Is the QCCT Agreement That Supports Indigent Care Still In Force?

Current agreement outdated, parties in arguable default.

Is less or more support for University Hospital necessary?
The indefatigable and prolific reporter Laura Ungar covered last week’s board meeting of the Quality and Charity Care Trust (QCCT ) for the Courier-Journal. Apparently the meeting was largely informational with no formal action taken. It was reported to the QCCT board that the percentage of uninsured patients for the first three months of this year decreased to 13% from 23%. This is good news of course, but University Hospital, like all other hospitals and safety-net providers, remains appropriately concerned about the ultimate effects of the accountable Care Act on overall provider revenues. All of us have our fingers crossed. Time will tell.

The substantial decrease in state funding for the QCCT that emerged from the recent Kentucky legislative session from the current year’s $18 million to $6 and $4 million in the next two years was obviously a subject for discussion. Apparently Louisville Metro is also decreasing substantially its annual local government contribution from the current $7 million, but this the first I have heard of that additional reduction. [Anyone out there who can clarify things for us?]

Funding and implementation of current program obscure at best.
What caught my eye and stimulated this article was a statement that in addition to the specific yearly state legislative appropriation, that the University of Louisville augments the state total from its own “fixed general funds” in the amount of an additional $5 million. As hard as I have been trying to learn about the finances and administration of the QCCT, this latter source of funding was also news to me. I confirmed from a University spokesperson that this additional funding is linked to the controversial and mysterious “rent” that has been paid by University Hospital to the University. This “pass-through” of money from University Hospital to the University of Louisville, to the state, and back to the QCCT for clinical care is part of a long-standing intergovernmental transfer (IGT) mechanism used to pull down matching Medicaid money for the state’s use.

Note that previous declarations of the “rent” paid by the Hospital to the University spoke of $8,876,993.  I am not confident that everyone is talking about the same thing!  When talking about public money, it should’t be this confusing. Continue reading “Is the QCCT Agreement That Supports Indigent Care Still In Force?”

Governor Steve Beshear Exercises Line-Item Vetoes on State Budget.

Gov. Beshear used his line-item veto on the state budget passed by the General Assembly to alter two higher-education education items. They relate to the Kentucky Community and Technical College System, and to the University of Louisville.

With regard to the former, the Governor altered language with the intent of giving more leeway to the governance of KCTC to use agency bonds and fees to fund capital projects on their campuses. With regard to the latter, the Governor reduced the University’s role in evaluating its own need for QCCT funding for indigent care or the effect of the reduction in the amounts appropriated. Continue reading “Governor Steve Beshear Exercises Line-Item Vetoes on State Budget.”

Kentucky Legislature Restores Partial Funding for QCCT Indigent Care Fund – Sort of.

Amounts in House budget reduced.
Strings attached.
Meddling in Metro-Louisvile’s business.

The Kentucky House and Senate completed an increasingly contentious budget process last night after a weekend of behind-the-scenes horse trading. (The multitude of coal severance earmarks were also restored– a not-unrelated observation.) I suspect that few people actually believe the accompanying bilateral declarations of how well the two political parties worked so wonderfully together in the public interest. The lyrics of Kumbaya are known by heart in Frankfort: “Someone’s laughing, someone’s crying, someone’s singing, and lots of people are praying that things turn out all right!”

The 253 page document (House Bill 235) is only an outline of the various administrative units and projects receiving public funds, or of expenditures for which legislative approval is required. A summary of changes made in-conference is available here. No one can read it without recognizing the large number of earmarks that are the price for securing votes. The budget document also provides an indicator of the priorities of Kentucky’s State Universities and Community College system. Their itemized requests for public funds (or for permission to spend other money) make up 20% of the total budget document! I will write more about this latter use of the document later. In this article I summarize the partial restoration of funding by the legislature of the increasingly complicated and controversial QCCT indigent care program used to support inpatient services at University of Louisville Hospital. Continue reading “Kentucky Legislature Restores Partial Funding for QCCT Indigent Care Fund – Sort of.”

QCCT Fund for Indigent Care Takes a Further Beating in Kentucky Senate.

As reported in these pages earlier, the Governor’s budget (and that of the House) decreased QCCT funding for indigent care at University Hospital by 70% percent over the next two years. The justification for this decrease was that the new healthcare reforms being put into place would result in fewer patients showing up for care at Louisville’s designated poor-people’s hospital. Perhaps there were other reasons too.

QCCT gets zeroed out.
The Senate’s Budget Committee upped the ante by immediately eliminating this subsidy altogether! Senate Republicans justify this further decrease with an amazingly cynical bit of political sophistry. Senate Republicans argue that because every person in Kentucky is now eligible for some form of health insurance, that no patient will be eligible for QCCT funding in any case. Some folks may actually believe this. Of course not even the most ardent defenders of the Accountable Care Act (ACA) claim that everyone will be covered by the complicated system of programs and options that could be cobbled together against intense partisan opposition. Among other reasons, out-of-pocket costs to patients will still present a prohibitive barrier for many. Failure to fund the full “traditional” $21 Million program releases University Hospital from its obligation to provide care to all comers. There will still be plenty of work to go around for all Jefferson County providers to take their share. Continue reading “QCCT Fund for Indigent Care Takes a Further Beating in Kentucky Senate.”