You to and from the vehicle and making sure you're secured every step of the way.

Scheduling is simple.

Just call 813-272-7272 to see if you qualify and start your application process today.

Sunshine Line is here to keep you moving safely, affordably, and with a smile.

Visit HCFL.gov slash Sunshine Line to learn more and get started today.

Sunshine Line.

Hillsborough's ride on the bright side.

Good afternoon, and welcome to the Hillsborough County Board of County Commissioners Health Care Plan workshop.

And this time I'm going to pass things over to the County Administrator for opening remarks.

Thank you.

And good afternoon, everybody.

Happy New Year.

And we have our county attorney here today.

Welcome, Julia.

Thank you.

So our workshop today is on the Hillsborough County Health Care Plan.

This workshop is in person, obviously, but it is really due to the board's interest in having our various partners participate today.

We've had two or three discussions about this plan before, but this current board was not all serving at the time.

So some of this information is going to be repetitive for some new for some others.

But regardless, the information will be comprehensive and informative for all of you, we hope.

At this workshop, no formal action will be taken because it is a workshop.

That said, however, your guidance, your input, your suggestions and feedback are welcomed and appreciated because that will help us guide whether any information should come back to the board for further consideration.

And I'd like to thank you for your time today, extend our appreciation to our partners who are going to be participating in the discussion today.

I'll turn it over to Kevin Wagner, who is the department director.

He'll provide an overview of the plan, and following his presentation, we'll briefly briefly hear from our community partners and answer any questions.

So thank you all.

Good afternoon, Kevin.

Good afternoon, Commissioners.

Kevin Wagner, Healthcare Services Department.

So I'd like to first say thank you for having this workshop.

We always think it's a great opportunity to promote and talk about the Hillsborough County Healthcare Plan to you, the board, and to the public.

So again, thank you for doing this, setting your time, and we value your leadership.

On our presentation, this is quite robust by design because there's a lot about the health care plan, but I promise to move quickly through some slides and through detail on some other ones.

So to manage everyone's time.

So we appreciate it, and so we'll get started.

After I speak, as Bonnie indicated, our community partners will briefly discuss their role as well.

The question is why do we exist?

What is the purpose of the Hillsborough County Healthcare Plan?

Back in the late 80s and early 90s, the board itself recognized the high cost of health care as a public and private sector concern problem.

The plan was really a response to the strain, financial strain that the county public hospital TGH was having.

From an oral history standpoint, since I've taken this job, there were explanations to me that there was a concern the safety net system would have collapsed and been significantly impacted due to the strain on TGH.

So the plan was really to address that.

The board appointed a health health care advisory committee to look into the problem of finance and engine health care.

Now, this committee was one of the values of what Hillsborough County does by having community representation.

It involved health care industry, USF, public, private, and the chambers of commerce, the business were supportive of this role and it participated.

As a result, the Hillsborough County health care plan started in 1991 to address the rising costs of providing care for the uninsured low-income residents.

And today we have clients throughout the county.

We have 23,000 plus residents throughout the county through all the districts.

So it is countywide program.

Our mission statement really is quite simple.

It's to provide quality health care to the county's eligible medically poor residents who lack other coverage.

So I won't go through all four bullets, but the objectives are quite simple.

Looking at a prevention, early intervention, and health education model.

So what does that mean?

That's through primary care.

We know we our biggest access point is individuals going through the hospitals through emergency rooms through the ER.

We get them into the health care plan and we transition them through our partners through primary care model.

So that's the prevention and early intervention.

Getting them medication management, pain management, stabilization, getting them on a schedule of care.

So really transferring them from the ER or diverting them from the ER to a primary care model.

And that's that last bullet.

One of the other things with this model, primary care is a model that would consume less resources when we look at comparing it to the hospital.

So that's why back in the 91, moving into a primary care model where we can with the health care plan members.

Adopted the sales tax and the plan.

We had to have a plan because the state required it.

The state statute required that a plan must be included for funding health care for qualified residents and the services alike, and include services cost effective, which the county is the payer of last resort.

So the development of a plan was state required.

Now, any changes to this plan, program, services, eligibility are recommended by our health care advisory board, but always approved and implemented by you all, the Board of County Commissioners.

Now, with that one second, I'd like to recognize our health care advisory board chair and members that are standing behind me, Dr.

John Kern and the members.

If you'd like to stand real quick, these are the members that you appoint board, then we value their subject matter expertise, their guidance, and helping us make decisions that we present to you from a health care standpoint.

So thank you for your service and thank you for all you do.

With regard to the plan, it really was to increase health care access.

The original plan in the 91 documents looked at income ranges of zero to 100% of the federal poverty level with the goal of always going up to 150% of the federal poverty level.

To date, through board's actions, actions, you're at 175%.

We also look at the quality of health care with our providers, right?

Our providers are the backbone.

We have an integrated medical mental health, substance abuse, and social service system, which I'll talk about a little bit later.

But this integration is key in how we're providing services for the members.

We increase level of prevention and early intervention that I mentioned before.

And we have a measurement system to evaluate our effectiveness through our contracts and outside vendors to monitor how well our providers do.

As Bonnie may have said, we are award-winning.

We've been recognized multiple times locally and nationally.

Harvard University's Kennedy School of Government in 95.

We had an Innovations in American Government Award recognized by Rutgers University, as well as the Robert Wood Johnson Foundation for a model program.

And since I've been with the office, we've had multiple visits from jurisdictions about how we do HGHP, the health care plan, and how do we do it so successful?

I'm not going to go through all nine boxes on this particular slide, but this is our management control slide.

So we at the department with the program have significant management controls.

We try to be good stewards with the dollars, try to have strong policies and operations and such.

So again, we follow all board policies and procedures under the county administrator and the the Board of County Commissioners.

We use our OSA committee, the health care advisory board, as well as other vendors on the other support items.

One thing I will mention on our last box, box nine at the bottom, we do have a contract monitoring section.

So we monitor ourselves the contracts that we have for the indigent trust dollars, the upcoming opioid settlement dollars that are in the department, the American Rescue Plan dollars, Ryan White grants, and general fund dollars.

And last year, this section monitored 114 contracts themselves.

So we take management control of in the department very seriously.

The statute, the statute that really created the opportunity for the sales tax 212.055, population of 800,000.

Well, we know Hillsborough County is above that now, or probably double that.

A rate for a sales tax not to exceed 0.5%, and for services for health care related for qualified residents.

Now, from 1991 to 2023, the sales tax was able to be created by extraordinary vote or supermajority by the Board of County Commissioners with the ability to increase or decrease the rate.

So when this was created in 1991, it was done at the board level as allowed by statute.

There has been modifications since the statute since 2023.

The removal of the ability of the board to impose the tax on supermajority or extraordinary vote, that's been modified and removed.

If a community wanted to do uh such, it would have to be through a referendum.

Interesting on the third bullet, if the board ever had a desire to repeal or reduce the current sales tax, this board, it would be done by a two-thirds vote.

So mechanically, you could do that as well, repeal or reduce.

But if there's ever a desire to go back up, it would be a referendum.

A lot a lot of words on this particular slide, so I'm not going to go through all the details.

Um we focused on the qualified residents who are Hillsboro County residents, who are medically poor, needing who need resources or lack of resources thereof.

As I stated earlier, we're at we started at zero to 100% of the federal poverty level.

Now we're at zero to 175% of the poverty level, but that pie chart I think tells a great story.

83% or nearly 20,000 people last year were still zero to 100%.

So that's the low-income, very low income, extremely low income, transient homeless population.

So while we've pushed up eligibility through board action, by and large, we are still serving the medically poor with that income range.

We also serve as a pair of last resort, and we have the ability through board action for innovative and cost-effective programs.

I like this particular slide.

This is kind of an index slide to me.

We do primary care medical home as I mentioned.

Our population last year was 23,527.

We serve 18 to 64.

So why is that?

Individuals under 18 typically are on Florida Kid Care.

Individuals 65 and plus typically have Medicare.

So we serve that 18 to 64 range, that working adult range.

We are a payer for contracted services.

