COD E R E D

AdministrationThe Health and Hospital Corporation (HHC) of Marion County is a municipal (non-profit)corporation that operates Wishard Advantage and the Marion County Health Department. TheHHC is governed by a seven-member board consisting of members appointed to four-yearterms. Three of the members are appointed by the Mayor of Indianapolis, two are appointed bythe County-City Council, and another two are appointed by the County Commissioners.Funding for the HHC comes from local property tax dollars and HHC has legal responsibility toprovide health care to all who become ill or injured within Marion County.Carelink ix,xBexar County(San Antonio, Texas)Start Date: 1997OverviewCarelink utilizes the maximum family liability concept (MLC), or the amount a family canbe expected to contribute based on their income, to help offset the costs of a designated set ofbenefits that it offers to the uninsured in Bexar County. The program uses a provider networkthat includes medical school and private practice physicians, pays providers on a fee-for-servicebasis, and collects payments from the family over an extended period of time. An integratedpatient record system has also been developed allowing for a system-wide quality assuranceprogram.Carelink is the Bexar County Hospital District’s (now called University Health Service)indigent care program, and can best be described as a financial assistance plan with managedcare features. Carelink began in 1993 as CostShare when UHS officials introduced the conceptof maximum family liability (MFL) 3 , which was an amount used to determine a monthlyrepayment schedule for services received. The plan is administered by the UHS with a providernetwork that consists of one hospital, six ambulatory centers, five Federally Qualified HealthCenters (FQHCs), and one private physician. The plan purchases health care for enrolledparticipants who use the UHS network. The hospital and physicians are reimbursed on a feefor-servicebasis. Families with incomes below 200% of the FPL who reside in Bexar Countyare eligible and make monthly membership payments and service co-payments based on theirincome level. Benefits include primary and specialty physician services, hospital care,prescription drugs and mental health services. Another potentially valuable service is a 24-hournurse-staffed hotline that serves to help refer patients appropriately, help make doctorappointments and deter misuse of the emergency room.All low-income uninsured families in the county are encouraged to enroll. At enrollment,families select a primary care provider and clinic site as their usual source of care and mustseek all their care through that provider. Non-Carelink patients receive services but may beasked to pay, in advance, for primary and preventive care.3 Maximum Family Liability (MFL) = (11%) * (annual family income) * (FPL index).D-6