County sets up TulareCare for indigent patients

As a precursor to the Affordable Care Act going into effect in 2014, Tulare County supervisors Tuesday approved the establishment of the Low-Income Health Program or LIHP, also called TulareCare, for eligible Medi-Cal patients.

TulareCare will target adults 19 to 64 years old with incomes at or below 75 percent of the federal poverty level. That takes in a large portion of those in Tulare County who have no ability to pay for health insurance or medical care.

Rob Stewart, administrative specialist for the county’s Health and Human Services Department, said, “it is a bridge to provision of the Affordable Care Act, especially Medi-Cal expansion.”

It was explained the county has been working on the plan for the past 13 months, but it is only temporary until the ACT goes into effect in early 2014.

“It is a tremendous opportunity for use to provide care,” said Stewart.

TulareCare will offer a core package of medical services, lab services, mental health benefits, physical therapy, podiatry, prosthetic and orthotic devices, and prescriptions. In order to enroll for benefits through TulareCare, residents must meet income, age and residency requirements.

“The goal of TulareCare is to provide a bridge to healthcare reform and assist our community in preparing for the changes that will take place in 2014 under the Affordable Care Act,” said Jason Britt, director of Human Services for Tulare County Health and Human Services Agency.

The program will be financed through a county and federal partnership, each contributing to a portion of the funding.

The program is in partnership with local health care providers, such as Sierra View District Hospital, Family HealthCare Network and other hospitals and clinics in the county. Half of the cost of the program will be paid for by the federal government, with the county having to pay for the other half. However, the county will use existing funds and is basically shifting patients from the Tulare County Medical Services program to TulareCare.

Officials said the goal is for the program to not cost the county any extra funds, a point on which supervisors wanted extra assurance.

While TulareCare is pending approval from the Centers for Medicare and Medicaid Services, officials sought the board’s approval to move forward and begin filling six new positions to monitor the program.

Stewart estimated that 1,500 to 2,000 people could enroll in the program. Besides the income requirement, those eligible must be either U.S. citizens or legal residents. Non-citizens would still fall under TCMS coverage.

Stewart said the total cost of the program is estimated at $8.6 million, of which the federal government will pay half of that.

Gary Herbst, chief financial officer with Kaweah Delta Regional Medical Center, applauded the program, saying Kaweah Delta was glad to be a part of it. He pointed out that medical facilities in Tulare County spent $9 million in 2012 carrying for people who had no ability to pay. FHCN president Harry Foster also endorsed the program.

Stewart said facilities participating in the program will be eligible for 50 percent reimbursement for treating non-paying patients, and the facilities agreed to cover any extra costs the county might incur.

“This program is important because it provides health coverage for thousands of low income residents who typically seek basic services through local emergency rooms,” said Pete Vander Poel, chairman of the board. “We hope residents who qualify will apply and begin to utilize preventative care in lieu of unnecessary emergency room visits thus reducing wait times for all Tulare County residents.”