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The hospital provides about $3,000,000 each year in uncompensated care. These are patient charges, not the actual cost to the hospital. Uncompensated care includes various sub-categories such as charity care, the amount of our actual expense not covered by Medicaid… and about $2,000,000 in indigent care charges. The actual cost to the hospital to provide this care is roughly 75% of these charges. The subject of this article is just this indigent care portion.

You might think an indigent hospital patient is simply a person who cannot –or won’t- pay for his or her healthcare services at the hospital. But actually, to be classified as indigent a patient must meet strict State of Florida’s qualifying criteria. It works like this: If a patient comes to the hospital needing healthcare but has no resources to pay for the care, then a financial counselor determines if the patient might qualify for the County indigent care benefit. If so, the patient is asked to complete an application documenting how he or she meets the State of Florida criteria. The criterion the patient must meet includes information on total household income and the number of persons in the family. The only exception to this is if the patient is an emergency, then care is provided before any financial questions are asked. Federal law mandates this.

The hospital provides the care and a bill is generated. The bill, along with required indigent qualifying documentation, is given by the hospital to the County. The County reviews the information and confirms that the patient indeed meets State criteria. If the patient does, and if there is any money in the County’s indigent care fund, then the patient’s bill is paid. If there is no money left in the fund, the hospital isn’t paid.

If a patient meeting the above criteria is classified as indigent and receives care at Madison’s hospital, but is later transferred to another hospital for further treatment, the Madison hospital still gives a bill to the County for payment of the services it provided while the patient was in Madison. It is my understanding that the out-of-county hospital will send a bill to our County too. Our county pays these out-of-the county hospitals an annual total of approximately $35,000 a year for their services to Madison’s indigent patients. Fifty percent of the current fund of about $70,000 annually goes to Madison County’s hospital and 50% of it goes to pay bills from out-of-county hospitals.

On June 29th, the Madison County Commission began the first steps to increase the fund to pay indigent healthcare claims from Madison County Memorial Hospital (MCMH) up $250,000 from its current level of about $35,000 to $285,000 ($35,000 + $250,000) a year. However, if the fund is increased, none of this additional money will be paid to out-of-county hospitals. I think that level will likely still stay at about the $35,000 mark, but that is for the County to determine.

Money received from the County in payment for indigent care will be paid to MCMH on a “one patient-by-one patient” basis. The hospital will not receive a big single or monthly check, for “indigent care.” Each claim must stand alone and make its own case for meeting State of Florida criteria.

MCMH spends about $1,750,000 a year in actual expense to provide care to indigent citizens. This money comes directly out of the hospital’s cash register (operating fund). When the hospital is reimbursed the current $35,000 a year, or the proposed additional $250,000 a year for these services, this money goes (and will continue to go) right back into the hospital’s cash register, just like a payment for services from any other payment source. It will be spent on such operational expenses as food for patients, pharmaceuticals, utilities, et cetera.  It is important that everyone understand that even putting $285,000 a year toward the crushing total expense of providing care to indigent citizens, the problem continues. This is will not make it go away.

If the County’s indigent healthcare fund is in fact increased, MCMH will still continue to carry alone the annual actual expense burden of about $1,465,000 for additional indigent healthcare. Again, these are not charges to the patient; this is the actual approximate expense to the hospital.

Madison County is a beautiful place. The canopy trees on Shrine Club Road and the big oaks scattered all around the county never fail to make my heart beat a bit faster. But the fact is that Madison is a poor county and poverty isn’t beautiful. It’s awful. Whether we’re talking about how poverty affects our County’s healthcare or how it affects education, or any other integral part of the lives of its people, we can’t bury our heads in the sand and say that it is someone else’s problem, or that the hospital, or the school system, or the churches handle “that.” The upkeep on poverty is expensive and you and I own it.