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OVERVIEW: Georgia law does not mandate free care. There is an optional county-based Hospital Care for the Indigent Program, jointly financed and administered by the State and participating counties, that provides matching state funds to reimburse hospitals for care to indigents. In addition, Georgia’s Indigent Care Trust Fund may be used to reimburse hospitals and other medical providers that provide services to the medically indigent.
Hospital Care for the Indigent Program
Official Code of Georgia §§ 31-8-1 to 31-8-11
Hospital Care for Nonresident Indigents
Official Code of Georgia §§ 31-8-30 to 31-8-37
Indigent Care Trust Fund
Official Code of Georgia §§ 31-8-150 to 31-8-160
Hospital Care for the Indigent
Rules and Regulations of the State of Georgia §§ 290-5-5-.01 to 290-5-5-.01
The State Board of Health (hereinafter “the Board”), which sits within the Department of Public Health, administers the Hospital Care for the Indigent Program (hereinafter “the Program”). Ga. Comp. R. & Regs. 290-5-5-.01(5). The Board is authorized to adopt rules and regulations necessary to administer the Program after consultation with the Hospital Care Council. Id.
Counties that choose to participate in the Hospital Care for the Indigent Program must either designate the County Board of Health or another agency acceptable to both the county’s governing body and the State to administer the Program locally. Ga. Comp R. & Regs. 290-5-5-.02(c).
DEFINITIONS AND DISTINCTIONS:
An “indigent person,” for purposes of determining Program eligibility, is anyone “who is ill or injured and who from his own resources or from resources of those upon whom he is legally dependent is financially unable to meet the full cost of hospital care as prescribed or ordered by a physician.” Ga. Comp R. & Regs. 290-5-5-.08(c).
A “participating hospital” is any hospital that has agreed to cooperate with the Program and has been certified as eligible based on the eligibility criteria set forth in the Rules and Regulations. Ga. Comp R. & Regs. 290-5-5-.08(l).
FREE CARE AS A COMMUNITY BENEFIT: N/A
The Program is jointly financed and administered by the State of Georgia and the counties that choose to participate. Ga. Comp. R. & Regs. 290-5-5-.01. It was created with the purpose of assisting counties in purchasing hospital care services for medically indigent individuals: county residents who are “ill or injured…who can be helped by treatment in a hospital, and who are financially unable to meet the full cost of hospital care from their own resources[.]” Ga. Comp. R. & Regs 290-5-5-.01(1)-(2). Generally speaking, a person must have resided in Georgia for at least six months and have no other access to hospital care in order for the cost of their care to be eligible for reimbursement under the Program. Ga. Code Ann. §§ 31-8-2(6); 31-8-7 (but note that the six months’ residency requirement may be waived if a physician certifies that the illness is an emergency).
While the statutes state that the Commissioner of Human Resources must adopt a state-wide standard for determining who is indigent, the current regulations defer to the counties in terms of assessing indigent persons. Ga. Code § 31-8-32(a); Ga. Comp. R. & Regs. 290-5-5-.05(1)(b) (stating that there is no “rigid state-wide formula” for determining indigency or medical indigency). Rather, each county’s Board of Health is responsible for developing a local standard for determining who is indigent within that county that satisfies the following broad standards:
- Reasonable assurance of uniform basis of review for requests for assistance;
- Inclusion of specific standards of eligibility relative to family income, assets, hospitalization insurance, and number of dependents;
- Requirement of an inventory of economic resources of a person who has requested assistance; and
- Recognition of need for higher priority where an indigent or medically indigent resident is hospitalized outside of the county. Ga. Comp R. & Regs. 290-5-5-.05(2)(b)(1)-(4).
The Program is jointly financed by the State and participating counties. Ga. Comp. R. & Regs. 290-5-5-.01(2). County participation in the Program is voluntary. State funds are used to assist counties in providing hospital care for indigent residents. A county must pass a resolution to provide funding for the project. Ga. Comp R. & Regs. 290-5-5-.02(2)(b). The amount each county budgets for the Program is left to the discretion of the county, but should match available State funds except where a lesser amount is reasonably related to the needs of the program. Ga. Comp R. & Regs. 290-5-5-.02(3)(a).
