Combined state and county costs for the medical indigency/catastrophic health care fund in 2013 came to $52.7 million. That’s up from $25.3 million in 2002. It’s slightly down from the prior year due to the federal PCIP program, a temporary program that covered some costs, but expires March 31. “We anticipate that trend will reverse in the future,” Bonneville County Commissioner Roger Christensen, chairman of the state Catastrophic Health Fund board, told JFAC this morning.

The program covers catastrophic medical costs for patients who can't pay the bills off in five years; liens are placed on patients' property, but little is generally recovered. State general funds and local property taxes cover the full cost of the program. For next year, the CAT fund is requesting $38.5 million state general funds. That’s a 10.6 percent increase from the current year’s state appropriation of $34.8 million, and reflects the latest projections; the governor’s recommendation, submitted earlier, was for a 3.4 percent increase to $36 million. The rest of the cost for the program is directly picked up by county property taxpayers.

“One area that’s a real concern to our counties is the issues of mental health,” Christensen told legislative budget writers. “We’re seeing quite an increase.” He said the nature of the program is that it doesn’t provide preventive care; it just picks up catastrophic costs. “This is an area where prevention pays dividends,” Christensen said. “When we deal with it, it’s usually after an episode. It’s unfortunate, because people are being treated in our jails. … We just want to point that out as an area of major concern and pressure on program costs that we may have in the future.”

Christensen said if the program continues as-is, costs are expected to continue to mount. Alternatives include expanding Medicaid to provide coverage for patients who otherwise would turn to the CAT program, and repealing the existing program; sending some of the patients to the insurance exchange; or cutting back the program to cover only emergencies. Currently, its highest costs are for heart disease and related conditions, followed by cancer, and then diabetes. The average claim paid has risen from $24,127 in 2010 to $26,602 in the first six months of this year.

“This is the nature of our program,” Christensen said. “It doesn’t allow for preventive care, so we deal with the results after it becomes catastrophic, which is much more expensive, and it’s paid for dollar for dollar.” No federal matching funds are available to the medical indigency/catastrophic care program. Costs would be reduced if the patients were covered with an insurance plan, he said.