Strengthening safety net programs in palm beach county, Florida through the use of intergovernmental transfers

Introduction. The funding of safety-net programs for the uninsured and Medicaid population continues to be challenging. In Palm Beach County, FL intergovernmental transfers (IGT) have been used to enhance local funding. This additional funding allows safety-net providers to provide services to a larger population. Methods: In 2005, the Centers for Medicare and Medicaid Services (CMS) approved an 1115 Research and Demonstration Waiver for the state of Florida. Part of the waiver implemented a Low Income Pool, an annual fund of $1billion with the purpose to ensure continued government support for the provision of health care services to Medicaid, underinsured and uninsured populations. Local governments and health systems fund the pool and as a result of the funding, they draw down enhanced payments from the federal funders through an intergovernmental transfer process. The Health Care District (HCD) of Palm Beach County, a local health system taxing authority, has utilized this process to enhance funding to safety-net providers. Financial data was extracted from the HCD records to review the extent of this enhanced support. Results: From 2009 to 2013, intergovernmental transfers were used to enhance funding to ten safety net providers. These providers included five Federally Qualified Health Centers, two primary care residency programs, one rural hospital, one skilled nursing facility and one health plan. Over the four year period, $62,603,393 of local funding was utilized to draw down enhanced payments. These payments added up to an additional $24,141,337. These additional dollars were used to provide services to an expanded population of the uninsured at each of the safety-net sites. Conclusions: Intergovernmental transfers can be utilized to strengthen the primary care safety net. In Palm Beach County, they were used to enhance local funding by 39%.