The Department of Public Health is charged with creating a graduated matching formula for the disbursement of state funds based on population and median income. Under this formula, the state contribution cannot be more than $1 per capita based on the latest federal census data. Ga. Comp R. & Regs. 290-5-5-.03(1)(a). The Department may also establish a set amount of state funds to cover indigent hospital care, as long as any unexpended state funds are reallocated by the Department according to the matching formula. Ga. Code § 31-8-3.
The Nonresident Indigent Health Care Fund is used for financing care provided outside the patient’s county of residence. Ga. Code §§ 31-8-33; 31-8-35.
There is also an Indigent Care Trust Fund—Georgia’s equivalent of a Disproportionate Share fund—which is administered by the Department of Community Health. Ga. Code § 31-8-151. Monies in this fund may be appropriated for the following purposes: 1) to expand Medicaid eligibility and services; 2) for programs to support rural and other health care providers, primarily hospitals, who serve the medically indigent; 3) for primary health care programs for medically indigent citizens; or 4) any combination of the above. Ga. Code § 31-8-154.
Counties should only choose general hospitals providing medical and surgical services as participating hospitals in the Program. Ga. Comp. R. & Regs. 290-5-5-.04(3)(c). The Eugene Talmadge Memorial Hospital shall not be selected as a Participating Hospital by a county program though emergency or highly specialized hospital care may be authorized here. Ga. Comp R. & Regs. 290-5-5-.04(3)(d). In the case of an emergency where the condition of the patient prevents using a participating hospital, hospitalization may be authorized in any Participating Hospital without reference to a county program. Ga. Comp R. & Regs. 290-5-5-.04(3)(e). Hospitalization for an individual under the program cannot exceed thirty days in any twelve month period. Ga. Comp R. & Regs. 290-5-5.06(1)(c)-(e).
Each participating County may opt to include normal obstetrics as part of covered services under the Program. Ga. Comp. R. & Regs. 290-5-5.06(1)(b).
NOTIFICATION REQUIREMENTS: N/A
A standard application is required of all individuals applying for participation in the Program and must be initiated by a physician. Ga. Comp R. & Regs. 290-5-5.06(1)(c)-(e). In order to apply for assistance through the Program, each applicant must agree to: 1) undergo an investigation or review of the economic condition of the applicant; 2) certify that he is unable to pay for the full cost of hospital care as deemed necessary by a physician; and 3) agree to pay as large of a share as possible of the cost of hospitalization through family resources and hospitalization insurance. Ga. Comp. R. & Regs. 290-5-5-.05(3)(a)-(c).
A person must be certified as indigent by the governing authority of that person’s county of residence. Ga. Code § 31-8-2(1). If the governing authority does not certify the person as indigent within five days after its next meeting, the person remains responsible for the care received at the hospital. Id. Each county’s governing authority must designate a person as the Health Care Advisory Officer for the county. Ga. Code § 31-8-32(b). This person designates individuals as eligible for indigent hospital care based on the standards issued by the Commissioner and must maintain a file of these determinations. Id. at (b) and (e).
When a non-county resident patient claims indigence following hospital care, the hospital shall notify the Health Care Advisory Officer in the patient’s county of residence and request that a determination of indigence be made. Id. at (c) and (d). If the Health Care Advisory Officer fails to respond within 30 days, the county of residence becomes responsible for payment. Ga. Code § 31-8-32.
An applicant may appeal to the County Board of Health if the application is denied in whole or in part on seemingly arbitrary action or if no action is taken at all in a reasonable amount of time. Ga. Comp. R. & Regs. 290-5-5-.08(2)(a).
By April 1 of each year, the governing authority of each county participating in this program must submit a budget to the Department that contains an estimate and supporting data for the costs of indigent hospital care in that county. Ga. Code § 31-8-5. Each hospital must also maintain records of the cost of care for non-county resident indigent patients and report these costs to the Commissioner quarterly. Ga. Code § 31-8-34.
PENALTIES FOR NONCOMPLIANCE: N/A