Clay County approves special assessment program to help local hospitals draw Medicaid match

The Clay County Board of County Commissioners unanimously approved a resolution on Sept. 27 authorizing special assessments on three hospital properties to enable state‑level Medicaid matching that will reimburse hospitals for the gap between Medicaid payments and actual costs.

Rob Bradley, an attorney representing Ascension (St. Vincent's Clay Hospital) and HCA (Orange Park Medical Center), explained the mechanics: assessed funds are remitted to the state, which draws federal matching dollars and returns funds to the providers to reduce the cost shortfall created by Medicaid reimbursement rates.

"The hospitals are going to literally come out of pocket a dollar, and then they're going to get a check back for $2 for that little piece," Bradley said, describing the matching formula. He noted the program applies only to three properties in Clay County: Orange Park Medical Center (HCA), St. Vincent's Clay Hospital, and Kindred in Green Cove Springs.

County staff and hospital representatives said the assessments are legally enforceable special assessments on the listed properties and not a general tax on homeowners. Commissioners asked about the annual review process; Bradley said the board will revisit the program each year and that total assessments for the current year will be slightly under $6 million, subject to change if additional hospitals (Baptist) join next year.

The board opened a public hearing; no members of the public spoke. Colleen Ernst, representing the hospital group, explained that hospitals cannot self‑assess and that local government authority is required to make the mechanism enforceable. After staff confirmed the agreement and resolution covered the required procedural steps, the board moved, seconded and carried the resolution and associated letter of agreement unanimously.

The county will implement the assessments and return to the board for annual renewal or adjustment, staff said.