September 13, 2010, 03:30 AM By Michelle Durand Daily Journal Staff
The civil grand jury’s recommendations that San Mateo County adjust just how much care it provides indigent patients without a medical need, illegal aliens and those earning more than the federal poverty level received a mixed reaction from county officials who dispute some of its findings and say solutions are underway.
The county is already looking at how it allocates revenue to departments like the Health System, which may decrease the general fund subsidy needed to maintain the current level of service, County Manager David Boesch wrote in a response letter to the grand jury.
The state requires counties to provide care to the poor and uninsured but the guidelines are broad, particularly when it comes to the undocumented population. San Mateo County provides more than the minimum, leaving local funds to make up the difference and creating a larger eligibility pool. Approximately 76,000 patients were treated at least once during 2008 at either the San Mateo Medical Center or its clinics, according to data used in the jury’s report.
The ongoing economic downturn has skyrocketed health care demands, adding to the county’s indigent care rolls. Federal health care reform will expand coverage in 2014 and likely reduce the number of uninsured residents needed the county’s safety net. Until then, though, the grand jury in its June 24 report suggested the county goes above and beyond what is legally mandated. While nice, the extra help is ballooning the county’s structural deficit, the jury concluded. Specifically, the jury recommended the county, prior to the 2011-2012 budget cycle, eliminate those services not mandated or fully funded by the state or federal government, such as aid for undocumented people, treatment of indigent patients without a medical need and those services dropped by Medi-Cal coverage in 2009. The jury also recommended lowering the medically indigent income level from $44,100, which is 200 percent of the federal and state mandated level of $22,050.
Boesch wrote that the county partially agrees with the recommendations and is trying to work with state and federal legislators to maximize funding potential. The county is also identifying non-essential services and those that the county overmatches.
One example of efficiency efforts, according to Boesch, is the medical center’s reduction of the new primary care patient waiting list.
As of June 1, the waiting list was approximately 5,000. As of Aug. 2, efforts to reduce the waiting list have brought it down to 2,216 with an overall wait time of 113 days.
Another example is a two-year grant for the Seamless Care Initiative to increase efficiency in all the hospital’s clinics.
But while Boesch, on behalf of the county, accepted the recommendations, he did disagree with some of the jury’s findings. Although the jury knocked the county for having a medically indigent income level at 200 percent of the poverty level, Boesch argues that there are no specific statewide minimum or maximum levels. Each county sets its own eligibility criteria and San Mateo County must look at its “very high” local cost of living.
San Mateo County is also not among the 16 counties in California that offer medical care to those without a need, he said.
However, the Health Plan San Mateo — a separate entity from the county — determined it was less expensive to continue providing services cut by Medi-Cal to prevent more costly care in the future. For example, podiatry services now may spare a diabetic patient more expensive services at a later date.
Civil grand jury reports carry no legal weight but recipients are required to respond in writing within 60 days. The Board of Supervisors is scheduled to accept the response at is Tuesday morning meeting.
The Board of Supervisors meets 9 a.m. Tuesday, Sept. 14 in Board Chambers, 400 County Government Center, Redwood City.
Michelle Durand can be reached by e-mail: michelle@smdailyjournal.com or by phone: (650) 344-5200 ext. 102.
http://www.smdailyjournal.com/article_preview.php?id=140948&title=County%20responds%20to%20grand%20jury%20over%20indigent%20care
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