Tax levy review finds indigent-care levy financially stable but vulnerable to federal funding changes

Indigent-care levy review shows current reserves but warns of federal funding risk. The Tax Levy Review Committee told the Hamilton County Board of County Commissioners on July 29 that the county’s indigent-care levy is in good financial condition after implementing memorandum-of-understanding (MOU) agreements and cost-containment steps, but committee members cautioned that reductions in federal funding or changes to Medicaid could sharply reduce services to underinsured and uninsured residents. The committee’s midpoint review highlighted several implemented changes intended to clarify responsibilities and control costs. Committee member Gwen McFarlane and assistant city administrator Lisa Webb reported that MOUs now define agency responsibilities and performance metrics for levy-funded programs; a cost-containment plan caps sheriff inmate-health and related sheriff staffing at 38% of levy expenditures with excess spending to be covered from other sources; and the Mental Health and Recovery Services Board released more than $1.4 million in previously encumbered funds back to the levy. Committee members said the levy supports health and hospital services provided through University of Cincinnati Medical Center and Cincinnati Children’s Hospital Medical Center and funds county public-health programs, charitable pharmacy services, homeless medical services and probate-court guardianship work. The probate court used levy money to hire a second guardianship investigator and has proposed adding a third investigator to meet demonstrated need. The review also reflected a recent state-level legal change that allows individual hospitals to participate in a state-directed payment (SDP) program. Staff modified levy contract language to permit UC Medical Center and Cincinnati Children’s Hospital to use levy payments toward SDP eligibility, and the committee said staff are monitoring that change to ensure it does not reduce the charity-care level historically provided by levy-funded programs. Financial figures presented to commissioners included a projected 2025 carryover balance for the indigent-care levy of about $19 million and an expected fund balance of roughly $16 million at the end of the five-year plan, before accounting for encumbrances. Assistant city administrator Lisa Webb told commissioners the levy is a roughly $80 million-per-year levy and that it typically spends less in early years and more in later years because of rising costs. Committee discussion emphasized that many county programs and justice-center obligations are funded through this levy. Members urged continued monitoring of provider finances and of potential federal or Medicaid changes that could increase demand or reduce available funding. No formal policy changes or levy submissions to voters were made at the meeting; the committee’s report was presented as the final scheduled presentation of its midpoint reviews for the four levies under review. Looking ahead, commissioners asked the committee to include reserve balances at the end of the five-year levy periods for all levies in future reports and to continue monitoring the potential effects of Medicaid and federal funding changes.