Stanislaus County health fees up for review

Under the threat of a lawsuit, Stanislaus County supervisors this morning will consider reversing a policy that sharply raised copayments for patients in the adult indigent health program.

The policy, approved by supervisors Sept. 1, required certain low-income patients to pay hundreds of dollars per month for health care at the county health clinics.

The nonprofit Western Center on Law & Poverty challenged the policy in January, saying it violated a state law requiring the county to provide health care for poor adults. The center, which assists low-income people in affordable housing, health care and public benefit cases, suggests that some clinic fees charged before Sept. 1 may be unlawful.

If the board gives approval this morning, the county health clinics will revert to the patient cost-sharing rules prior to Sept. 1. County staff will complete a cost-of-living study to establish fees that program participants could afford.

The program annually serves about 6,000 adults who are not eligible for Medi-Cal or Medicare. County officials said the clinics needed to collect higher fees from patients to bridge a shortfall in the $14.7 million program budget.

Reversing the policy could cost the county as much as $500,000 this fiscal year, a county staff report says.

"(The law center) pointed out to us that there were flaws in the manner that we put out the last schedule of fees," Deputy County Counsel Dean Wright said. "We agreed to go back and do a cost-of-living study and reverse course until we have accomplished that."

Attorney Abbi Coursolle of the Western Center, based in Los Angeles, vowed in a Jan. 26 letter to file suit if the policy remained in place. The center maintains that the patient fees must be based on people's ability to pay.

"We believe the county needs to do the cost-of-living analysis that is required by law," Coursolle said Monday. "We hope, in the meantime, they adopt the old policies that will allow folks to access the health care they need."

As many as 2,650 people were affected by the change in policy, especially those with incomes ranging from $600 to $1,806 a month.

The Western Center on Law & Poverty represents Leslie Cook, a Hughson resident who was expected to pay the first $355 every month when she needed treatment for chronic obstructive pulmonary disease and other health problems.

As she applies for disability, she said, her only source of income is her husband's $1,075 in monthly disability.

Coursolle doubted the county will be able to justify fee increases with the cost-of- living analysis.

"The studies for the county that I've seen put the cost-of-living for a single individual at around $2,000 a month," she said. "We think it's likely that, under the old policy, some folks were paying more than they could afford for medical care."

Before the Sept. 1 policy change, the county was charging fees to people whose incomes were as low as $450 a month, the attorney said.

The legal aid center filed lawsuits over similar issues in San Diego, Fresno and other counties, citing court decisions that county health program eligibility rules and fees must be based on patients' ability to pay.

Court decisions required San Diego to use cost-of-living factors in setting eligibility rules for indigent health care, and Fresno County adopted new indigent health care policies in February based on living costs in that county.

Bee staff writer Ken Carlson can be reached at or 578-2321.

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