COD E R E D

EligibilityPatient eligibility and enrollment is performed within the primary care clinics where theCounty Department of Social Services has out-posted its Medicaid and CHIP eligibility andenrollment staff. Eligible patients are residents of Buncombe County, ineligible for federalprograms, and below 200% of FPL. The program staff matches qualifying patients needingspecialty physician care or chronic primary care with volunteer physicians through an onlinedatabase linking county care clinics to a central server at the Buncombe County MedicalSociety. For its recordkeeping, the Buncombe County Medical Society keeps online clinical anddemographic records gathered via patient enrollments, physicians' no-charge invoicing andhospital service reports. Patients sign responsibility agreements and use "Access" cards forvisiting physician offices and for prescriptions obtained through pharmacies at cost.In 2004, 27,000 Buncombe County residents were eligible for Project Access. ProjectAccess served 26,000 of these residents and 3,000 of the 26,000 were provided with advancedprimary care services and/or specialty care services.FinancingPharmacists provide pharmaceuticals at cost; patients pay a $4 co-pay, and countyfunds managed by the Medical Society are used to pay the difference. All lab tests, inpatientand outpatient services are donated by the hospitals. Referrals and appointments forspecialists are made through "on-line, real time" connections with the CARES system at eachprimary care site based upon availability of physician appointment slots. The community clinicspay the local match (5%) to pull-down state and federal funds which then pay for out-stationedeligibility and enrollment workers. Each year, over $3.5 million in services are donated byprivate practicing physicians and other healthcare providers at no charge to low-income,uninsured patients.Cost-SharingHealth care services are provided free to enrollees.Indigent Care Collaboration xx,xxi,xxii,xxiii,9Austin, TexasStart Date: 1992OverviewSafety net providers in three counties came together to form the Indigent CareCollaboration (ICC) in Austin, Texas in order to promote coordinated implementation of localinitiatives to better serve the indigent population of Central Texas. ICC’s members include thelocal public health department, ambulatory medical center, FQHCs, and major hospitals. ICCfunctions to help providers in developing tools and initiatives that make service delivery amongproviders more efficient and cost effective including its integrated patient record system (I-Care)and eligibility system (Medcaider). The I-Care system creates an electronic medical record for apatient that is then accessible at any ICC member facility, but it tracks patient utilization ofhealth care services across the ICC system and facilitates the development of disease9 Personal Communications with Sandy Coe Simmons, Indigent Care Collaboration, April 2005D-13