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~~r 3 Assembly passes the nutrient sensitive regulations would enable the County to enfcrce that program. Thompson requested the addition of 52,930 to the markda~•m list for Sail and T•7ater. IN-HOPfE SERVICES Thompson noted same changes in Medicare which will affect in•-home services. The federal government will be paying costs that it estimates for different types of treatment rather than the costs reported to them; hospital stays will be shortened and the demand for in-home services will increase. Four different agencies within the County will be affected: (1) Social Services with their Chore Service Program; (2) Aging Department with their homemaker-home health aides, (3) Health department with some in-home delivery of Nursing care on a limited basis, and (4) Chapel Hill Rome Health Agency which provides skilled nursing care within the home. The Chapel Hill Home Health Agency projects a higher level of indigents because of these changes in Medicare. There is a grant but the indigent cost is expected to exceed the amount of the grant. The projected loss of 534,560 for 84-B5 will be partially offset by the 517,025 grant and other contributions of 52,535 leaving a net loss of 515,000. Orange County residents make up 89$ of the case load of ~•rhich 95~ are indigent. Tony Zizzamia, 'e'xecutive Director of Home Health Services pointed out that the 515,000 request is related to Orange County. The 517,025 state grant is for the total service area. He noted that if a patient is indigent and unable to pay for the services from a surrounding county, the state money would be used for that and the S1S,000 would be restricted to Orange County residents only. Commissioner P•iarshall asked if Orange County should not receive some of the grant money for indigents in Orange County. Zizzamia noted that the prooess would be to go ahead and use the state grant for all counties before using the money from Orange County. A small percentage of the grant would be held back to insure monies far the surrounding areas. It would be very small; the major part of the grant would go to Orange County. Zizzamia and Lynn Taylor-Rimer, Chairman of the Board, spoke in support of their budget. Commissioner Pdhitted requested the amount of S1S,000 be placed on the markup list far further consideration by the Board. Commissioner PZarshall stressed coordination among the Home Health agencies. Bill Baxter, Tony Zizzamia and Jerry Robinson all supported this coordination. She requested that the Home Health agencies work with the County Manager and report back to the Board on this coordination. She requested that the Have Health agencies work with the County P,anager and report back to the Board or, this coordination of in-hame services. ADJODRA'^; ENT Tvith no further business to come before the Board, the meeting was adjourned. Hever],y A. Blythe, Clerk Don j~illhoit, Chair