Again, we are a payer.

So I have no doctors in my department, right?

I have three administrative nurses to help with case management, but the county does not have doctors.

We are a payer for contracted services with our provider network system.

Tampa Family Health Center, Suncoast Community Health Centers are federally qualified health centers for primary care, Tampa General Medical Group, part of Tampa General Hospital Primary Care, Bay Care, Specialty, and Ibis Health Care, which is primary as well.

So again, we we are a payer, we have a network system.

We have good access with 13 local hospitals, our contracts, and 30 primary health care clinics and ever growing based upon need.

We pay for invoice services for eligible HACP members.

We don't pay for services related to illegal or undocumented individuals.

So again, everyone goes applies, they are legally here.

The integrated model, as I mentioned earlier, I think this is a really good model when we think about it.

Yes, it's primary care, medical home, we physical and medical health, absolutely.

We've also added substance abuse and mental health treatment.

I think we've all been affected or know someone been affected either before COVID or post COVID with mental health issues or challenges or substance abuse.

So we've added that through the board action over the last decade.

Our wellness social determinants of health.

While health is a very health care is a very key, there's also food insecurity, housing, transportation, education, job need, unemployment.

And we address those social determinants of health by our partnerships, our community partnerships and resources of the people behind me, the agencies represented as well.

We do this in this model and model, and we are looking forward to further growing this model and expanding it where we can.

We work with our providers to emphasize the patient's physical, mental, and social health in an efficient manner.

Our services that we provide.

We like this graph because it really does show a wheel of services.

It is a comprehensive view.

It all starts generally with primary care.

We've added services such as vision, ambulance, substance abuse, dental, and specialty care.

So again, we have a comprehensive program.

These services are offered to the community through BOCC approved contracts for innovative programs and service delivery goals.

Again, you have to be a resident of Hillsborough County, have to be a U.S.

or documented legal resident of the U.S.

income less than 175% of income, limited on assets, and must not be eligible for any other health care coverage.

So again, there's a we really focus on eligibility.

As a health care program that's been around for 35 years, we have a lot of data.

That's not all represented here, and that's by design because that could be 20 slides by itself.

But on this row, row one, the middle box, we had 58,000 claims or visits last year in the primary care, just over 13,000 people.

That's about four visits a person, four to five visits a person.

Now, when I go back to the very beginning of what I said, those 58,000, they would have gone to the ER if primary care wasn't available.

They might not have had stabilized care.

They might have gone when care or their need was so great, and ER is the most costly.

So providing them this option is so key.

Applications on the second row.

We had 23,000 applications this year, and I mentioned that because when I look at October, November this year, November October, November, December this year to October, November, December last year.

I'm up 15% out in applications for the program already.

So the need is there.

So the the need is is continuing, and the applications we are seeing a higher trend this year in FY26, and we're only three months in our enrollment.

We have an open enrollment process.

So if you think about the Affordable Care Act, you get two or three weeks to sign up, you go work in an employer, you get four or five, six weeks to sign up.

We have an open enrollment process.

That means someone can sign up January 1st, January 8th, February 9th, March 17th, it's an open enrollment.

So what we see here is everyone that we had covered during that particular fiscal year.

In 2016, it was 18,700, and the NFY 25 is 23,527.

So we are seeing an increase in the number of enrolled.

That's due to our technology increases, our business processes, our certification unit, and our partners behind us.

So we are actively doing a job enrolling people.

We look to communicate with our communications department, but we are also very mindful with this enrollment that in the community, the Affordable Care Act enhanced subsidies have expired, and we are anticipating seeing more an impact of that.

And what does that look like?

How we are addressing that?

We're working that internally, but we are anticipating an impact on those ACA and enhanced subsidies ending in the community.

Our budget, we do a zero-based budget.

We budget up to the contracts every year, again through our budget office, which we have a great relationship with, zero-based budgeting.

Our medical service budget is 129 million.

Our admin budget's 38 million.

And that last category that I'll go back are other non-planned health expenditures.

A lot of words there that I say it as eligible items that can be spent by the trust fund that are health care related.

Examples of that include the mental health services, the health care responsibility act, the fire rescue ambulance transport for 10 million, the 13th judicial for problem solving court for 1 million, the inmate health care funding for 15.7 million that you all approved.

Included in that bucket, the unfunded county mandates, the county Medicaid contribution for 29 million, which is under statute, the level one trauma payment because we have the lien, the sales tax of 3.5 million, and our Baker Act Marchman and Trauma for about 4.7 million.

Again, all those items are examples of what's in that category.

In our briefing, Commissioner Wassel, you brought up a good point about an attorney general's opinion.

I thank you for bringing that up actually.

Regarding the Medicaid contributions.

So we've broke this out and we spoke with the county attorney's office.

We are allowed to pay the indigenous dollars for the Medicaid contributions under that first paragraph as required by 409.915.

There are restrictions of using those dollars, but we don't do that, it's not accumpable, so it's something that we don't do.

So we do pay that first paragraph where it's allowed to pay the surtax funds to pay the mandatory Medicaid contributions.

We also looked at our partners at Folk County under their budget.

I did that myself.

They do the same thing under the same statute 40915.

Our 30 year budget, I promise I won't go through all 30 years.

But we do see dips and valleys for various things, such as reducing the sales tax in the late 90s, that was going to be done at the state side.

It ultimately was completed at the local BOCC side.

We also see in 2008, the Great Recession, and I think most of us remember there was a dip, significant dip and valley there of revenue, and then rolling forward to the far right, and that's where I'll spend my comments.

We can see in the last 10 to 12 years, we've expanded eligibility.

We've added new services, dental vision, for example, mental health, substance abuse, we've increased our specialty reimbursement rates, we've increased our primary care rates.

So the board, through all board action, has done those items to expand services.

Post COVID, we had a significant impact on the sales tax revenue in the yellow line there.

Nothing we can do.

That was a result of consumerism, people desiring to live in Hillsborough County, spend money and inflation and other economic factors.

And then our spending, as we see in the last three years, has gone up.

It matches the activities that you all have approved.

So, and plus the enrollment.

That's where we're trending.

Now that last slide was 30 something years.

This slide's a little bit more easier, I guess on the eyes, it's probably about 12 years or 11, but we've also overlaid the fund balance, and I think that's part of the conversation of what we have to have today.

Is we can see the yellow and red line are revenues and expenditures, but the fund balance has really grown in correlation with the impact of the sales tax revenue starting in 2021-22.

As of today, with our actuary, it's going to be 531 million at the end of FY25.

The books haven't closed, so I'm hoping it comes in less, but this is the number that we're speaking with you today on 531 million as a fund balance.

So the question is what are the funding considerations for you all to kind of have a soft landing to where we need to be with the fund balance?

Because I think we can all agree 531 million is quite high.

So these options I will present these scenarios.

Scenario one enhanced our trauma payment for the level one trauma center.

So let me be a little bit specific.

That trauma center currently gets 3.5 million in engine funding through the engine trust fund as statutory requirement.

We park that that's still staying, that's on the side.

This request from the provider will be up to an additional 12 million.

Now that could be implemented in faces or scalable as you all see fit.

That'd be 12 million for level trauma one in addition to the 3.5.

The level trauma two payment, they currently get nothing as statutory requirement.

The request from the provider from the provider would be 5.5 million.

Again, scalable at your desire.

Line three of scenario one.

I think this is really an investment opportunity for the engine health care system from a resource standpoint and an asset standpoint.

We're looking at providing capital outlay for funding for the community.

We're envisioning an RFP, RFA, and it would like a 50% match.

So again, it would work like a 50% match and up to 10 million.

And again, that's scalable as you all see fit.

Fourth line, this is actually on your agenda for next week.

It's a program service uh funding for the community step-down facility that was graciously graciously funded by the board through the uh uh what is it, American Rescue Plan dollars for the community step-down facility at Orient Road.

The ribbon cutting is next week on the 26th.

The agenda is on for January 21, and it's 5.3 million in service dollars.

