Sunday, June 27, 2010

San Mateo County can't afford to offer extra health services for the poor and uninsured, grand jury says


Posted: 06/25/2010 07:54:44 PM PDT
Updated: 06/25/2010 07:55:16 PM PDT

San Mateo County Medical Center should stop treating poor and uninsured patients through programs that aren't mandated or funded by the state and federal governments because it relies too heavily on growing county subsidies to operate, a new civil grand jury report recommends.

On the chopping block should be long-term care to indigent elderly patients, full health-care services to undocumented adults and to individuals and families with incomes between 100 to 200 percent of the federal poverty level, and optional Medi-Cal services such as acupuncture and podiatry, according to the San Mateo County civil grand jury.

Concern about the medical center draining the county's coffers is not new: Within the past six years, the board of supervisors has launched several studies, a work group and a task force to assess the disparities between what health services are mandated, needed and offered.

The grand jury found that San Mateo County offers more health services than is legally required and offered by other California counties.

San Mateo is one of nine counties among the 58 in California that provide full health care services to illegal immigrants.

Also, like other Bay Area counties, San Mateo County allows individuals and families with incomes higher than the federal poverty level to receive health services mandated by the state for the "medically indigent." Instead of 100 percent, San Mateo allows incomes up to 200 percent. San Francisco has set its ceiling at 500 percent.

And while some California counties, including Alameda and Fresno, eliminated optional Medi-Cal services — such as podiatry, optometry, acupuncture and chiropractic — after the state stopped covering them last year, San Mateo County has not, according to the grand jury report.

"The county should consider eliminating programs that are not mandated by, or fully funded by, federal or state monies," the grand jury recommends.

Supervisor Carole Groom said she disagrees with the report's conclusion.

"We're a civilized community and a civilized country and we have to take care of people," Groom said. "It's not just the right and decent thing to do, it's a public health issue. You can't have people ill out on the street."

As required, the county will draft a formal response to the grand jury report, said spokesman Marshall Wilson. He noted that the health-care services also serve a preventative role that "ultimately saves money by reducing costly visits to the emergency room."

Bill Blodgett, the grand jury's foreman, said he understands that supervisors frequently reflect the socially progressive values of their county. In difficult financial times, however, the county just can't afford to be as generous.

"We'd love to do everything for all people, but the fact is the revenues aren't there," Blodgett said. "It's not easy, but our elected officials need to make the call on how far we are going to go to serve the indigent."

On Wednesday, the board adopted a $1.7 billion budget for the coming fiscal year. To offset a deficit of $126 million, the county plans to take $90 million from its dwindling reserves and cut $36 million from programs. But the deficit could increase by up to $100 million, depending on state budget decisions, according to County Manager David Boesch.

The $242.1 million medical center operation received a $66.6 million subsidy from the county this fiscal year. Almost 7 percent of San Mateo County's estimated 718,989 residents are living below the poverty level, according to the grand jury report, and 7.6 percent are uninsured.

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