County commissioners are hoping to beat the state to the punch in using its own indigent funds for health care.

At the Nov. 18 county commission meeting, Commissioner Georgia Otero-Kirkham brought up the subject of a recent mobile mammogram unit in Los Lunas.

"They were here for two days, and they were busy from the time they opened until they closed," Otero-Kirkham said. "But there were still about 40 women who could not get the screening. They had no insurance and could not afford to pay for the test out of pocket. Could we use the indigent funds for this kind of care?"

Every month, the commission approves a list of indigent claims filed by county residents. The funds pay for hospital visits, for a variety of reasons, and ambulance services.

The subject of the state's projected budget shortfalls being supplemented by county indigent funds from across the state was broached. Commissioner Ron Gentry expressed concern that the county's indigent balance of nearly $1.8 million might be vulnerable.

"We need to provide more services, not just more doctors or providers. We need innovative programs," Gentry said. "We have a $1.8 million balance. I asked staff to look into whether we could use this money for other things. Has anybody done anything, or are we still sitting on it?"

With only silence in response, Gentry continued, "I guess we're still sitting on it."

County business manager Kenny Griego said staff did look into the matter.

"We can do just about anything, so long as it is medically related," Griego said. "Any changes to the program do have to go through the local indigent committee and the commission."

Not mollified by that answer, Gentry argued that for four years the county has been saying it can be used.

"And we're still here, saying it can be used. I would like to see us identify all those little pockets of specialized services that it can be used for. We have $1.8 million. That is way too much after we've paid the bills, and it's too much to be collecting from taxpayers."

The fund is taxpayer funded through a gross receipts tax. It is a county-wide tax, so all taxable goods and services paid for anywhere in the county are subject to the .125 percent tax.

Gentry continued, saying the legislature is going to start looking around for money

"And it's sitting out there, wide open," he said. "I think we should hire a specialist to recommend where we can utilize a half million, up to a million. Maybe even use indigent funds to alleviate the general fund."

Barbara Baker, the indigent and insurance administrator for the county, said she, along with Griego, could talk to the health policy commission and the county's indigent affiliate to get ideas about where others are using those funds and get the ball rolling.

Commissioner David Medina asked if the commission could get an update on the uses at the Wednesday, Dec. 2, meeting. Both Baker and Griego indicated they would update the commissioners then.

Pointing out that the county can use 10 percent out of the indigent fund for hiring and staffing, Gentry reiterated the need to get a professional who understands the funds.

"We need to make a solid plan rather than sitting and talking it to death," he said. "I'm talking about a temporary contract to help us form a health care providing policy rather than wishing we had done that before the money was gone."

Griego said in the meantime the county is going to make sure the money is encumbered.

"We took the actual expenditures from last year and increased them by 5 percent. We will encumber those amounts so that when the state looks at our indigent fund, they see the money is encumbered to UNM health care, ambulance services, burials and cremations, inmate care and so on, instead of one big bag of money," he said. "All those things we've paid for in the past."

The business manager said the county still needs to find other areas it can spend the money on and still comply with the state statute on the indigent fund.

Coming back to the issue that started the discussion, Otero-Kirkham noted that the people running the mammogram service told her they would be down in this area every four months.

"Can we get the word out ahead of time so that before they come, we can have the paperwork done for these women if they qualify for indigent funds and they can get the mammograms?," she asked.

Baker said as long as they qualified for the funds, the county could do that.

Gentry said he would like the county to look at one-shot services that are offered year-to-year like the mammograms or dental service.

"We have talked about expanding the qualifications, adding more people to the program and paying out a larger allocation," he said. "I'm concerned that we are going to whittle down our surplus and then have to start cutting back services."

In an interview the following day, Griego said Commissioner Gentry was on point.

"It has taken us 10 years to get here," he said. "If we deplete that balance, we may not have enough for future needs. We plan to encumber those monies based on last year's expenses.

"We want to make it clear this is money we've spent in the past. We want to be sure to have it when people need it. If it is encumbered, that will leave a balance of $250,000 to $300,000. If they (the state legislature) are going to take anything, that is what they will get. The rest is spoken for."

Griego said right now the talk of using county indigent funds to balance the state budget is just that — talk.

"It's the general consensus we're getting from messages and e-mails out of Santa Fe," he said. "There was a formal letter from the governor telling us all funds are being looked at. If they want to, the state could withdraw money from Medicaid and put the indigent money into Medicaid."

The theory being that there are 31 counties who collect indigent funds and with the use of Medicaid and other state medical programs, that move would not be taking the money from its intended use, Griego said.

"It's still putting it into medical use. Because so many counties are involved, the thinking is it will go back to the people," he said. "But I don't know. I'm not saying this to try and scare people into doing something with the indigent funds. This is what we're hearing.

"The state is looking anywhere and everywhere for money. They have to balance their budget by law. If there is someplace with a surplus, we've heard they might borrow that money. They may pay it back with interest or not, in one lump sum or in payments. We just don't know."

The indigent fund balance is between $1.6 and $1.8 million, Griego said. The account fluctuates, depending on collection and spending.

At the Nov. 18 meeting, Baker presented 79 indigent claims totaling $645,107.83 with the recommendation that $47,097.27 of that amount be approved.

The commission voted 4-0 to approve the recommended claims.

For more information about the county's indigent service, call Baker at 866-2020.