The last two items in peach you all have currently approved funding, the inmate health care funding at the HCSO, Hillsborough County Sheriff's Office, and the Hillsborough County Fire Rescue Ambulance Transport that's in the budget for 10 million.

So those peach items have been already done.

The items in gray would be up for your discussion or input.

Scenario two with 531 million were being transparent and totally agreeable that there would be a conversation if you all want it to reduce the sales tax to a level to ensure the program could continue.

Now, note if you wanted to do a sales tax reduction again, it would be a two-thirds vote.

And if you ever want to go back up again, it would be a referendum.

So the question is as we had our briefings, what is the money, Kevin?

What does it look like?

What is it?

Where are we going?

So to get to that soft landing, line one is scenario one fully loaded.

All 12 million, all 5 million, all 10 million, etc.

We go from 531 million in the fund balance down to 326 million in the fund balance by 2030.

So decreasing by 60, 70 million dollars a year.

You have options there from an expenditure standpoint if you want to increase expenditures or decrease expenditures.

Um that's scenario one from a board perspective.

Lines two, three, and four are the reduction functions, reducing the sales tax from 0.5%, half a percent to 0.45, goes from 531 million to 335 million in line two, line three, 0.5 to 0.4 percent, and the fund balance projected would be 222 million in FY30, and if you decided to do 0.5 to 0.3, the program wouldn't be financially feasible at our current expenditure rate.

So those are generally the options that we're presenting from a scenario.

Line one again gives you options from an expenditure standpoint.

Line two again would be a two-thirds vote uh from a uh uh ordinance or a procedural standpoint.

When we brief Bonnie, as she always does because she does a great job.

She said, What is the benefit if we give additional funding to the level one trauma center?

What is the benefit to the community if we give additional funding to the level two trauma center?

So, what is the return on investment?

Because 12 million and five million is quite high.

So Tampa General did provide a program items, trauma injury prevention and outreach, trauma programs and outreach, and increased specialty access, and they can certainly speak about that.

The level two also provided additional programs in conjunction with this funding, injury prevention and outreach, uh, new food insecurity, and access to health and social services again from the social determinants of health.

So that's my general presentation.

We would like to bring up the providers to briefly talk about their program, their role and involve involvement with HGHCP, and then we will answer any questions.

Sounds great.

So we'll go in alphabetical order.

Bay Care will be first.

Good afternoon.

Good afternoon, commissioners and all.

On behalf of Bay Care Health System, we are so grateful for the opportunity to be here this afternoon to share a little bit about the impact that the plan has on the work that we do.

My name is Sarah Dodds.

I'm president at St.

Joseph's Hospital North.

Um Bay Care's footprint in Hillsboro is six hospitals.

So addition to St.

Joe's North and Lutz, we also have Saint Joe's South in Riverview, South Florida Baptist and Plant City, and then in Tampa, our women's and children's hospital, and our St.

Joseph's main campus, which is our designated level two trauma center.

When we look back at about the last three calendar years, Bay Care has seen and treated about 6,500 individual patients, and that's over 26,000 encounters.

In addition to our hospital level of care, that might also include A care home care for home health services, Baycare imaging, behavioral health services, uh as and also under the plan, we're a specialty care provider where we have access to over 50 different specialties.

Lots of impact that the plan has on us, but I will keep it brief.

My abbreviated version as asked, one of the big things, things for us is access to medication.

We hear routinely that our patients have to make the choice, maybe between getting gas to going to work or getting their prescription filled.

Patients under the health plan don't have to make that choice.

Without those medications, that could result in a worsening of chronic health care conditions or even unnecessary costly visits to the hospital.

And we have a really efficient process to get those patients enrolled either while they're in the hospital or briefly after, and that really ensures a smooth transition back into the community where they have access to that follow-up care that is also critical in preventing the costly care of a potential readmission.

We hear lots of stories about the impact.

It may be a cancer patient with a new diagnosis that has to stop working, and maybe they're eligible for Medicaid.

That process we know can take a minimum of three months, but we also see that can take up to a year.

That's where the health camp health plan comes in to save the day for those patients while they're in transition.

We also hear from a lot of parents of children who have aged out of Medicaid, and the critical role and helpful role that the health plan has made for them.

And my final remark is just that by able by being able to receive patients through the health plan, we are able to expend extend our community benefit in so many ways.

A couple of programs in Hillsborough County that we've been able to do is we sorry about that.

We have our Baycare Mobile Clinic that treats uninsured or underinsured individuals.

That program sees about 1,500 patients per year, gives things like free vaccines, um, well visits, sick visits, um, and lots of services in between.

We also recently partnered with the U.S.

Marshall.

Baycare is the largest provider of behavioral health services and pediatric services in the region.

And through that two-week operation called Home for the Holidays, we were able to re uh rescue over a hundred children that were victims of trafficking.

Um Hillsboro County and surrounding areas were able to come to a hub that was run by Baycare and receive all the services that they need behavioral health support, medical support as they transitioned back in many cases to their family.

We also last year started a navigator program at our women's hospital, again designed to support women through their pregnancy journey that may have limited resources and to guide those women, connect them with resources to ensure a healthy mom and a healthy baby.

Um that I'll mention is that we have a partnership with Hillsborough County Public Schools where we've been able to open food clinics in 15 schools around the county in areas that uh are in need of better nutrition and nourishment, and we have been able to provide those families with healthy foods to ensure healthy families in Hillsboro.

Thank you.

Thank you, Ms.

Dodds.

Good afternoon.

Good afternoon, members of the commission.

My name is Joe Liney.

I'm the executive director for IBIS Health Care, formerly Grace Point, for those that know Grace Point.

Uh IBIS is a large behavioral health organization.

We've been a large behavioral health organization going on 75 years here in Hillsborough County.

Very comprehensive.

Inpatient services for adult and children, outpatient services, and community-based services.

So why would we get into primary care five years ago?

Simple.

Our life expectancy of our behavioral health patients is on average 12 to 15 years less than the general population.

That means our patients are dying in their 50s and early 60s.

In addition to that, uh IBIS has a history of serving a very large homeless population.

Now you can imagine how many homeless people actually go to a primary care office next to none.

Their primary care doctor is our emergency rooms.

And they are, we actually uh work very closely with all of our emergency rooms, Tampa General, St.

Joe's, and Advent Health.

And we hear of the stories of people coming in there that really don't need to be there.

Those are what you might call avoidable ED visits.

So those are the really the two reasons that we decided to get into primary care.

I can tell you right now that the Hillsborough County Health Care Plan has saved lives.

I talked to patients from time to time, and I spoke to one just last week.

This is the first time he's been to a primary care doctor.

He looked like being in his late 50s since his high school physical.

That's a fact.

I've also talked to patients that well, let me put it to you this way.

I had a conversation with patients after the fact, where two patients over the last five years have come in.

We had to bring them right to the emergency room.

It was the first time seeing a doctor in probably over a decade or longer.

And they were in such poor health, uh they were sent to the ER.

What would have happened if they wouldn't have come to us?

I don't know.

These are people on the Hillsborough County Health Care Plan.

I mentioned earlier we do a lot of work with the homeless.

The homeless is, as I noted, they go to the ER.

They now come to us.

And we help them through our continuum of care.

It is integrated care.

And they are here today, healthy.

A lot of them are in our residential programs, and it's just been uh amazing what this plan has been able to do.

Uh so I will end it with that by just simply saying the plan saves lives.

It helps us financially.

When you're a community mental health center, behavioral health center, uh, you're working on a margin that you're lucky to get four percent.

Okay.

So we do a tremendous, a tremendous amount of charity care.

And I know part of the plan was to help us in that area.

So uh this plan, I am witness to it saving lives.

I am witness to it, taking homeless people off the street.

I am witness to it, taking people who normally go to our emergency department and are no longer going there for very minor reasons.

And I'm also uh witness to uh we ran a project uh several years ago where law enforcement encounters have dropped significantly when people are getting behavioral health care, addiction care, and most importantly, primary health care.

Thank you.

Thank you, sir.

Okay.

Good afternoon.

Good afternoon, commissioners.

Good afternoon, uh County Commissioners.

