreed to extend the agreement until the end of November.

The extension began Sept. 1. Eleven days later, Hurricane Ike roared ashore, effectively shutting down the medical branch.

Even as the medical branch struggled to get its operations going, a notice was sent to Galveston County and about 40 other counties that contract with the medical branch for indigent health care that UTMB would notify counties when it was able to resume service, Beverly Dowling, the medical branch’s vice president for community health network, said.

Another letter was sent in the spring, stating the medical branch would resume indigent medical services for all of the counties that had “active” contracts, Dowling said.

Consortium Forms

That included 33 counties but excluded Galveston, Fort Bend, Chambers, Liberty and Brazoria because those counties had either failed to extend their existing contracts beyond the November deadline or had not signed new contracts, Raimer said.

Dowling said another letter was sent to those counties saying “we’d like to bring you back as soon as possible,” but with changes to the terms of the contract. Those counties, along with the Liberty County Hospital District and Montgomery and Jefferson counties, formed a consortium last summer to negotiate the indigent health care contract with the medical branch.

Raimer said about 75 percent of the health care dollars consumed at the medical branch are from patients from those counties. Not all of that spending is for indigent health care as defined by the law.

By state law, indigent care must be paid for by the counties. To be considered as an indigent patient, the county resident must be classified at 21 percent of the federal poverty level. The federal poverty level for an individual is $10,830 a year in income and assets. For a family of four, it is $22,050.

New Requirements

Because of mandates set forth by the Texas Legislature, the medical branch was required to make sure the counties were in “better compliance” with the state’s indigent health care act, Raimer said.

Part of bringing counties into compliance was a little-known provision introduced during the 2007 legislative session. It requires the counties within the medical branch’s primary service region to increase the eligibility requirements for indigent care above the state minimum standard of 21 percent of the federal poverty level.

Yarbrough said the county was unaware of that provision until medical branch officials brought it up this summer.

Two of the counties within the consortium have balked at the idea of raising eligibility above the 21 percent mark.

As part of a pilot program, Galveston County agreed to increase the eligibility of patients for secondary and tertiary care to 50 percent of the federal poverty level.

Raimer said a $30,000 per patient cap the counties would pay for care also has to go.

Medical branch officials want to eliminate the cap, while the consortium led by Galveston County has said it is willing to increase the cap.

New Terms Coming

At a meeting between negotiators, the medical branch “dictated those terms had to be in the contract,” Yarbrough said.

But Raimer said he plans to seek approval from his executive board next week to approve changes to the language in the contract. He said he was “90 percent” sure the board would approve conditions acceptable to Yarbrough and the other leaders of the consortium.

Raimer said the focus on the indigent care program was distracting from the bigger picture.

“This is much ado about 300 individuals,” he said. “What we have out there is 90,000 without access to health care.”

The goal, Raimer said, should be to create a system that would give individuals better access to health care.