$7.2 million left from CHOICES


Published: Saturday, August 23, 2014 at 6:30 p.m.
Last Modified: Saturday, August 23, 2014 at 6:30 p.m.

$7.2 million left from CHOICES

By Christopher Curry

Staff writer

Alachua County’s CHOICES program ended at the end of 2013 with a significant amount of money left unspent.

About $7.2 million remains from the -cent sales tax that was in place from 2005 through 2012 to fund access to medical care for the working uninsured as well as “innovative, cost effective health care programs” open to all residents regardless of income.

The amount left is more than twice the $3 million initially projected.

“There was not the enrollment rush at the end of CHOICES people had expected, so that’s why the number is so high,” County Commissioner Robert “Hutch” Hutchinson said.

How should the county spend it?

County staff and the CHOICES Advisory Board have recommended the establishment of a trust fund that would provide money to the area’s health care safety net organizations and agencies for a decade.

“That’s the basic plan, to continue to provide health care services to the low-income residents of Alachua County,” said Candie Nixon, the acting director of CHOICES.

In one of two dozen states that rejected the Medicaid expansion in the Affordable Care Act, Dr Allan March, the chair of the CHOICES Advisory Board, said that many of the county residents who used to be on CHOICES now fall in the so-called health care coverage gap. They make too much to be eligible for Medicaid and not enough to be eligible for tax credits to purchase insurance under the Affordable Care Act.

“The needs of these people are ongoing, and the advisory board wants to see this implemented as soon as possible,” March said of the recommendation.

The Advisory Board voted on its recommendation in July. County staff is expected to present the County Commission with a more detailed version of the recommendation at the Aug. 28 budget meeting. Commissioners eventually will have the decision on any plan moving forward, and at this point, nothing is set in stone.

Hutchinson, a non-voting member of the CHOICES Advisory Board, said he was not present at the July meeting but received a presentation from staff.

He said the recommendation would function similar to the county’s Community Agency Partnership Program, where nonprofit groups that provide services for the poor in the community come to the County Commission to apply for money each year.

Some safety net health care agencies now funded through CAPP instead could receive money from the trust fund, Hutchinson said.

March said agencies and nonprofit groups could enter long-term funding agreements but then be up for review each year based on their performance.

Hutchinson said an option discussed during the presentation to him included pledging 60 percent of the money to groups that provide general medical care, 30 percent for mental health care and 10 percent for dental.

March said the advisory board did discuss potential eligibility requirements to receive services that capped income at either 138 percent of the federal poverty level, the same threshold included in the Medicaid expansion that the Legislature did not implement, or 150 percent. Unlike CHOICES, employment may not be a requirement for eligibility.

As the sales tax for CHOICES neared its sunset and the implementation of the Affordable Care Act drew closer, a County Commission majority voted multiple times in 2011 and 2012 to let CHOICES run through 2013 and then end the program.

The expectation was that many people on the program then would transition immediately to coverage through the Affordable Care Act.

For much of a decade, CHOICES was an oft-debated program. State statute allows county governments to levy a sales tax to fund health care for the indigent. Under that law, county voters approved the CHOICES salex tax by fewer than 90 votes during the 2004 primary election.

Over the years, the legal opinion from the County Attorney's Office has been that any shift to use the monies in an area not related to health services or medical care would require a change to state law and another voter referendum.

Maligned by some because membership never approached projected levels of 12,000 to 14,000, CHOICES has had its eligibility requirements loosened by the County Commission on multiple occasions and saw a significant increase in enrollment over the last two years.

During its last few years, the program gained traction. In 2013, its last year, it saw enrollment in the range of 4,500.

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