I'm Sherry Hoback, president, CEO, and nurse of Tampa Family Health Centers.

My journey began with Tampa Family Health Centers nearly two decades ago, starting out as their director of nursing and ultimately eight years ago becoming the CEO.

This odyssey has allowed me firsthand the opportunity to be a part of the Hillsborough County plan.

The plan is pivotal for the move of exclusive acute care model to a preventative care model for our community that has delivered exceptional quality metrics and quality of care for our patients.

Tampa Family serves as your largest network provider for Hillsborough County Health Care Plan, delivering comprehensive patient-centered medical home services across the county.

Tampa Family continues to serve over 115,000 patients who rely on access to consistent high-quality care with 14 centers, five mobile units, and two additional sites in development.

Since 1995, Tampa Family has been a long-standing partner with the Hillsborough County Health Care Plan.

Our core services offer patients a wide range of access from primary care, specialty care with coordination, infusion, chronic care management, pharmacy services, behavioral health, dental, infectious disease, and prevention treatment.

In addition, food Tampa family food pantries allow both perishable and non-perishables to be provided to our patients through our food as RX program as well as our community garden.

It doesn't stop there.

Being a part of a patient-centered medical home means our patients are navigated through our care management system, our patient navigation system, as well as our financial counselor system.

From the moment a Hillsborough County patient walks through the threshold of Tampa family, they are care coordinated every step of the way.

Which brings me to the why.

Why Hillsborough County Health Care Plan matters.

Without the plan, many patients will lose access to essential medical care as you've already heard.

The plan supposed supports both primary and chronic care services that would be restricted without this partnership.

At Tampa Family, we focus on a triple aim approach.

We keep the patients out of the emergency room, we keep them on their chronic care medication, and that they are connected to their primary care.

As we take a look at utilization impact and cost efficiency, Tampa Family Health Center's 2025 year-to-date utilization shows our per member per month cost is 463 dollars.

This is the lowest in the Hillsborough County primary care network.

Benchmarking against the national average cost, the average cost in the U.S.

is 1,214 per patient per month.

Tampa family's cost is 463 dollars per member per month.

This is a strong indicator of our cost efficiency value-based care.

HCHCP total plan membership is just over per my numbers, 23,000, which of 54 percent of those members are members of Tampa family.

Those patients had over 41,000 encounters at Tampa family facilities this year, ranging from services from primary care to specialized care.

I cannot speak to utilization impact and cost efficiency without speaking to quality heatis measures.

As a federally qualified health care center, we are highly regulated, published, and transparency is at our core.

Tampa family's commitment to quality outcomes directly aligns with the Hillsborough County Health Care Plan to improve the overall health of the county residents through our strong performance in our quality measures.

We demonstrate measurable impact in not only preventative care, chronic disease management, but most importantly, patient experience.

For the health plan provider performance in 2024 and year to date, Tampa family continues to outpace the national average for hypertension control, hemoglobin A1C control, cervical cancer screening, and best breast cancer screenings for our Hillsborough County members.

With the ending of the ACA subsidies, the need for the Hillsborough County Health Care Plan is needed now more than ever.

As I close, I'd like to end with where I began why HCHCP matters.

It is the collective tapestry of all of us here today as a network to ensure that the health care needs are met for our patients, but also the social determinants of health needs are addressed as well to make certain that the whole person is cared for.

Because here in Hillsborough County, we do things differently.

We work together to improve the health and the well-being of our patients and our community to create and sustain a healthier Hillsboro.

Thank you.

Thank you.

Good afternoon afternoon, commissioners.

My name's Steve Harris.

I'm the senior vice president for payer in government affairs at Tampa General Hospital.

I just want to say thank you for allowing us to talk today, make a few brief remarks about the plan.

I think most of the commissioners are aware of the profile for Tampa General Hospital.

We're the only level one trauma center in the area.

We're one of the largest transplant centers in the United States, and actually, some some news just from this week, we uh were named the second highest volume kidney transplant centers in the United States for 2025.

So that's just off the off the presses.

Uh we're one of four uh ABA verified burn centers in Florida.

I could go on, but I I think why we're here today is to talk about TGH's role as Tampa Bay's largest safety net hospital, and we pride ourselves on caring for all the who walk through the doors, regardless of the ability to pay.

Last year, to give you an idea, we reported to the federal government 289 million dollars in community benefits, community benefits consists of things like charity care, subsidized health uh health services, education, research, uh community health improvements, et cetera.

TGH has a mission statement.

Most of you are probably familiar with it.

We heal, we teach, we innovate, care for everyone every day.

And with that being said, I I don't think it should be any surprise that since the plan's inception in 1991, DGH is the largest provider of hospital services for HCHCP.

Also, just as important in partnership with USF Health.

And I should say that now that USF Health and Tampa General are both clinically and financially integrated.

We're really a university-based uh academic health system uh for the area.

And that academic health system uh in some cases provides the only uh specially physician services uh for the HCHCP population.

And that a lot of that is provided at a at an area called Health Park on 30th Street.

And I'll I'll get into Health Park in a second a little bit more.

Uh but it's really that partnership between USF Health and TGH that makes Health Park run.

Uh if I if let me uh let me go back to inpatient for a second.

If you if if we think uh inpatient, we think Davis Island's uh main academic hospital, just to give you some utilization numbers to get a flavor, since we are the largest provider of hospital services.

Last year we had about 800 HCHCP discharges.

Those patients had an average length of stay of 5.6 days, which is roughly uh just a little less than our overall average for all payers.

The types of patients that are that uh are uh have are getting you uh inpatient services at Tampa General really vary across the board.

Uh we had a heart transplant patient for last year, uh tracheotomy.

Uh we the the three largest DRGs for the HCHCP population inpatient uh last year were cellulitis without major complications or comorbidities, uh septicemia or severe sepsis and uh diabetes with complications and comorbidities.

So all that's to say is it is it it can be a sick population that that has but has the benefit of the HCHCP coverage on the inpatient side.

Uh now turning to the outpatient.

I mentioned Health Park.

Health Park is a uh it's a it's a unique uh area if you've never been to it out in East Tampa.

There's about 20, 20 plus uh uh specialty clinics, and the uh the staff is all there at Health Park.

So everything from clerical up to the mid-levels, the nurse practitioners are there to support the USF specialists who come over to Health Park for one day, two days, you know, a week to see those patients that otherwise for HCHCP population wouldn't have those specialty care services.

That's really important because a lot of times those specialist visits are what keeps those patients out of the hospital or gets them to the hospital in time to save their lives.

So that we really uh value the health park um uh uh uh infrastructure.

I will say that uh we don't run it without a cost.

Um if you look at the uh operations of health park and you take into consideration any payments that might have been received by primarily Medicaid and HCHCP.

We still run that uh that operation at Health Park at about a $15 million loss per year.

Um it is it is at capacity, uh there's physically is that capacity.

Um we don't have it uh currently don't have specialists so we're at capacity from a manpower uh perspective to uh to offer more, but and uh but but future investment could uh provide more access at Health Park.

Uh and that's true of of other areas like South County as well, that additional uh investment could could bring about that.

Um but I I I wanted to keep my remarks brief and um you know we we uh we're we're here for a follow-up uh for questions and just thank you for your time.

Thank you, Mr.

Harris.

One last speaker.

Good afternoon.

Good afternoon.

Kevin made the mistake.

Let me go last.

My name's Brad Harriman's I'm the CEO of Suncoast Community Health Centers.

Uh it's been my privilege to to actually know many of you for a quite a while.

Uh I took over at Suncoast in 2010.

And if you look at like where the Hillsboro County Health Care Plan was back then, uh for those of you that remember that and kind of where the community was back then, we've all grown together, and we've grown in many ways.

I look at the Hillsborough County Health Care Plan is yes, it's it's a payer.

It does what it's supposed to do, but it's so much more than that.

It's that one entity here in Hillsborough County that brings all of us together.

Uh Dr.

Kern and Gene Early before Kevin and now Kevin, and the leadership that they provide, not just in managing the Hillsborough Healthcare Plan, but coordinating health care response throughout the entire community cannot be underestimated.

