IM this article to a friend!

January 15, 2003

Health officials fight for funds

From: Sacramento Bee, CA - 15 Jan 2003

Proposed state cuts risk an 'intolerable strain,' they warn.
By Lisa Rapaport -- Bee Staff Writer
Published 2:15 a.m. PST Wednesday, January 15, 2003
Local health officials moved Tuesday to deflect new red tape and billions of dollars in budget cuts proposed by Gov. Gray Davis in an attempt to balance California's budget.

Under the proposed budget, total spending for health programs administered by the state Department of Health Services would drop to $27.7 billion in fiscal 2003-04 from $32.2 billion in the current fiscal year.

Poor, elderly and disabled residents face a direct financial hit from new enrollment restrictions and benefit reductions to the state's Medi-Cal program.

But this swing of the ax, several health officials said in a telephone news conference, could lengthen lines in emergency rooms and further aggravate spikes in the cost of health care for Sacramento consumers.

"We have a fragile health care system already," said Jim Hunt, director of the Sacramento County department of health and human services. "These proposals will deny our people health care coverage and place an intolerable strain on local health systems, both public and private."

Three proposed changes to Medi-Cal procedures would generate most of these savings, and they rank as the biggest source of concern for local health officials.

Health-care officials expect the changes would also cause many individuals to eschew preventive care because they will not be covered.

New eligibility restrictions, for example, would lower the maximum household income for Medi-Cal enrollees to 61 percent of the federal poverty level, or $12,000 for a family of four, a move that would affect as many as 350,000 people statewide. Currently, people with income up to 100 percent of the federal poverty level, or $18,000 for a family of four, can enroll in Medi-Cal. Families would also have to reapply for Medi-Cal on a quarterly basis.

"We have more people uninsured after they are removed from Medi-Cal, and we will also have more people who should qualify for Medi-Cal but get dropped or don't apply in the first place because they can't keep up with the paperwork," said Elizabeth Landsberg, an attorney with the Health Rights Hotline, a nonprofit that advises patients on their health-care options.

In addition, those who do qualify for coverage would not receive many of the services that Medi-Cal has covered in the past under a proposal to cut benefits including dental, optical, hearing aids, and durable medical equipment such as wheelchairs and prosthetics.

The budget also calls for a 5 percent reduction in fees paid to doctors who treat Medi-Cal patients, a move that comes on top of a 10 percent payment cut announced in December.

This cut, many predicted, would reduce the number of primary care doctors and specialists willing to treat Medi-Cal patients.

"Community clinics that provide the safety net care will no longer be able to treat every patient or provide the full range of services they are set up to offer," said Carmela Castellano, chief executive officer of the California Primary Care Association, which represents the clinics.

To be sure, the budget is a work in progress, and nobody knows just how many local residents may lose coverage or how much money may be lost locally as a result of proposed changes.

Sacramento County has about 200,000 uninsured residents. Hospitals in the county earned net patient revenue of $261.7 million from Medi-Cal last year, accounting for 29 percent of their gross revenues, state records show.

In addition to losing some of this revenue, hospital executives fear a loss of income as more uninsured patients come through their doors, said Bob Chason, chief operating officer for UC Davis Medical Center.

Emergency rooms would become more crowded as the number of uninsured patients and Medi-Cal enrollees rise because they cannot get preventive care.

That would jeopardize efforts around the county to reduce waiting times for emergency room care and limit the need for hospitals to divert ambulances when ERs are too full to accept non-critical patients.

"The governor has walked a very fine line here under difficult circumstances," said Chason, "but the bottom line is, this could mean longer waits for patients to be seen, more costs for people who lose insurance, and ultimately higher insurance premiums if we raise rates to make up money we lose on Medi-Cal and the uninsured."

Copyright © The Sacramento Bee