Hughson woman feels effects of health-care cuts to indigent

Stanislaus County’s indigent adult health program has been a safety net for some of the county’s poorest residents, as well as people whose jobs and health insurance have disappeared during the recession.

But the county’s struggles to maintain the state-mandated program, amid a budget crisis and a shortfall in the revenues that fund adult indigent health services, has threatened to cut off many patients who need the help.

Under the program, county residents age 21 to 64 who earn less than $1,806 a month and don’t qualify for Medi-Cal, receive free or low-cost care at the Health Services Agency clinics in Modesto, Ceres, Turlock and Hughson. The county also pays for medication, lab tests, surgery, hospitalization and other medical services.

The funding, which mainly comes from vehicle registration fees and sales tax, has steadily declined from the $14.4 million in 2006. It was $12.6 million last year and budgeted to be $12.46 million for the fiscal year that ends June 30.

At the same time, the number of adults using the program grew from 5,953 in 2006 to 7,829 last year. The rising costs of caring for those patients, coupled with the revenue decline, is expected to create a $2 million program deficit this year.

About 18 months ago, county supervisors approved a new co-payment policy that made the costs prohibitive for patients such as Leslie Cook of Hughson.

Cook, 42, has chronic obstructive pulmonary disease and a heart arrhythmia, which requires her to make regular visits to the Hughson health clinic for treatment and monitoring.

The new policy required Cook to pay up to $355 every month for her health care, instead of the $5 to $25 co-payments under the previous rules. Cook, who relies on her husband’s $1,075 monthly disability check, couldn’t possibly pay the bills.

The Health Services Agency said the cost-sharing rules, affecting 2,650 program participants with incomes above $600 a month, were an attempt to keep program’s costs in line with declining revenues.

The county suspended the policy in February 2010 after the Los Angeles-based Western Center on Law & Poverty threatened to file a lawsuit on behalf of patients. The center said the patient cost-sharing policy was illegal, and it cited court rulings that have required county indigent health programs in California to set rates according to patients’ ability to pay.

Health advocates waited nine months for the Health Services Agency to come back with rates more consistent with the cost of living in Stanislaus County. In December, California Rural Legal Assistance, assisted by the Western Center, filed suit on Cook’s behalf, seeking a court order to invalidate the program’s co-pays and income eligibility cap.

“We are not sure how long this cost-sharing policy will be suspended,” said Andrea DeTellis, a CRLA attorney in Modesto. “The county cooperated by holding off and saying they would look into (revising the policy). So far, there has not been movement toward what we would like to see.”

Mary Ann Lee, managing director of the Health Services Agency, would not talk about the lawsuit.

She said it’s challenging to meet the state indigent health services mandate when revenues are down and yet more people are eligible for the service. To address the looming deficit, her department is looking to cut costs by managing care more efficiently and reducing prescription drug costs, she said.

The department is searching for other ways to fund the shortfall, she said, but she would not discuss specifics.

Cook said her current co-pays of $5 to $25 were hard to make during a battle with pneumonia in December, when she was going to the Hughson clinic every other day. After paying medical bills, she and her husband sometimes run out of food before the end of the month, she said.

Even under the current rules, program participants earning more than $1,174 a month have steeper costs than Cook. For example, a person with $1,500 in monthly earnings or unemployment benefits, has to pay $280 for health care each month before the county covers the bills.

Some also believe the program’s eligibility rules are too strict. People falling within the $1,806 income cap, or $2,428 for a married couple, often are not approved for the program because they have savings, a second car or other property that puts them over the $2,000 asset limit.

“I can’t afford the co-pays and there are people worse off than me,” Cook said. “They are making it hard on patients to get the health care they need.”

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

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