The St. Thomas East End Medical Center Corp. is working on a concept for a new public health insurance program to help more than 30,000 underinsured or uninsured people in the territory, the center’s Executive Director Wilbur Smith said during budget hearings Tuesday.
The goal would be to expand the number of people covered by some form of insurance and also bolster the territory’s Medicaid matching funds, Smith told the Finance Committee.
"Families will pay a monthly premium similar to our sliding fee scale, which is determined by family size and increases as your percentage above the federal poverty level increases," he said. "The program will be administered by an agency of the governor’s choice and income from premiums can be used for the Medicaid match," but "CMS approval would be required," he said.
"The concept is: If we can structure a program and use subsidies on a sliding scale to help with premiums, but get them to purchase coverage, those premiums could be used to … drawdown the Medicaid expansion dollars," Smith said.
The Affordable Care Act has provided $274 million for Medicaid expansion in the territory, but to actually get all of that funding will require the territory to spend millions of its own for matching funds, he said.
"We are just putting forth the concept," Smith said, when asked by Sen. Tregenza Roach when this may come to pass.
Meanwhile staff testified the center sees more and more patients every year. Medical Director Debra Wright-Francis said that since 2006, she has seen monthly visits increase from 200 per month to more than 1,600 per month. "This increase is solely due to the increase in provider staff," she said.
Patient use of the clinic has increased from 4,247 visits in 2009 to 15,067 visits in 2013, and 17,080 are projected for 2014.
A plurality of clinic patients – 41 percent – in Fiscal Year 2013 are self-pay – a reduction from 49 percent in 2009. Medicaid patients comprise 35 percent – up from 29 percent in 2009. Commercial insurance covers 19 percent of patients, and Medicare another 5 percent in FY13.
Smith presented the center’s FY14 General Fund budget request of $1.7 million. STEEMCC projects about $2 million in program income, from billing for services, and $676,00 in federal grant funding, for a total budget of $4.3 million.
Wages and salaries for 34.5 full-time equivalent employees comprises $1.9 million of the budget. Employer contributions for Social Security, Medicare and benefits comprise another $635,000. Another $1.1 million is for outsourcing contracts for consulting services, lab services, translator services and other expenses. Supplies are budgeted at $156,000. Facilities rental consumes another $223,000.
No votes were taken at the information gathering budget hearing.