Indigent Care Trust Fund

LEGISLATIVE BRIEF
Indigent Care Trust Fund
How Funds are Received and Used by the Indigent Care Trust Fund?
Contributions made to the Indigent Care Trust Fund (ICTF) by non-federal sources include:
Intergovernmental transfers from hospitals participating in the Disproportionate Share Hospital (DSH) program. The DSH program helps to compensate hospitals for their uncompensated indigent care1;
Nursing home provider fees2; Care Management Organizations (CMO) Quality Assessment (QA) Fees3 ; Penalties related to the non-compliance of Certificate of Need (CON)
requirements4; Ambulance license fees; and Fees collected from the sale of Breast Cancer License Tags5.
The ICTF is also allowed to retain for use interest earned from funds contributed into the trust fund6.
As required by Georgia Statute, contributions to the ICTF are matched with federal funds or other funds from a public source or charitable organization7. The type of match applied to the ICTF contribution is dependent on the use of the funds. The primary source of federal matching funds is Title XIX of the Social Security Act (Medicaid) and the Disproportionate Share Hospital Program (also Medicaid).
Unless otherwise precluded, uses of ICTFs are limited to any one or a combination of the following:
To expand Medicaid eligibility and services; For programs to support rural and other health care providers, primarily
hospitals, who serve the medically indigent; and/or For primary health care programs for medically indigent citizens and
children of this state8.
There are three exclusions: Georgia Statute requires Nursing Home Provider Fees be remitted to the ICTF to be matched with federal Medicaid funds and made available for the provision of support to nursing homes that disproportionately serve the medically indigent9. Georgia statute requires CMO QA Fees be remitted to the ICTF to obtain federal financial participation for medical assistance payments to one or more providers pursuant to Article 7 of Chapter 4 of Title 49 (i.e., the Georgia Medical Assistance Act of 1977) or for purposes as authorized for expenditures from the trust fund10

SOURCES
1 OCGA 31-8-153 2 OCGA 31-8-163 3 OCGA 31-8-172 4 OCGA 31-8-153.1 5 OCGA 40-2-86.8(f)(1) 6 OCGA 31-8-156(a) 7 OCGA 31-8-156(c) 8 OCGA 31-8-154 9 OCGA 31-8-166 10 OCGA 31-8-174(a)

The Georgia Department Community of Health - www.dch.georgia.gov

Indigent Care Trust Fund
Proceeds from the sale of breast cancer license tags are to be used to fund cancer screening and treatment related programs for those persons who are medically indigent and may have breast cancer. Such programs may include education, breast cancer screening, grant-in-aid to breast cancer victims, pharmacy assistance programs for breast cancer victims, and other projects to encourage public support for the special license plate and the activities which it funds.

Sources of Revenue for FY 2008:

Federal Medicaid DSH Funds Intergovernmental Transfers from Hospitals for DSH State Funds for DSH
SUBTOTAL for DSH

FY 2008 $252,974,446 134,241,092
13,713,384 $400,928,922

CMO QA Fees Matching Federal Medicaid Funds for CMO QA Fees Matching Federal PeachCare for Kids Funds for CMO QA Fees
SUBTOTAL CMO QA Fees

$153,360,265 235,151,142 63,021,295 $451,532,702

Nursing Home Provider Fees Matching Federal Medicaid Funds for Nursing Home Provider Fees
SUBTOTAL Nursing Home Provider Fees

$120,805,958 215,064,801 $335,870,759

Breast Cancer License Tag Fees Prior Year Reserves from Breast Cancer License Tag Fees State Funds for Georgia Cancer Coalition
SUBTOTAL for Breast Cancer

$ 1,129,490 965,262 500,000
$ 2,594,752

Ambulance Licensure Fees Matching Federal Medicaid Funds for Ambulance Licensure Fees
SUBTOTAL Ambulance Licensure Fees

$ 2,140,952 3,721,599
$ 5,862,551

Prior Year Reserves CON Penalties Other Federal Medicaid Funds ICTF Interest

$ 8,346,142 2,728,787 1,765,885 607,311

Total

$1,210,237,811

The Georgia Department Community of Health - www.dch.georgia.gov

Indigent Care Trust Fund

CMO QA Fees* $451.5 37.3%

FY 2008 Indigent Care Trust Fund

Revenue Sources

($1,210.2 M)
Nursing Home Provider

CON Penalties $2.7 0.2%

Breast Cancer Tags $2.6 0.2%

Fees* $335.9 27.7%
DSH* $400.9 33.1%

Other $22.3 1.8%

Other

Ambulance

$2.7

Fees*

0.2%

$5.9

0.5% PY Reserves

$8.3

0.7%

All figures in millions * includes federal matching funds

FY 2008 Expenditures:

DISH Payments

$400,909,558

Medicaid Payments Financed by CMO QA Fees

Medicaid Payments to Nursing Homes Financed by Nursing Home

Provider Fees

Medicaid Upper Payment Limit Payments to address CMS disallowance1

Ambulance Medicaid Rate Subsidy

Breast Cancer Initiatives

Health Disparities Grant for HIV/AIDS

FY 2008
451,532,702
335,870,759 2,914,002 5,862,551 510,809 100,000

SOURCES
11 The Centers for Medicaid and Medicare Services disallowed a series of calendar year 2002 Upper Payment Limit (UPL) payments made to Erlanger and T.C. Thompson hospitals. These hospitals are located in Chattanooga, TN but serve the north Georgia region as a trauma center and children's hospital, respectively. Like other public and critical access hospitals serving Georgia Medicaid members, the state made UPL payments to those hospitals financed with intergovernmental transfers. CMS ruled that the state could not accept an IGT from an out of state public provider and disallowed the federal share of payment. The state successfully pursued legal remedy against CMS; however, later determined it was not in the best interest of the state to continue with its position after CMS appealed to the U.S. District Court. To maintain the UPL funds earned by these two hospitals, the state utilized CON penalties to replace the hospital's IGT's to support the state share of the UPL payments.

The Georgia Department Community of Health - www.dch.georgia.gov

Total

Indigent Care Trust Fund

FY 2008 Funds Reserved for Specific Use in FY 2009:
Breast Cancer Initiatives (from Tag Receipts) Health Disparities Grant Health Information Exchange Initiatives Mental Health e-Prescribing Initiative
Total Reserved for Specific Use in FY 2009

$1,197,700,381
$ 2,083,943 900,000
2,750,000 3,000,000 $ 8,733,943

The Georgia Department Community of Health - www.dch.georgia.gov