Stanislaus County could be facing a legal challenge to its decision to sharply raise co-payments for patients in the indigent health care program.
Other California counties have tried to save money by slashing health services for the poor, but often have been defeated in the courts by patient advocacy groups. Counties are required under state law to provide health care for uninsured adults who are not eligible for Medi-Cal or Medicare.
The Western Center on Law & Poverty is taking a dim view of the cuts to Stanislaus County's indigent health program, which has been a safety net for the poor and people who have lost jobs during the recession.
"This is one of the worst examples we have heard of," said attorney Katie Murphy of the nonprofit center, which is involved in indigent health care lawsuits in San Diego, Fresno, San Francisco and Sacramento counties.
"We believe the Stanislaus County policy is unlawful," she said. "We intend to be in touch with the county shortly, demanding that they change this on behalf of (Leslie) Cook and other patients like her."
Cook is a Hughson resident featured in a Jan. 6 Bee report on the program changes. She said she can't afford care for her chronic lung disease and other health issues if she has to pay the first $355 every month.
At issue is a county board decision Sept. 1 requiring about 2,653 program participants to pay a much greater share of their health care costs. The new policy applies to adults with incomes of $600 to $1,806 a month and goes into effect when their enrollment comes up for renewal.
The county has been reducing social services to keep pace with a slowdown in tax receipts and a drop in property values because of the recession and the region's foreclosure crisis. The county's latest budget showed a $42 million deficit before supervisors plugged the gap with reserves and spending cuts.
Co-pays to increase
Patients whose co-pays were as low as $3 are now expected to pay up to $574 a month when they see a doctor, need medication or require other treatment. Others with more income are seeing their co-pays increase from as low as $45 to $1,205 a month.
The county also tightened the program's eligibility rules, stopped providing preventive dental care and is requiring patients to pay half the cost of dental services such as dentures or crowns.
Murphy said previous court decisions established that the county programs cannot simply pass health care costs to participants, who often are unemployed, disabled or on the verge of homelessness.
The payment requirements must be based on patients' ability to pay, she stressed.
"Not one word of the board report from September says anything about the affordability of these fees," Murphy said. "If a person has $1,700 a month income to live on and they have to pay $1,100 to use indigent health care services, the county can't justify that as affordable."
Murphy was the center's lead attorney in lawsuits in San Diego County that stopped the county health program from excluding people with income exceeding $802 a month. When the Superior Court allowed the county to place a strict cap at $1,078 a month, the center appealed on grounds that patients with more income should have access to services if they paid part of the cost.
The group prevailed in the 2007 appellate court decision, which required San Diego County to consider the costs of housing, food and other essentials in setting the patient's share of cost.
Must consider ability to pay
A Sacramento County case that proceeded to the state Supreme Court and prior court cases also established the principle that county health programs must consider patients' ability to pay for services, she said.
Mary Ann Lee, managing director of Stanislaus County's Health Services Agency, said Tuesday the county is complying with the state mandate to provide health services to uninsured adults. The county has contended with a shortfall of program revenue and increase in applications for serv-ices.
"The policy changes were made through a public process and they were made within the Board of Supervisors' authority," Lee said.
According to Lee, the program's eligibility process considers patients' essential living expenses, using a calculation similar to one used in the state Medi-Cal program.
The new policy requires patients to pay up to $140 to see a doctor in the county health clinics. Those needing additional services or specialty care can make payment arrangements as low as $20 a month, the agency has said.
People stuck with a larger share of cost can appeal to a fair hearing panel. First, they request a fair hearing packet from the indigent health program and submit the appeal within 30 days of receiving the packet.
The agency has 60 days to respond. A hearing will be scheduled with a panel made up of a physician, nurse and attorney from the community. "The panel determines if the indigent health care program has applied the rules of the program correctly," said Maria Blanco, indigent health services director.
Cook has questioned whether county health services has adequately informed people of the policy changes or appeals process. She said she never saw a notice sent to participants after the September board decision.
A family services specialist told her about the policy change when she renewed her enrollment early this month and gave her a share-of-cost statement saying nothing about an appeal process, she said.
She inquired about an appeal Jan. 6 and an agency employee promised to send the packet, but it has not arrived in the mail, she said Tuesday.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.