Polk County commissioners debate TAC pilot for dependent premium assistance, raise liability and data concerns

Polk County commissioners on an agenda item about a TAC pilot program heard staff say the pilot appears to apply to dependent tiers (employee plus child or family) but not to spouse-only coverage, prompting questions about who would be eligible, how much it would cost and how stable the program would be.

Staff told the court that the county had received conflicting information from TAC and that the most recent clarification shows the program applies to dependent tiers — employees with children or family plans — but excludes employees who would seek assistance only for a spouse. County staff said they received the clarified data late and that several enrollment counts in TAC’s reports did not reconcile with Polk County payroll data.

The discrepancy matters because county enrollment is skewed toward employee-only coverage: staff reported 251 employee-only enrollments, nine employee-plus-spouse, 22 employee-plus-children and seven employee-plus-family on the county’s plan. Staff also cited department-level counts that showed 41 employees with children and a separate count of 70 listed as family; staff said those figures appeared inconsistent and that they would follow up to verify who would actually be eligible under TAC’s definitions.

Commissioners raised multiple concerns: TAC’s right to modify or discontinue the pilot at renewal, the program’s potential to create an open-ended long-term liability for the county, and how adding a recurring benefit could affect Polk County’s other-post-employment benefit (OPEB) obligations and bond ratings. One commissioner summarized the worry as a risk of committing to an ongoing cost without a reliable history to predict future exposure.

Staff described enrollment and utilization data reported by other participants in the pilot. They said two counties currently in the program showed large percentage increases in dependent enrollment (figures presented for those counties were not independently verified by Polk County staff) and that TAC retains the ability to change rates or discontinue the program at renewal. Staff also identified specific cost figures in TAC materials but told the court those totals appeared inconsistent across documents and therefore required additional verification.

Given the eligibility limitations and the uncertainty in TAC-provided numbers, several commissioners said they were not comfortable committing Polk County to the pilot at this time. Instead, staff recommended focusing on increasing utilization of existing benefits and exploring alternative options that would cover entire households, including an ancillary telehealth product the county learned about through its broker.

County staff said the broker Higginbotham recently confirmed an ancillary telehealth option that employees could elect for roughly $11 per month and that would cover an entire household without a copay; the county’s current Blue Cross Blue Shield telehealth benefit covers only the enrolled employee. Staff also reported existing utilization rates for Polk County: approximately 35 percent of employees have used Teladoc, about 25 percent have used MDLive, and roughly 2 percent used the 24-hour nurse line. The wellness committee plans targeted outreach and a wellness clinic and to repeat outreach at the county appreciation lunch to increase awareness and sign-ups.

No formal action to enroll Polk County in the TAC pilot was recorded during the discussion. Commissioners directed staff to verify the enrollment and cost figures from TAC, to continue work by the wellness committee on telehealth and promotion, and to return with clarified information and recommendations before making a final decision.

Polk County staff said 98 employees are currently income-eligible for Medicaid under county salary thresholds and noted that moving employees on and off public coverage (Medicaid/CHIP) can create short-term coverage gaps; staff flagged that some employees currently receiving Medicaid or CHIP may not benefit from a premium-assistance pilot and that churn would complicate planning.