Health affairs scholar · 2026
County Indigent Care programs fill coverage gaps left by Medicaid restrictions: evidence from Texas.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Hong Arthur S, Paul Grant R J, Cerise Frederick P, Gordon Abram O, Sadeghi Navid, Liao Joshua M, Rc Jenisa, Halm Ethan A
Аннотация
INTRODUCTION: Medicaid restrictions exclude some low-income adults, especially in nonexpansion states and among immigrants. Local governments are payers of last resort. Texas offers an important case study: state law requires counties to maintain Indigent Care programs to extend healthcare coverage for uninsured low-income residents, yet no recent report describes their structure.
METHODS: We cataloged programs in all 254 counties, using publicly available data, contact with county officials, and a state open records request, characterizing reporting, eligibility, and services, along with estimates of uninsured working-age adults in counties with broader eligibility and services, overall and by county metropolitan status.
RESULTS: Required annual reports were unavailable for 144/254 (57%) counties, and 19/254 (7%) had eligibility or benefits inconsistent with state law (minimum eligibility of 21% of federal poverty level-FPL; $30 000 of care including prescription and skilled nursing). 39/254 (15%) set income eligibility ≥138% FPL, reaching 50% of uninsured adults but only 14% of uninsured adults in nonmetropolitan counties. 5/254 counties (2%) combined higher income thresholds with broad service availability; all were metropolitan, containing 47% of uninsured adults statewide.
CONCLUSION: Indigent Care reaches those excluded from Medicaid, but eligibility and services varied widely, and more generous programs were only in metropolitan counties.
METHODS: We cataloged programs in all 254 counties, using publicly available data, contact with county officials, and a state open records request, characterizing reporting, eligibility, and services, along with estimates of uninsured working-age adults in counties with broader eligibility and services, overall and by county metropolitan status.
RESULTS: Required annual reports were unavailable for 144/254 (57%) counties, and 19/254 (7%) had eligibility or benefits inconsistent with state law (minimum eligibility of 21% of federal poverty level-FPL; $30 000 of care including prescription and skilled nursing). 39/254 (15%) set income eligibility ≥138% FPL, reaching 50% of uninsured adults but only 14% of uninsured adults in nonmetropolitan counties. 5/254 counties (2%) combined higher income thresholds with broad service availability; all were metropolitan, containing 47% of uninsured adults statewide.
CONCLUSION: Indigent Care reaches those excluded from Medicaid, but eligibility and services varied widely, and more generous programs were only in metropolitan counties.