COD E R E D

FinancingSources of revenue include a county property tax levy and state funding from the ReliefBlock Grant Program (RBGP) and intergovernmental transfer (IGT). The RBGP fundingoriginated from legislation enacted in 1996 to convert the state’s mandatory general reliefprogram into a block grant program to counties. v The legislation allowed Milwaukee County toshift from being a provider of health care to becoming a purchaser of health care. The blockgrant program is capped at $16.6 million and consists of federal Medicaid DSH funds andgeneral revenue funds allocated to the county. Each year the county applies for the block grantwhich the county matches with at least $20 million, $13 million in county tax revenues and $7million from the IGT. The GAMP budget was $38.4 million in 2003.Cost Sharing viThere is a $20 copayment for emergency room visits, $1 copayment for genericprescriptions, and $3 copayment for brand name drugs on the formulary. Also, there is a $35application fee for each six- month enrollment period which is waived for homeless individuals.GAMP reimburses clinics on a fee for service basis at Medicaid rates. Hospitals arereimbursed at 80 percent of their costs. If the total cost of the program exceeds the programbudget, providers are responsible for the additional costs.AdministrationThe Milwaukee County Division of County Health Programs, Office of Related HealthPrograms administers the GAMP.Health Advantage vii,viiiMarion County(Indianapolis, Indiana)Start Date: 1997OverviewFaced with the loss of a contracted private safety net provider, Marion County chose torestructure their care system by acquiring community clinics, and securing a contract with aphysicians group for staff. A managed care program was created, with a designated set ofbenefits, a network of providers, and each primary care provider responsible for referrals.Providers are reimbursed through capitation and other performance-based methods.Historically, Wishard Memorial Hospital was the primary safety net provider for MarionCounty through a contract with the Health and Hospital Corporation of Marion County (HHC). In1990s, The University Hospital, which also had a role in providing indigent health care, mergedwith Methodist Hospital of Indiana and reduced its commitment to indigent care. The task forceresponsible for the merger also created the Indiana University Medical Group (IUMG), aphysician group sponsored by the Indianapolis medical school. Concerned about meeting itsindigent care obligations, the HHC worked with Wishard Hospital to expand its health caresafety net by taking over several community clinics of the Marion County Health Department.D-4