COD E R E D

HHC also developed a contract with the IUMG to staff Wishard Hospital and its primary careclinics.Wishard Advantage was created in the late 1990s to increase coordination betweenprimary and specialty care in the Wishard Hospital system. It is a managed care medicalassistance program for low-income, uninsured residents operated by the HHC. The providernetwork is comprised of the IUMG, the Wishard Hospital, and its seven primary care clinics.The medical assistance program offers a comprehensive benefits package including primaryand preventative care, inpatient and specialty care, prescription drugs, laboratory services andmental health services. Vision and dental services are limited but dental check ups, visionscreening and discounted eyeglasses are included.At enrollment, patients select their primary care physician from a list of providers in thenetwork. Although there is no official gate keeper, the chosen physician is responsible foroffering primary and preventive care, and for specialist referral and hospital admission. Thehealth clinics contain pharmacies and other social services, and are available during daytimehours. There is one after-hours clinic next to the hospital and a 24-hour consultation hotline.The primary care physicians receive capitated payments per member per monthcovering primary care, specialty and inpatient referrals. Specialty care funding is pooledthrough the dean of the medical school, who distributes these funds to specialists based on arelative value unit (RVU) payment schedule. The HHC provides payments for inpatient serviceson a fee-for-service basis and also provides prescriptions free of charge to patients via the clinicpharmacies.EligibilityAll uninsured Marion County residents with incomes at or below 200% FPL are eligible.Participants must not be eligible for other public programs including Medicaid or SCHIP.FinancingWishard Advantage is financed through city and county property tax levies as well asfederal DSH matching funds at amounts of $56 million and $20 million, respectively. The HHChas the authority to levy taxes at its own rate but has to seek state legislative authority. TheHHC tax levy generates a total of $70 million with $56 million going towards Wishard Advantageand the rest for Marion County Health Department and the HHC staff. The property tax levy rateof 79.1 cents per $100 property valuation has remained the same since 1992. Medicaid DSHpayments also contribute a significant percentage of the hospital budget.Cost SharingThere is no charge for services to enrollees with incomes less than 150% FPL.Participants with incomes between 150%-200% FPL are required to pay a $5 copayment onoffice visits and 20-60% of the cost of other care based on income. Providers bill patients forservices and there is no cap on out-of-pocket payments.D-5