Local Government County Struggles to Find Funding for Indigent Care

BRADENTON -- The Manatee County Commission faces severe budget challenges as the need for services continues to rise in a weak economy, without the rising revenues to meet the demand. At Tuesday's morning work session, they heard tales of economic woe from Manatee Glens and Manatee Memorial regarding the costs of treating the least fortunate among us, but are hoping a modified facility that will allow more indigent patients to be treated at the One Stop Center will at least help alleviate some of the burden.

Homeless Coalition

Former State Senator John McKay spoke for the Homeless Coalition and the new physician resident program aimed at reducing the indigent healthcare costs in Manatee County. The "One Stop" homeless facility has had five physicians and interns participating in a program that is relieving some of the local hospitals from the overwhelming number of people checking into the emergency room because they can't afford to see a doctor. 

One Stop is seeking $150,000 from the county to increase the size of the program and the amount of people they can help. Currently the county reimburses the hospitals for much of the indigent care costs they accumulate, close to $20 million annually (that includes doctor reimbursement). 

One Stop's budget is primarily supported by grants and contributions, but is seeking help from the county because it will be relieving Manatee Memorial, Manatee Glens and Blake Medical Center of much of their emergency room costs in this arena.

A modified facility to assist a larger amount is in the works with a cost of nearly $400,000, and a plan to increase the number of doctors to 12 within another year, and up to 24 within three years. This could save the hospitals and the county millions of dollars.

Mental Health

Mary Ruiz, President/CEO of Manatee Glens said, "The treatment for prescription pain pill addiction is up 85 percent and children inpatient service has increased by 75 percent," adding, "The volume is unprecedented." 

Manatee Glens is requesting assistance of $545,000 a year over the next three years ($1.7 million). They are the facility that accepts the most problematic disorders because they are the only ones equipped to handle them.  

Ruiz explained, "Manatee Glens is the first behavioral walk-in clinic in central Florida. First patient detox is up to 15 a day. We're demanding more of our staff. We exceed the state requested standards by 25 percent, and we provide innovative home services." 

Commissioner Whitmore said she was having trouble with the request. "I have to prove to the public that this is where the money must go," said Whitmore.

Ruiz responded, "We supply an annual audit and a monthly expense report. Our cost reduction has come at the expense of staff, the number of days off has been reduced from 24 to 20, and no salary increase in five years. I can't ask the staff for anything more."

Whitmore answered, "Everyone is afraid to say it, but we need a health care tax."

Commissioner Gallen added, "I think we all agree, the ripples of this are very serious. Either way, we need a solution."

Whitmore summed up her thoughts, saying, "I just don't feel comfortable right now giving this money."

Health Care

Manatee Memorial Hospital CEO, Kevin DiLallo said, "We had $11 million in bad debt last year and I had to report $7 million in debt last month. We take all of the patients that come to us." He said, "The top 50 cost us the most because they show up the most. The number one (highest costing patient) on the list showed up almost 50 times last year. Those who are very sick and have no money have nowhere else to go."

One Stop can take many of the top 50, Diallo said, "When the governor said no to Obama's health care plan, we're getting stuck with the bill."

Commissioner McClash asked, "How much would we receive if the governor were to accept?" 

Diallo told the commission that Manatee Memorial is the largest medical provider in the county for the uninsured. He added that they had 2500 deliveries last year. He reminded the commission of the dire conditions that health care cuts will bring.

Children Services

The Children Services Advisory Board has maintained a near constant in support from the county for program funds over recent years, even under a drop in the property taxes collected. CSAB vice-chair Jennifer Radenbach fought to secure the $416,727 in additional funds requested in order to pay for new services, but commissioners felt the original amount would have to do for now.

Hopes are that in the near future, an Administrative Law Judge's order -- requiring the state to reimburse Manatee County for over-paying the Department of Juvenile Justice (DJJ) -- will stand against any appeal. It challenges the state's use of the property, by which the facility is built to house juvenile residents from many counties, and hopes the ALJ will recognize Manatee's invested interest and refund some of the many millions paid to the state.

If so, the money will go to the children's services program, because they were funding DJJ cost. There is a consensus to ween the children's services from the annual $1.7 million it takes to fund the DJJ over the next three years.