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Indigent health care program passes audit

County auditors have concluded that Hillsborough County's Indigent Health Plan adequately dealt with the intricate financial demands of the program given limited resources for an enormous task.

The audit, compiled by the clerk of the Circuit Court and released Tuesday, concluded plan officials need to fix an automated billing system, and find improved ways to determine program eligibility, maintain client information, recover medical costs and process claims.

All things considered, not a bad audit, said Michael Zagorc, the assistant chief deputy who carried out the review.

But from a political standpoint it is not a great one, either. Legislators in Tallahassee already are divided in their support of the nationally acclaimed program to treat more than 27,000 of Hillsborough County's poorest adults. State and local lawmakers want to reduce its $120-million reserve or reduce tax support for the health plan, despite assertions from county officials that any tinkering could damage a successful program.

Assistant County Administrator Pat Bean, leading the lobbying effort for the plan, said the faults identified in the audit are not unique to the county's program. Most of the problems, including the failure to adequately recoup money from Medicaid, were identified in an earlier audit of a pharmaceutical contract with Kash n' Karry.

Bean said recouping money from Medicaid is a difficult process because so many clients shuffled in and out of the federal program.

"You can be treated one day and not be eligible the next," she said.

Meanwhile, Richard Ake, clerk of the Circuit Court, released his analysis Monday of the plan's large fund balance, which has drawn criticism from legislators.

Ake said the county should maintain a fund balance of 125-percent of annual expenses, currently estimated at $65-million. He said that reserve could be depleted by the year 2005 if the program is extended and health care costs continue to rise. He also said the county would need at least twice the annual costs of running the program, or about $130-million, to phase out the program if the Legislature fails to extend the tax.

If that happens, and the state continues to require Hillsborough to pay for indigent health care, local officials might have to raise property taxes and seek another revenue source, plan administrators said. The plan currently is funded through the half-cent sales tax and $26.8-million in property taxes. The half-cent tax expires next year.

An internal analysis by the county's debt management department also recommends maintaining a large reserve.

"We very specifically were directed to generate enough revenue in reserve so we could handle a phase down if we had to," Bean said. "When you do what you're told to do and get hit for it, it's strange."

An outside draft performance audit released earlier this month concluded the health plan, which was developed as a way to stem indigent health costs, achieved its main goals: It successfully has developed a countywide network of clinics that keep the county's poorest residents from neglecting their health and seeking medical attention only in expensive hospital emergency rooms.