The Fairfax Board of Supervisors is contemplating an agreement with Fairfax Hospital System that, if adopted, would enable more low-income Northern Virginia residents to qualify for less expensive medical care at several area hospitals starting next year.

The board will conduct a public hearing on the proposed agreement at its Jan. 14 meeting.

"The old agreement was not very specific. It didn't really address the kinds of health issues we have today," such as containing the cost of providing medical care to indigent patients, said Supervisor Kate Hanley (D-Providence). The proposed agreement is "important to the folks unable to get health care, but also to everyone else."

The county currently requires the hospital system to provide free medical care to eligible uninsured or under-insured low-income patients at the hospitals it operates, including Fairfax, Mount Vernon and Fair Oaks in Fairfax County; Jefferson Hospital in Alexandria; and several area clinics. To qualify for free care, a patient's household income must not exceed 200 percent of the federal poverty level, which is $12,700 for a family of four.

In exchange, Fairfax and Mount Vernon hospitals rent their facilities from the county for $1 a year.

But like other not-for-profit hospitals nationwide, the system's facilities are caught between the commitment to provide hospital care to all who request it, regardless of their ability to pay, and the mounting cost of providing that care to a growing indigent population. Last year, the hospital system swallowed about $23.7 million, or 5.3 percent of its total revenue, to provide free care to indigents.

In the past few years, the hospital system has attributed some increases in the medical charges of paying patients to helping the system recover the cost of providing free care.

Under the agreement that the county is considering, the hospital system would update the income eligibility from 200 percent of the federal poverty level to 250 percent, to enable more residents to receive subsidized care. But the hospitals also would charge people who make slightly more at least a portion of their medical bills, instead of writing them off entirely.

Patients who are paid less than 126 percent of the federal poverty level would still pay nothing. But patients who make 126 percent to 250 percent of the federal poverty level would pay up to 75 percent of the charges, depending on their income levels.

To further ease the financial burden on low-income patients who pay a portion of their medical expenses, the agreement would limit the size of a patient's annual hospital bill according to annual income level, giving some patients more than a year to pay their bills.

So far, the hospital system is encouraged by the proposed agreement, said Tom Jacks, vice president of Inova Health Systems Foundation, the hospital system's parent company. "It is a recognition by Inova and the county that we have an obligation to serve patients who cannot pay in full . . . also a recognition by the county that it costs us a substantial amount to serve these people."

Although the hospitals would receive a portion of their charges from some indigent patients, it would be "only a very small portion," Jacks said. "I do believe that the policy as it is written will increase our financial obligation. There's no way around that."

Jacks said it is too early to tell whether the proposed agreement would affect hospital rates in the long run. But, he added, "we are in an incredibly competitive health care area . . . . We are expecting to swallow these costs simply because the paying customer won't pay for it."