Hospitals in Collin County would pay into a county-run Medicaid fund under a new formula if commissioners approve a set of orders at their Monday, Nov. 9, meeting.
The Commissioners Court will hold a public hearing on amended mandatory payments for its Local Provider Participation Fund, known as an LPPF, for fiscal 2027. State law lets counties create these funds by charging local hospitals a mandatory payment.
A form from the Texas Health and Human Services Commission in the agenda packet describes how the county then moves money from the fund to the state to support the non-federal share of Medicaid payments.
What changes
Commissioners already approved the fiscal 2027 payments on Sept. 28. The draft order now on the agenda says there is "good cause" to amend that rate. Under the new version, each institutional health care provider in the county would be charged 6% of its net patient revenue from inpatient hospital services and, separately, 6% of its net patient revenue from outpatient services.
Each hospital's most recent Medicare cost report would be used to calculate the two figures, or another acceptable source if a hospital has no such report.
The state form spells out the shift. For tax periods that began on or before Sept. 30, 2026, assessments could be based on a hospital's total net patient revenue. For periods starting Oct. 1 or later, the state is asking local governments to attest that the charges are imposed separately on inpatient and outpatient revenue.
A second order would add a 14th rule to the fund's administrative rules, first adopted in December 2023 and amended in September 2025, to make the separate inpatient and outpatient method permanent. A third would create a new bank account for fiscal 2027 payments, which the draft order says HHSC requested.