A number of years ago, we were having problems with with the pill mills.

It was the Hillsborough County Healthcare Plan that kind of took the lead locally to shut those things down.

Um we were also having difficulty.

If you remember, we knew you would have primary care and you would have behavioral health.

If you had a behavioral health issue, you were in this lane.

If you were in primary care, you were in this lane.

It was the Hillsborough County Health Care Plan that brought that entity together to integrate behavioral health and primary care.

This body right here actually put um money towards those programs.

And if you look at where we're at now, we integrate our behavioral health in our primary care.

For those of you that have visit visited our clinics, you know exactly what I'm talking about.

Well, you walk in now, you go to a doctor's appointment and try to take away some of that stigma that really should never have been there in the first place, but sometimes it still is.

And people still want to just go to that appointment and receive the proper health care that they do.

Without the Hillsborough County Healthcare Plan, I'm not sure we ever would have gotten there.

They also took the lead on the opioid discussion.

Uh that was devastating our our uh our community.

Um I've been chairing the behavioral health task force, your behavioral task force now for a number of years.

A little three-month projects turned into like six years.

Um I'm trying to get off of it.

Um but it was that organization that put forth that idea to help draw down those opioid funds that are now here in Hillsborough County that we're gonna get on the street, you're gonna get on the street to help uh alleviate some of that that has happened.

Every month at our meeting or every quarter at our meeting, uh Kelly Devers, uh, you guys probably know her well, um, gets up and gives a uh a briefing, and it shows the amount of suicide or overdose deaths in Hillsborough County.

And you sit there and you look at that and you tie it right back to when uh fentanyl started hitting the streets, and you just see this thing go up exponentially.

And it wasn't until the Hillsborough County Health Care Plan got us together and started focusing on that that you start to see that curve go down.

So uh I I just think it's a wonderful uh program, not just for the payment aspect of it, which is critical.

At Sun Coast, we uh we care for about 4,000 of your patients, 4,000 of our patients within the Hillsborough County Health Care Plan.

Um and we've been part of the program from the very beginning.

We will be part of this program until you guys decide you don't want to do it anymore.

Uh but as long as uh you keep it going, we're gonna keep going with you.

Um of the things that we have partnered on down in our Womama area.

If for those of you that have been there, um it's a wonderful program where you have your community health center, and you and the Hillsborough County runs the senior citizen daycare, which is right right next, it's it's part of the same building.

And and you look at that that crossover between the health care entity and what the senior citizens do.

And then part of that that whole loop that you have in the partnership aspect of that, like on the dental side, we provide the uh us and Tampa family uh do the dental services for the schools.

Well, it's not really Hillsborough County Health Care Plan, but it's still Hillsborough County, and and all that kind of gets tied back together.

That plan itself led directly to NYU Langum coming in here for a pediatric dental residency program that is in Hillsborough County, second largest in the country.

Without the Hillsborough County Health Care Plan and the work that you all do, that one would be here.

And and so I'm I'm very passionate about the plan.

Uh yes, that that number's pretty high.

You and you look at that and you go, okay, that's got to come down.

Um, but the good that that does for the citizens, but then also for the whole community itself, I don't think can be underestimated.

And so I just wanted to come here and say that today.

And I really appreciate all of you.

Uh for those of you that have been to our clinic, uh, thank you for coming.

And for those of you that haven't, you always have an invitation to come visit.

So thank you.

Thank you, Mr.

Herrmanns.

Uh we appreciate uh Kevin Wagner and all of our partners' uh presentations, they were extremely informative.

Kevin, do you want to close before we go into board discussion?

Like thanks, Brad, for going last.

That was a great I appreciate that.

Um, but no, I appreciate all the partners.

We appreciate your support.

We're happy to answer any questions and move forward with your offices individually anytime.

Please feel free.

So look forward to any questions.

I thank you.

Um I know we're gonna go into board discussion now.

I Kevin, I do have one question for you.

Um it appeared that after five years of fairly steady enrollment that there was a significant increase since 23.

And maybe I I guess the question I've got, and I know you mentioned Obamacare subsidies expiring.

But it appeared that the increase was less about economic factors and more about uh communication improvements or technological advancements.

Can you just that's 100% right, Chair?

I mean, our efforts with our communications department with our providers, with our technology, uh, through our processes absolutely drove the increase in enrollment.

So that's that's exactly right, sir.

Okay, thank you.

That's right.

Uh Commissioner Wolston.

Thank you, Mr.

Chair.

Mr.

Wagner, I'll just get my first question out of the way quick, which is uh few of the members, few of the speakers have said that they that this was supposed to help them leave charity care.

Correct, okay.

Charity care is a burden that's put on them by legal aliens, correct?

Well, I would defer to that, not with charity care.

So what we pay for with the Hillsborough County Health Care Plan is for service provided to members, right?

We're not paying for any illegals or undocumented aliens that we provide with the charity care.

I think you are specifically mentioning the IGT component potentially.

I mean potentially.

The one of the speakers, which was an IGT said that part of this was meant to alleviate charity care.

Um the gentleman from IBIS said that part of this he felt like was meant to relieve charity care.

That was his words.

But charity care burdens, to my understanding in the hospital system, is a burden that's put on them by their requirements to provide certain levels of medical care to anyone entering their emergency room.

Correct?

That would be a correct statement.

So how I'm just want to make sure how are we ensuring that our local taxes that are taken from our local residents are not being applied to that.

Like what's your process?

How are you verifying citizenship?

Sure.

When we look at eligibility, we enroll individuals with that one slide.

If they're U.S.

documented residents, if they're Hillsborough County residents, add addresses, two forms of ad um addresses, two forms of documentation, uh income.

So we work very diligently with our certification units to check.

One of the variables that I didn't talk about in our presentation on the bottom of that slide for eligibility, we looked at all our unduplicated applications from 2017 forward in our current enrollment system.

There was 52,553 unduplicated applications from individuals.

We found 28 that had no documents on file in our first run, and after our second run with the supervisor, the idea the number went down to five.

So five out of 52,000 did not have documents in our system.

Not saying they were undocumented individuals, we didn't have documents in our system.

So that's a very.009%.

So I think we have a very strong record of not undocumented individuals in our program.

So you're confirming on the record that we are absolutely certain this tax is not going to provide medical care to illegal aliens.

I just want to make sure.

From the expenditures that we pay for, absolutely correct.

Yes, sir.

Okay.

Um my next question is it was kind of glossed over in your in your report when you had up the slide that was talking about the expenditures that are and you put in the 2026 budget, I think it's like slide 10 or so of your document.

Umbership has stayed relatively flat for the entire existence of this program.

Is that a fair statement?

I th the membership has stayed flat but has increased.

When you and I had a briefing, I think that's slide 17 you're looking at, respectfully on the current version.

The month when I look at unduplicated individuals, that's the chart that's going on to 23,527.

Yeah, but the real number has been stayed that we've been presented even in this 2024 report.

The number has stayed flat around 15 to 16,000.

Sure.

Okay.

I just I don't want you to keep saying these other things because it makes it very confusing.

Sure.

What we've been presented is that the numbers have stayed flat around 15 to 16,000.

Call it an average of 15 and a half.

This new unduplicated thing, it's your you're throwing in different variables that have never been said before that don't make sense.

But the numbers that we've been consistently been told is that the numbers have stayed flat around 15 to 16,000 over and over, and it's even in the 2024 briefing that we got from your department.

Um but your expenses in just a short term doubled basically from 100 million to 200 million in one year, despite membership staying relatively flat, even when they did increase in 2022 before I got here, the eligibility to 175%.

So I first wanted to ask you to confirm on the record that you have never been directly or indirectly asked to maximize expenditures out of this 200 million dollar a year tax to justify it being on the record.

No, I've never been asked that to do that, sir.

So what was your motivation to find double the expenditures in basically a one-year period despite membership remaining flat?

So expenditures increase for various reasons.

One enrollment, as I said, eligibility, increase in specialty reimbursement rates.

