As details of the state budget deal emerged this week, some health care advocates said the agreement cuts too deeply into safety net programs for the poor and disabled.
According to one estimate, a $144 million budget cut to Healthy Families, the low-cost health insurance for the working poor, would result in denying coverage to almost 780,000 children in California.
That number includes 335,000 children who will be placed on a waiting list because the state board that oversees the program froze enrollment last week, plus 443,000 who would be disenrolled during the budget year that started July 1, said Health Access, a nonprofit concerned with increasing access to health care.
"The cuts would be the biggest rollback of coverage in state budget history," said Anthony Wright, the group's executive director. "These cuts are shredding the safety net."
Healthy Families has been a fallback for middle-class families that lose employer-provided insurance or have lost jobs during the recession. Health Access estimated that 5,750 eligible children could be denied coverage in Stanislaus County and the cuts would require 6,655 — or 48 percent of those enrolled — to lose their coverage.
Child advocates said it is more cost effective to give preventive care or treat chronic illness in the doctor's office rather than in the emergency room.
Mary Ann Lee, managing director of the Stanislaus County Health Services Agency, couldn't say how many of the 14,000 Stanislaus County children in Healthy Families could lose coverage.
"If a person does not have coverage, they are less likely to seek appropriate care," Lee said. "It has a negative impact on health outcomes."
Many kids to lose coverage
Healthy Families covers nearly 1 million children in California, and neither the governor's office nor the Managed Risk Medical Insurance Board disputed that large numbers of children would lose coverage under the plan.
"The governor sees the real consequences behind these cuts," said Lisa Page, a spokeswoman for Gov. Schwarzenegger. "But the state has no choice. Its wallet is empty, and its credit card is maxed out. The governor protected programs like Healthy Families from even deeper cuts by compromising on some one-time solutions."
In Stanislaus County, families denied coverage may be able to take advantage of the income-based sliding fee scale at county clinics, which ranges from $42 to $140 for doctor visits. The Healthy Cubs program also provides access to doctor visits and prescriptions for children 5 and younger.
The budget agreement includes funding cuts to mental health services, care for patients with AIDS, adult day health care, rural health care and financially distressed hospitals.
Under the plan, the most severely disabled of 425,000 people in the In-Home Supportive Services program still would receive the full range of services.
But advocates for the disabled said that 40,000 elderly or disabled people would lose caregivers provided through the program and 85,000 would lose domestic services, such as meal preparation, laundry or transportation to medical appointments.
The program, which in many cases pays family members to help their loved ones with bathing, dressing and using the bathroom, has proved to be far less expensive than caring for the patients in nursing homes.
New rules target fraud
The budget deal includes Schwarzenegger's proposals for rooting out fraud in the IHSS program by requiring fingerprinting of recipients and home caregivers.
Advocacy groups doubt those measures will uncover much fraud but say they will make it harder for people to find caregivers. "Very often, the wages paid to caregivers is close to minimum wage," said Dan Brzovic, associate managing attorney for Disability Rights California. "People at that wage scale won't want to deal with the additional requirements."
CalWORKS, the welfare-to-work program, could sustain $375 million in cuts to cash grants, including less housing assistance for low-income families, and the deal could pave the way for private contractors to replace county workers in handling the eligibility process for Medi-Cal and other social services.
Critics said the plan would impose new rules on CalWORKS that will confuse families that need the help.
"We are having historically high increases in the number of people who are seeking assistance," said Frank Mecca, executive director of the County Welfare Directors Association. "At the very moment in their lives when this assistance is most critical, we are going to pull the rug out from under these people."
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.