Manatee Memorial Hospital is cutting indigent and uninsured patient care with an exception for emergency room visits to meet legal obligations.
The for-profit hospital notified stakeholders on May 6 that it will no longer accept patients enrolled in Manatee County's health care plan, known as Good County, or unfunded referrals from the We Care Manatee nonprofit starting June 1. There are typically between 1,800 to 2,200 individuals enrolled in the Good County program at any given time.
"Our projected deficit from unfunded care, beyond charity care, amounts to several millions of dollars," Manatee Memorial announced in the unsigned letter. "The significant cost of unreimbursed care is unsustainable. We continue to be a supportive community partner and will maintain open discussions with Manatee County regarding solutions, however, we need to make this difficult, yet responsible, fiscally prudent decision."
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The decision has left Manatee County and local health care providers scrambling to fill the gaps in service for indigent or uninsured residents, and there is concern some surgical patients will be left without options.
"I literally just got off the phone with one of our patients," We Care Manatee Executive Director Shannon Hoyt said. "She is in very bad health and has been working with our doctors, and there are some times that she needs surgical procedures to help keep her breathing. She had one scheduled, and now she can't go. We had to tell her she has to go to the emergency room and hope that they will see her."
Manatee Memorial seeks funding but Manatee County pivots
Manatee Memorial Hospital CEO Tom McDougal announced plans to end indigent care services unless Manatee County agreed to a significant increase in funding during a public county commission meeting on April 16 focused on the local impact of illegal immigration.
During the meeting, McDougal took issue with the low amount of county funding for indigent and uninsured care and indicated that a new deal had not been reached for services in 2024 and beyond. He estimated that in 2023, it cost the hospital $21.2 million to provide charity, indigent and uninsured care, and an additional $2.9 million in uncollectable care, while only receiving $2.7 million in funding from Manatee County.
Rather than increase funding, Manatee County decided to pivot to a community care-based model focused on preventative care. Commissioners will consider a resolution for that option during a county meeting scheduled for June 11.
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"The resolution is going to allow us to expand to new providers," Manatee County Health Information Services Manager Geoffery Cordes said. "It really takes that primary care medical home lens to where we are going to direct people to the least costly, most appropriate, facility within the community who will then manage that care and send them out to specialty providers."
"In the interim, for elective surgeries, we have partnered with the federally qualified health center to help us navigate some of that. That's MCR Health," he said. "Then of course we are looking for additional community partners."
Cordes added that the Good County program also has case managers who actively work to help patients enroll in commercial or marketplace health insurance programs.
Hoyt said We Care Manatee — one of about 30 to 40 practices and organizations that use Good County funding — has been caught in the middle. The nonprofit serves clients enrolled in the Good County program but also receives funding from donations, grants and other sources.
"The hospital is making their decisions, which I get they are making business decisions, but I don't think that they understand the repercussions," Hoyt said.
"We understand that people sometimes fall on hard times and sometimes don't have insurance, and sometimes it's life or death," she said. "We save lives every day and we stand by that, and we are having to think outside the box."
Bradenton approves special assessment on hospitals
Manatee Memorial Hospital approached the city of Bradenton for help acquiring additional Medicaid and indigent care funding. The city commission obliged by unanimously approving an ordinance to impose a special assessment on property within the city limits owned by for-profit and nonprofit hospitals.
Collecting that tax makes the hospitals eligible for federal dollars that supplement Medicaid payments and indigent care costs, a net gain according to Colleen Ernst, Executive Vice President for Adelanto Healthcare Ventures, who presented on behalf of the hospital during the meeting.
"The state historically has only allotted so much money to allow for hospitals to receive about 60 cents on the dollar for reimbursem*nt for Medicaid, and for charity care costs it's about 1% for many providers across the state," Ernst said. "Here, by collecting the dollars in a special assessment, those dollars qualify for federal matching funds."
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"It's certainly not a very generous amount, but it is enough to get them more than the 1% that they are getting for charity care," she said. "In Medicaid that is where we are going to see a big difference.... Instead of getting 60 cents on the dollar, the hospitals are able to get about 80 cents on the dollar. So really, what this does, is it offsets the losses for that type of care."
Ernst emphasized that Medicaid is one of the largest providers for reimbursem*nt for births, and said that in Florida more than half of all births in Florida have been funded by Medicaid.
"So you can imagine costly procedures, only getting 60 cents on the dollar where hospitals don't have the ability to access resources like this very difficult trade offs are often are made. this program is one of the ways to help narrow that reimbursem*nt gap and allow hospitals to sustain facing that financial landscape."