Enrollment didn't double, so specialty increasement uh reimbursement rates, primary care reimbursement rates.

So we tried to on this mechanic, made our providers more whole from a competitive standpoint that were approved at the board.

So increases in our services, value-based and services were approved by the board.

With regards to innovative programs, we've added the fire rescue uh ambulance transport for BLS.

That was five million in FY25, 10 million in FY26.

Uh excuse me, where we sit today.

And then we've added in last year the inmate health care funding for 15.7 million, which was approved by the board in August of 2025.

That was through an evaluation of looking at inmate care, it's required by the county, and then through that evaluation, there's a portion, nearly 63% that we can determine that were indigent.

So we funded that with the trust fund dollar.

So those two items right there were nearly 26 million.

Okay.

On page 19 of your presentation, you quickly glossed over, and I don't even actually didn't even mention it, which was stunning to me, even though it's on the slide.

The real reason that this tax was created, um, is that we had a mandate from the federal government.

Yes, Tampa General was the underlying issue in 1991 where they were having some financial hardship.

They they are not anymore.

I believe their their EBITDA is like 10 percent at some something like this rate.

So that is no longer what what this tax is achieving.

But the real the real reason that this tax was put into place, and I will quote, is because there was a federal mandate, which costs escalated annually by approximately six million dollars a year.

Now, at that point, what the county government told the community to justify the tax is that they estimated by 1992 to 1993, health care costs would be sixty million dollars of this mandate for this Medicaid requirement that the federal government put on to us.

That the county was contributing with property tax value.

Growing, they said that that would be the amount that was going to be required from us at that point in time.

However, that number of that unfunded mandate on page 19, 35 years later, for the original reason that we levied this tax, which I want to be clear.

I fully support this sales tax consumption tax being in place to alleviate property tax pressures that we would have been required to pay for this Medicaid fund.

And I fully support it being in place for those reasons.

But the actual reasons that this was put into place are listed on page 19 in the bottom right.

It's a very small little section there called unfunded mandates, county medicaid contribution 29 million, level one trauma care pay payments, three and a half million, which I've said consistently to this board in the past is absurd that they would keep a flat rate for a 35-year period, but it was just hardlined.

That should have been scaling with costs.

Um I don't think that anybody would find it reasonable.

What how how many um counties does the level one trauma center service isn't like five or six?

It's like over four million people, right?

He just said Hillsborough County only.

Only local to Hillsborough County.

Um the the level one trauma care does things like fly a helicopter out too, right?

So those things I think are completely reasonable and codified hard into the statute that we're supposed to be doing this.

Um, if we can increase that amount without the state, which I don't really know how we're allowed to, since it you guys are stretching going after one word.

I've had many conversations on this, and I'll just say it very clear for the record that the changes that happened in 2023 to this state statute were directly changed by my efforts lobbying the legislature because this tax had already gotten so out of hand at that point.

Um, but this amount is 29 million for the county Medicaid contribution, and then the three and a half million for the level one trauma center.

Thirty-five years later, even though the county government's own words to convince the commissioners at that time, not even the voters, because they found a way to work around them without their permission, they said it would be sixty million dollars per year and growing, maxing out the 10 mil limit of ad valorum tax capacity and beyond.

But none of that stuff came to reality.

None of none of that was truthful.

It was just it was just a way to scare people into thinking if you didn't do the full half cent, you're going to have to increase your burden.

Um that Commissioner Platt said in 1991, which I don't think has ever been done, and I know that Obamacare doesn't alleviate anything, but this was actually moved, she moved to amend the plan with this requirement, which has never been done to my understanding, and I'm still not convinced why we haven't done it.

Commissioner Platt moved to amend this is uh uh September the third, 1991, Mr.

Chair, from the transcripts of when this um tax was imposed on our citizens without their permission.

Commissioner Platt moved to amend the health care plan with the language provided by staff to allow for the provision for when the state and or federal government initiated the new plan, then the board would look at this.

The motion was seconded by Commissioner Kimball and received a seven to O vote.

And I just don't know how we're not looking at Obamacare's implementation that gives subsidies for folks that are a hundred percent, I believe, is the the kicker that you start receiving a subsidy at a hundred percent AMI under Obamacare.

I believe that that's the requirement to receive eligibility.

Um, but we're at 175%.

So I don't know how we're not allowing the double dipping or at least having a conversation, making sure that that's not happening, providing those double subsidies despite us having a requirement in here to not do so.

Um the last comment that I'll make, Mr.

Chair, since I know we're not not making decisions today, but I would be remiss, especially since so many people from the community showed out today.

Um I'm only going to point out one of the speakers today that spoke.

Um the rest there this person's at the top of the food chain, and I won't um I won't say their name.

But a lot of the the speeches that we heard today were really emotionally invoking um one of the and uh collective tapestry and things like that.

Um a lot of these organizations are here to provide health care services for some of the most economically disadvantaged or challenged people, however you want to describe it in the community.

And I'm I'm full supportive of us being taxed to um alleviate what would have been a property tax burden on the taxpayers of Hillsborough County.

But when I have speakers coming in here asking for my voters' money that are struggling to live day to day, the lowest income people in the county still play sales tax, the average working class citizen.

And I want to be clear to them that one of the speakers today makes one million dollars a year and is in here asking for your taxes to subsidize their annual salary of one million dollars a year, and I find that repulsive, and I reject the idea that people making one million dollars a year, 11 and a half times the household annual income of the average family in Hillsborough County is in here asking for your money to continue to subsidize that level of a paycheck.

And from there, I will yield, Mr.

Chair.

Thank you.

Okay, Commissioner Cohen.

Uh thank you very much.

Um at least one of the reasons for today's workshop was that we were going to discuss the fact that the fund balance is growing on this account.

And I and we had a graph that you showed us um earlier that um if I could wish I could quite quickly find the point.

Page 22.

Page 22.

Yeah.

Uh so you know which one I'm talking about.

I think the graph, yeah.

Um shows the fund balance uh going up in relationship to our expenses and and what we're taking in.

Before we even get started on this discussion, after 2025, oh, for the next 10 years or so, what does what is the trajectory of these lines look like?

Is the fund balance continuing to get larger, or in a couple years are we gonna start to see that the lines start coming back together again?

So let me talk with the expenditure line.

That's that's essentially going to increase year over year because of reimbursement costs.

The revenue line is actually projected to flatten based upon the current budget office projections.

So that line won't continue.

So those two lines essentially will move in tandem, or the expenditures being a little bit higher than revenue in the next ten years.

So it they're gonna stabilize and perhaps narrow up a little bit.

Exactly.

Um, but we're not gonna continue to see this this gap uh get exacerbated.

Then that's why we're conversational.

So we have that number one.

We also have a a situation right now with a tremendous amount of uncertainty.

I mean, uncertainty on a on a week-to-week basis, doesn't even matter what your opinion is about it.

We don't know whether or not the Obamacare subsidies are going to be extended or not, or and if so if it's not, how many people might get thrown uh off their current programs and become reliant on this.

We we don't know what the legislature is gonna do in the next uh 60 to 90 days related to property taxes and how that might affect just things overall.

So we don't have we don't have a an in an incoming calamity.

Um we also have a lot of uncertainty.

So I I really want to predicate my remarks with the fact that of the choices that you gave us, um, we have we don't have a lot of the information that we would need to be intelligent about looking at some of those things.

We might have more information in six months.

We don't we don't really have it now.

Um seems to me that we have a philosophical choice to make whether or not we want to enhance some of the services that we currently provide or or augment them with some of the things that have been suggested.

There have been other things that have been suggested to me uh by USF Health, by the city of Tampa, different different other players who uh have some thoughts about uh what we could do to provide more service to more people and and really create a situation where we're doing a lot of preventative care in the community and trying to see the numbers of people uh who are actually admitted to the hospital go down.

Um we we can do that, you know.

It it looks like we could also look it there there might be some appetite for looking at some small reduction in it.

Um doesn't seem to me like we could get very much uh and also considering that that line doesn't have much of a trajectory, I don't I don't know how how meaningful that would be.

