Erath County Commissioners Court has put a process in place for the Indigent Healthcare Fund after an external audit found repeated overspending on medical bills going against state guidelines. As of Friday, Aug. 15 the county employee involved has been terminated.
During the Monday, Aug. 11 meeting, County Judge Brandon Huckabee gave background on what had occurred.
In March 2025, because the county had started using budget actuals instead of estimates, they realized there may have been a problem in indigent fund spending.
“A budget adjustment request was made that raised our auditor’s eyebrows,” Huckabee said. “He brought that request to me.”
The auditor had to get special access to the software used for the Indigent Healthcare Fund system since portions are protected by HIPAA due to the medical bills being paid.
Per state guidelines, 8% of General Revenue Tax Levy must be set aside for indigent healthcare, however, a county is not required to spend it all. For Erath County that amounts to about $1.2 million. The money has been secured in a CD in order to draw interest, while maintaining access.
“When we realized there was the possibility of overpayments being made, we contacted the appropriate officials that we were supposed to contact,” he said. “We made the commissioners court aware and we made changes in that department immediately.”
The county then pinned down an audit firm – BMY-to conduct an independent, external audit (Auditor’s Report on the Agreed Upon Procedures) on the Indigent Healthcare Fund and that process wrapped up last week.
County Attorney Bethany Espinoza and her office, especially Brandy Clements, have been working on the Indigent Healthcare Fund Handbook since March.
In 2019, the commissioners moved indigent healthcare from the county judge’s office to the commissioners and that is who had oversight.
“We went back to look the audit for the past five years and they were suppose to follow state law. There was actually no Erath County Indigent Healthcare Plan policy,” he said. “That’s the truth and we aren’t trying to hide anything.”
In the state guidelines, those enrolled in the Indigent Healthcare Program are only eligible to receive $30,000 worth of medical bills paid annually. There are qualifications to meet and those qualifications must be reevaluated every 6 months. The appropriate forms and paperwork must also be filled out.
“Our main responsibility is to the public and every taxpayer that contributes to tax money,” Huckabee said. “We can’t change the past but we can make sure it doesn’t happen again.”
In the external audit, a sample was provided of those who received benefits more than $5,000 or greater from fiscal year 2000 through April 2025. 25 individuals were examined and one individual did not meet the criteria to be enrolled in the program based on income guidelines.
According to the audit paperwork, “Despite the fact this individual was deemed ineligible by the county, $30,920.82 in county funds were disbursed on their behalf. Per Micki Bell, this ineligibility was overridden by her with the approval of a county commissioner. This override was not documented or evidenced in the supporting file.”
Other issues were found because guidelines established by Chapter 61, Indigent Healthcare and Treatment Act, eligibility of approved individuals must be reevaluated every 6 months until they have been removed from eligibility or no longer require assistance. During the audit, three people were identified as receiving benefits outside the approved eligibility period. Two more individuals were identified whose eligibility could not be verified due to missing or incomplete files.
Within the 25 sampled files, 20 of them were missing some element of required documentation.
“Of the 25 individuals receiving payments from fiscal year 2020 through April of 2025, BMY noted 19 instances of individuals receiving more than $30,000 in a given fiscal year with overages totaling $536,166. There was no documentation of formal approval for these overages. However, there was note within the software, at the time of the override, stating verbal approval was given by a commissioner,” the audit stated. All funds were paid to medical providers not individuals.
The new guidelines outlined by Espinoza at the meeting included multiple layers of security.
“Obviously the first priority is to make sure Erath County was in compliance with state law in our policy and procedures,” Espinoza said. “But it is also customized – one to meet the needs and particular circumstances of our county and two to address the deficiencies and shortfalls that caused the problem noted in the audit.”
First, Lindsey Merriman, the county’s Veteran Services Officer, is now over the Indigent Healthcare System forms for the county and will receive a small stipend to help cover additional work.
County Treasurer Angie Shawver is the supervisor of the disbursement of funds and will make sure Merriman has done her role.
“She will be the final signoff to say this is good,” Huckabee said.
The bills will then go to the auditor’s office, be finalized and then paid.
If there is an appeal for anything, it will come to the county judge. If someone is denied, they can appeal it.
“The old process had one person doing all three of those. We will be more transparent with more eyes looking at this,” Huckabee said.
The handbook also outlines services that Erath County must cover and those that they may choose to cover. The county will not cover optional services automatically.
The handbook also addresses inmates at the Erath County Jail.
“If you are in our jail and a resident of our county, we are going to deem you indigent while you are incarcerated,” Espinoza said. “Because it makes it clear what providers we are using, what is going to be covered. That is the way the majority of counties do it and that’s the way this is laid out.”
In the future, the county may look at a different option for inmate healthcare, such as enrolling them in the Marketplace.
At the beginning of the meeting, Erath County resident Carla Trussell spoke about the issue encouraging the commissioners to be transparent about the issue involving taxpayer funds.
“... Explain exactly what has happened with the indigent funds, why oversightof thosefundswas transferredtoanothercounty employee and whether there will be consequences for the mismanagement of those funds or firing over that,” Truesell said. “Who was in charge of supervising the employee handling the indigent funds?”
Commissioners did not address the continued employment of the individual, however, in an interview with the Citizen after the meeting, Commissioner Sherman Edwards offered the following quote.
“I think the best thing for the employee is to be separated from county employment, but I’m only one vote. I’ve made my suggestion,” he said.
No action was taken after a commissioner court closed executive session discussing personnel Friday, Aug. 15. Judge Huckabee confirmed the county employee was no longer employed on Monday, Aug. 18.