2. Georgia Legal Services Program Indigent Care Trust Fund HELP FOR HOSPITALS HELP FOR PATIENTS Linda S. Lowe GLSP Health Policy Specialist

3. Georgia Legal Services Program Indigent Care Trust Fund Help for Patients Under the ICTF, many Georgians can get relief from hospital bills. Participating hospitals must write off a certain amount of free care every year for people with limited income and follow certain other rules that help patients.

4. Georgia Legal Services Program What is the ICTF? Designated fund in the state treasury Holds money contributed mainly by hospital authorities through “intergovernmental transfers” Allows state to draw down federal Medicaid match by allocating ICTF money for services

5. Georgia Legal Services Program What is the ICTF? Designated fund in the state treasury Holds money contributed mainly by hospital authorities through “intergovernmental transfers” Allows state to draw down federal Medicaid match by allocating ICTF money for services

6. Georgia Legal Services Program Purposes of the ICTF Expand Medicaid eligibility and services Support rural & other health care providers (primarily hospitals) that serve the medically indigent

7. Georgia Legal Services Program ICTF Sources of Law Ga. Constitution Article III, Section IX, Paragraph VI(i) State statute O.C.G.A. 31-8-150 et seq State regulations Rules of Department of Community Health, Division of Medical Assistance, Chapter 350-6 State policy manual DCH Policies and Procedures for Hospitals, Appendix Q

8. Georgia Legal Services Program ICTF Administration Ga. Department of Community Health Division of Medical Assistance

9. Georgia Legal Services Program ICTF Payments to DSH Hospitals “Disproportionate Share” (DSH) hospitals are major beneficiaries ICTF helps Georgia meet requirement of federal law to pay extra to hospitals that serve a disproportionate number of low- income patients with special needs 42 U.S.C.A. 1396r-4 140 hospitals!

10. Georgia Legal Services Program ICTF/DSH Payments to Hospitals Are Substantial Hospitals get back more than hospital authorities contribute on their behalf Non-public hospitals cannot contribute, but receive payments & have obligations Payments are in form of higher Medicaid reimbursement $ = $$

11. Georgia Legal Services Program ICTF/DSH Hospital Access Rules for All Patients Can’t require patient to have doctor with staff privileges Can’t transfer or deny services to patient solely or significantly for economic reasons Can’t require deposits as a condition of treatment for medically indigent

12. Georgia Legal Services Program ICTF/DSH Hospital Access Rules for Medicaid Patients Treat Medicaid patients without discrimination Assure doctors and labs do not bill them for services at the hospital Refer them to doctors who will treat them in their offices

13. Georgia Legal Services Program ICTF/DSH Hospital Free Care Rules Use ICTF allocation minus transfer amount for free and sliding scale hospital care Free to people with incomes </= 125% FPL Sliding scale 125% - 200% FPL Report to state at 65% of charges Millions in free care this year!

14. Georgia Legal Services Program ICTF/DSH Free Care Formula Example: $100.00 Total Payment Adjustment - $40.00 Intergovernmental Transfer = $60.00 $60.00 Cost Reported / 65% = $92.31 Patient Charges Written Off To see which hospitals participate and how much free care they must provide, go to www.dch.state.ga.us & click on Indigent Care Trust Fund. Go to the current list of payments.

15. Georgia Legal Services Program Free Care Process Notices – posted & written Application at any time Criteria are income & family size Eligibility determined w/in 5 working days Written notice with reasons Reconsideration Complaint to DCH if not satisfied Public access to redacted log of accounts to see if obligation met