Um, but it does take five votes, and my understanding from what you said is you can't go back and and put it back again should the numbers start coming back together without a referendum, without a referendum, correct.

So, you know, that's what's in front of us, I think, for the next six months or so.

And um just because of all the uncertainty, you know, I I think that this is something that we, if we're gonna consider making changes, we move gingerly and particularly in the short term, wait to see how some of these things resolve themselves.

Commissioner Miller.

Thank you, Mr.

Chair.

Um, I want to thank all of the presenters.

Um, many of your facilities I've been out to visit and looked at your programs, um, as I'm sure many of my colleagues have been.

Um we're very new and we get a lot of information, and so we don't always know what questions to ask, and the programs are very good on their surface, but there are some things that just sort of led me to other questions, like what percentage of those programs are we funding?

In other words, what percentage of the money they're getting from this program fund the program?

Would it go completely away?

That's some of the data I would like to know if we could get that in the future for for future discussions without jeopardizing um the business plans, I guess you know, their proprietary information for their programs.

Um, I would be interested in that knowledge because it will help.

Um, and furthermore, um to the tail end of Commissioner Cohen's comments.

What is the timeline for this?

Because we do have to operate in the sunshine, and I don't want to be forced, as I've proven repeatedly, I think, and said it many times.

I don't like to be forced into a decision.

I want to have time to take in the options, and even though you have the scenarios sort of delicately put as one and two, there's any multitude of scenario or options that would go into that.

And I just think it's going to be lots of conversations before we can make a decision that's this important for the community.

Um, you know, to uh Commissioner Wistel's point, we have a lot of residents.

We hear on a regular basis, people are struggling, and if we have an opportunity to reduce taxes for them, we need to do that.

But we have to find where that line is, right?

And so I don't think this is gonna be done in in just a few short conversations.

Um those are my comments, and um with that I'll yield.

Commissioner Bowles.

Thank you, Mr.

Chair, and thank you, Kevin, and all of our speakers today for talking.

Um, one of the reasons why I had asked the administrator to bring this up was that like Commissioner Miller that you know being new to the board, it's kind of good.

Why not have a little history about it?

And I've heard that oh, we've talked about this before, and they talked about it in 24, but um and in the past, but getting uh a really comprehensive look at this, and as we look at the graph on page 19, you can see it almost every year since 20, it's gone up by about 80 to 100 million dollars our reserves, and as that keeps increasing, we got to find a way to burn that down.

I mean, there's we just can't have reserves just going on infinitely without that.

And you pointed out there's three things that we really can't control.

Um, and that's inflation, population, and this consumer, you know, consumption, you know, how what people are gonna buy and what they want, and those three things are have really nothing to do with anybody in this room outside of you know, I'm gonna buy what I want when I want it.

Inflation's going up, even though there's going down prices aren't really reflecting that.

So those numbers may go down and may go, they may continue to go up.

And I understand that's truly something you know, we can anticipate that, but I remember sitting on the 26th floor with administration during COVID and saying, Oh, the world's gonna catch on fire and be careful, and it was with you in a different capacity.

But it didn't look like it, it that didn't happen.

I mean, so we saw we got all these subsidies and everything that came out of there uh through the um AR, the American Rescue Plan and all the rest of the stuff.

So that being said, I you know, I think that we really needed to explore a way to burn that down to in a measured way.

I um I I agree that we got it to be very prudent with our tax dollars, and especially those who are being taxed the same.

So if I'm a millionaire or if I'm at the poverty level, we're all getting taxed on the same jug of milk the same.

So how we do that and how we you know kind of reflect on that in what we do, I think we need to really take a measured look at that.

Uh I think there needs to be a reduction of something of some you know of some amount uh on the tax.

I don't know where that is, and again, I think we have to again consider like Commissioner Cohen was saying, where does that break-even point come?

And I see what the numbers say today, but we don't know what tomorrow has in store for us.

Um one of the other things, and I think it was brought up.

You brought up that there was a few items in the past that we have 25 million going to basically fire rescue and so now that wasn't going there before.

So it's 10 million to fire rescue and 15, yeah.

Yeah, combined I was bringing it.

Yeah, combined.

So in the you know, one of the things that uh I pointed out years ago a few years ago was that the uh pre-hospital care has never been really looked at in conjunction with the indigent health program, um, is pretty much looked at once they get into either Bay Care, TGH or wherever, that that's when the pay or starts.

Uh that 10 million is not is a lump sum, though.

It's not based on actual transport.

We're not the fire department's not billing you, and SO is not billing you.

You're we put that in there as a budgetary amount, kind of a flat chunk.

Is that correct?

We did uh data analysis to kind of get to those numbers looking at yeah, yeah, you know, retrospectively looking forward and kind of projecting that out.

So that's so that's one of the things that's not necessarily a payer basis, but you're basically dropping it in.

Um if we looked at that wheel, and there's a couple things I think about the growth.

We talked about the growth of population, the growth of people coming in.

But on the graphs, we're looking at how many came in over looking at what we have in 22.

We had a jump what was the uh from from the enrollment of the end of the year, yeah.

Just under 19,000 in 22 to just under 20.

23 and a half now last year.

And one of those other things, and if we look back on slide, we had the increase also in the AMI percentage.

So whether it was also and with your communication efforts, I think that that that number also is reflective of it because if we go back to if we just looked at what it was 100 percent, it's at 19,000.

So it kind of goes right back.

So that and in addition to that, we added dental, we we've added some other services.

So it's you know, to say that it's just you know, well, we communicated when we got out.

I think that you know there may be some other things that we need to consider as well.

So you know, when I look at what's a better way to burn down the funds, it can we expand some services, sure.

Uh can we reduce it by some?

Sure.

But I think we also have to look at shrinking some things as well, and that you know, really getting those funds to those who need it the most, and that would come to if it's at that whatever that level and that line is that we make sure that we're giving the most amount to those people who need it truly the most.

Um so that's another thing that I wanted to kind of at least put on the record.

Uh the trauma services.

I've dealt with traumas a lot.

I've sent people to everyone's hospital here over the years.

Um the uh some of the services in here kind of interesting.

The I gotta find it.

There it is.

Enhanced trauma programs.

How does food working with echo and few food and security?

How do you lump that into trauma?

Would you think there want to talk about that?

I mean, I I know it goes to general health, and I totally get it.

That's exactly right.

Yeah, but to say that it's enhanced trauma programs and that a level one gets so much and level two gets so much.

If you're telling me it's a level one trauma program, it should be towards those services, I think, or those modalities or uh programs that enhance the trauma program, not enhancing other services that may give food security or dental or sure echo, it all great programs.

I'm not saying it's not all worthy causes, but I think it kind of masks some of the things that if we're looking to do that, because that's the biggest chunk.

And both of these, if I look at um Bay Care's food insecurities, 2.9 dollar or 2.9 million dollar impact, the Tampa General is 2.8.

Now it's not all, it's just the largest chunk of that.

So giving a lot of money to them, which I'm not necessarily against.

I just think that we need sure.

If we're giving it the trauma, maybe it stays in that in that wheelhouse.

We can look at that.

And the last thing, if we're all talking about this, if we looked at the wheel, wheel of services, um, there's so many on there.

I I would imagine that when this was put into place, and I think uh Commissioner Whistle brought this up pretty succinctly, was that most of those things probably were were not part of the program back then, or how much of that wheel would you say would not be there if they made a wheel then?

Yeah, I mean I think with 50 percent.

I would I would think a little bit less than 50 percent.

I think the the intent of the program from a core standpoint, I'll answer with core, okay.

Okay, um, primary care, your inpatient, your outpatient, your specialty, your pharmaceutical, your ER.

So what is it?

And then that would be the core.

The other items, dental vision, that would be growth or ancillary in this scenario.

Right.

DME, all that kind of thing.

Yeah, okay.

And DME may have been an original too, right?

But this this today is certainly a different model than the 91 model.

So over the years, we've looked for we collectively, the county have looked for ways to spend the money.

We've gotten so much, we enhanced our services over the last five years.

We look for we enhanced our our population of people we serve.

