COD E R E D

AdministrationThe County’s Department of Health and Social Services is responsible for operating theHCHCP. The Board of County Commissioners determines the policy of the HCHCP while the15-member Health Care Advisory Board makes recommendations to the commissionersregarding issues of fund allocation, coordination, planning and monitoring of the health caredelivery system.PlusCare xviiWayne CountyDetroit, MichiganStart Date: 1992OverviewWayne County purchases health care services for the uninsured from local managedcare plans and uses several federal/state/local match arrangements for funding. Enrollment inPlusCare may occur through an outreach worker placed in hospitals, the public healthdepartment and in other community health agencies. Potential participants may also enrollupon receiving health care services at emergency rooms, safety net providers or the publichealth department. Once enrolled, each patient is enrolled in one of four health plans and onedental care plan. The services covered include primary and preventative care, inpatient care,outpatient care, dental services, pharmacy services, emergency care, ambulance services,immunizations, family planning, laboratory services, radiology services and physical therapy.There are coverage limits on these services due to budget restrictions. Patients needing mentalhealth and substance abuse treatment are referred to the Detroit-Wayne County areaSubstance Abuse Treatment Programs that are administered by the Detroit-Wayne CountyCommunity Mental Health Agency.EligibilityAdults residing in Wayne County between the ages of 19 and 64, not eligible for anyother type of medical coverage are eligible for PlusCare. The income threshold is $250 permonth but family size is taken into consideration as PlusCare eligibility is determined on anindividual basis. A $90 standard work expense is omitted from the monthly net income andneither child support nor Social Security payments are considered as income. Enrollment lastsfor one year.FinancingThe primary source of funding is federal/state/local match funds generated through anupper payment limit (UPL) and other arrangements. Wayne County and the state contribute toan indigent health care fund. An intergovernmental transfer from Wayne County is used todesignate the indigent health pool for federal matching funds. These funds are distributed toqualified hospitals in the county based on each of their estimated Medicaid outpatient payments.A total of seven hospitals qualify to receive these funds. Providers in the health care networksare reimbursed on a capitated per member per month basis. The dental provider is alsoreimbursed in this manner, however the payments are based on the total number of patientsserved each month.D-11