Leslie Cook got the news Monday when she renewed her enrollment in the Stanislaus County indigent health program.
Starting this month, the county expects her to pay the first $355 every month for the medical attention she needs.
She frequently has required medical care since developing chronic obstructive pulmonary disease three years ago, making it hard for her to breathe and leading to a rapid heartbeat that needs to be controlled with medication, she said.
Cook, 41, lives on her husband's $1,075 in monthly disability income, so she can't afford to pay for physician visits, the medication she takes for fibromyalgia or the home oxygen machine that keeps her breathing while she sleeps.
"I will have to take the bare minimum medications," said Cook, who lives in Hughson. "I am probably going to end up in the hospital before it is over."
The indigent health program has been a safety net for the county's poorest adults, people who cannot afford private insurance and do not qualify for Medi-Cal or Medicare.
In September, county supervisors approved health benefit cuts that removed much of the coverage for adults with incomes of more than $600 a month. Adults with monthly income of less than $1,806 a month or $2,428 for a two- person household are accepted under the county's tighter eligibility rules.
About 5,450 adults were receiving health care from the county program in November, a 19 percent increase over the previous year, according to the county. As many as 2,650 people are affected by the cuts.
Many patients such as Cook were paying $5 for physician visits and $3 for prescriptions before the cuts. Now, their share of the medical costs is $300 to $575 a month if they need to see a doctor, require lab tests or need medication.
Others with more income are seeing monthly co-pays increase from as low as $45 to $1,205.
Funds down, applications up
County officials said the cuts were in response to a funding shortfall and a surge of applications from people who recently had lost employment. Program funding from state vehicle license fees and sales tax is down about $1 million from the amount two years ago.
The county's Health Services Agency notified patients in letters sent after the September board decision. Patients who didn't see the letters are getting the word when they come up for renewal. The county agency is hearing increasing complaints.
"With so many people enrolling, we have to look at how many we can cover with the decrease in funding every year," said Maria Blanco, indigent health program administrator for the county.
Blanco said the patient co-payments are similar to those in the state Medi-Cal program. She said the county clinics are not dropping patients who have a pressing need for medical care, but are working out payment plans with patients who need surgery, expensive diagnostic tests or life-sustaining medical equipment.
To assist patients who rely on medication, the Health Services Agency has assigned more staff to process applications to pharmaceutical companies that provide free medication to the poor. The agency is informing patients about other low-cost health clinics, which pushes the burden to those health care providers.
Advocates for the poor said counties are cutting health programs to save costs and deal with rising caseloads because of the recession, and it's forcing patients to forgo vitally needed medical treatment.
Following state mandate?
They warn that counties making severe cuts may be out of compliance with a state mandate to provide the services.
"There is greater need for these programs when people are losing their jobs, but what happens is counties scale back these programs and make them inaccessible," said Michael Herald, legislative advocate for the Western Center on Law & Poverty.
The nonprofit center brought a successful lawsuit against San Diego County after its health program denied adults with incomes of more than $1,078 a month.
Cook has tried for three years to obtain disability benefits that would cover her health care. To see her doctor at the county's Hughson clinic, she would need to pay $140 in advance for the visit, plus additional charges for any lab tests or other services. The county would cover costs of more than $355 for that month if she requires additional treatment or hospitalization.
She said drug companies provide some of her medications free of charge. She plans to keep her breathing equipment until someone comes to repossess it, she said.
"It is extremely sad that things have to come to the point that we put these assessments on people who are sick," said Dianne Hernandez, president of the Community Services Agency board, an advisory panel for the county health clinics.
Hernandez said a federal initiative is needed to make insurance affordable to everyone, or the state should take action to give more support to counties. "We can't let people just sit at home and die," she said.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.