Um we continue to get money, we couldn't spend it all because it was still going up.

Uh and but now we're faced with an issue that we may, I think 200 over 200,000 people in the area may be affected by the subsidies.

Is that a fair and accurate number?

From the public use files zero to 200% of the federal poverty level, there were 229,000 people at all um age ranges, I believe who have that in Hillsborough County, yes, sir.

That could possibly be affected by the ACAA subsidy in some form or fashion, correct?

Yes, sir.

So um, and again, getting back to Commissioner Cohen's point, I think we have an issue that maybe while we I believe we need to do something, we just can't let it grow, we can't let it go with the something has to happen.

Sales tax reduction, I think, and it comes back to what Professor Miller was saying as well, and Commissioner Whistle to some degree that we need to shrink this.

Um but anything we do, if we did something today, it wouldn't go into effect the next year because we don't transmit till October to the DOR and how we were going to collect tax on this, right?

So you're talking about a tax reduction.

Yeah, if I say we reduced it by 0.1 or 0.05, whatever.

Right.

If you went through your process during the next six, eight months, the effect of the reduction would not occur until January.

I think it's 60 days before January or 90 days before January, you have to do your final vote, and the county attorney's office can verify.

Yeah, I think it's October.

Yeah, but the final rechange would occur the following January, January 1.

So even if we said we want to reduce it today, nothing actually happens.

Right, and that's due to statute.

That's due, that's not our choice, that's due to the statute.

And then the other side of that, and this is kind of directed, I guess a little towards my if we were going to make some changes and think about from a budgetary standpoint, which I think Commissioner Miller was referring to, which we have a lot more control over, that we can mean we can add or take away easier.

We would have to do that within the next three or four months.

That probably fair.

Um now would be good timing because we're gonna be starting the budget process for the upcoming year.

Right, right.

So I mean that's just something so to have those conversations.

I could get folded into it as well.

Right.

Okay.

So time is of essence, but we're not urgently making the decision today or tomorrow or in two weeks.

So I think um a lot of good information again, thank you.

Uh I think you know, there's gonna be some hybrid, at least if I I would present a hybrid to this because I I'm really interested to see what's gonna happen with the ACA stuff.

I've heard President Trump says if it comes to his desk, he's gonna veto it, but you know, who who knows how that's gonna end up, but um, and then see how that really plays out with the families in here because our health care providers out there who are out there are gonna may have an influx as well, and that may kind of trickle down to us.

So, anyway, absolutely I yield.

Thank you, Chair.

Commissioner Myers, and we're gonna wrap things up.

Okay.

Uh thank you, Mr.

Chair.

First, I'd like to just thank all the providers uh who came and gave their their comments today.

But I want to just share with us, because I'm probably the only one sitting around in this desk that had the opportunity to work directly with a lot of the providers because I was staffed here in Hillsburg County back in the 90s, and when our health care plan was established in all and working with the some of the same uh nonprofits, particularly our two fellow qualified health care centers, Suncoast, and uh Tampa community.

As we all know, I represent District Three.

And in District Three, we have a population of people who really really rely on our health care plan for services, meaning they don't have health care.

They don't have health care.

Still today, there are many people here in our county don't know about our health care plan.

I shared that with Kevin the other day.

Just last week, I met with a medical group was talking about our health care plan.

They did not know anything about our health care plan.

I invited them to come today.

Health care is a part of our economy.

Health care is what people know and how they want to get well.

We have providers that provide excellent services over the years.

I was a health care supervisor with the plan.

I know what this plan has done for so many residents of Hillsburg County.

I can remember when TGH went from the public hospital to private.

And everyone was running to TGH back in the day to the ER.

And found that TGH got it right.

Did you on a health care plan and started except in our clients?

Because many of the black families were crying that they could not get the services for their child or for a mother father crying out.

And yet today we sit in this boardroom and we talk and we're saying, and I just want to put it out there.

If a CEO makes a million dollars, two million dollars or five million dollars a year, I don't care.

Because if your board think you are worth that and what you mean to the organization and what you're bringing, that's fine with me.

I'm only concerned how what we can do, Hillsburg County, not the person aside.

And yes, I serve the poorest area of Hillsburg County.

My clients don't talk.

The constituents that I serve, they don't bring that up to me.

Who makes what?

It's commissioner, how could you help me?

How can I get good services from the county?

Some of the things that we talk about here in this boardroom is irrevalent to the people of Hillsburg County.

Can you make sure my rent is paid?

You fix my roads.

What about sidewalks?

Keep our health care plan.

I was just talking with people the last two weeks of this item coming before us today.

That was on our plan.

How do you feel about a Hillsburg County plan?

Don't take it away from us.

I cannot afford anything else.

The plan is all I have.

I've introduced my children who don't have to our health care plan.

Understand one of the things, Kevin, I'm going to ask, because I always felt even when I was working here back in the day, but I'm in a different role today.

Okay.

We have to market the plan.

We have to market our plans, and I'm going to ask to provide us.

If you're talking about it, and you're talking about the media, market our plan so people would know.

We have the health, the best health care plan in America.

People come here to Hillsburg County to know about our plan and how they can take it back to their county or their state to implement our plan.

That speaks by volume of what we're doing here in Hillsburg County.

Whether we get that.

So Kevin, we have that why we're going to market it to the media.

Absolutely, ma'am.

Okay, because I'm on GMA in the morning, I look to CS on there.

On GMA.

Okay, yes.

A little bit of time, but yes, no, send it to all the stations.

Okay.

Absolutely.

But it's important.

Absolutely.

That we tell our story and why this plan is so impactful to our communities.

And I have county staff at my town hall meetings talking about our plan because we are enrolling people into the plan, and we can enroll more people.

Remember, this plan started at an 80%.

And now today we're at 175%.

What does that tell us?

And the gene before Gene left last year.

We increase our eligibility to be able to what?

Serve more people.

We got to get it.

We got to get it, boy.

We we're here to help people in our county.

We're not talking about our neighboring county, Pasco, Pinellas.

It's what we do here in Hillsburg County to serve our people.

Yes, former staff mentioned years ago.

We got to work with the jail.

Same ones coming out, they need to be enrolled in our health care plan.

We finally got that right.

And I appreciate what staff, what we're doing every day to make sure people are being served in our plan.

It's preventive care.

Everyone cannot afford the insurance.

We we hear it all the time when you turn your TV on, what we're facing right now.

There are gonna be many others, probably here shortly gonna roll into our plan.

But if we market it well, we can do a good job.

And I hear my chairman tapping telling me to wrap it up.

So I'm gonna go ahead.

Oh, I know the signals.

Thank you, Mr.

Chair.

I know the signals.

So I'm gonna wrap it up.

But again, again, thanks everyone for coming out, listening, and tell folks about our plan.

We might not qualify, never qualified, but there's others, whether you're in church, civic organizations, and you know someone hurting, tell them about our plan.

I still know the number, 813-272-5040.

Thank you, Mr.

Chair.

That's my smart woman, uh Commissioner Myers.

Um couple quick things and then we'll wrap up.

We're a minute past our time.

Uh Commissioner Myers, I've said for a long time we could do a much better job marketing all of Hillsborough County services, and that's why, if you remember a couple months ago, I had uh iHeart Media come in and give a presentation as far as pro bono things that they can do to help us in that regard, and certainly this would be one of those things where we could do a much better job getting the word out.

Um, again, I thought it was excellent comments uh and questions from board members.

I want to uh thank all of our partners for their presentations, I want to thank the uh task force for your uh leadership and direction through the years.

Uh clearly we're not taking any action today.

I do agree with uh Commissioner Cohen when he said that we should um proceed gingerly uh prior to getting uh the necessary information that we need.

Um we have several potential funding considerations to uh to consider just one thing that I would throw out there that I would strongly consider any supporting any um additional program that would uh relieve our general revenue fund burden.

So I don't know.

I know what we've done the last couple of years.

I don't know if there's anything else that we can consider, but something I would like to take a look at if there is.

But with that again, thank everyone for coming out today and for all of your uh participation and comments and we're adjourn.