Stanislaus County rethinks indigent care plan

February 08, 2010  |  The Modesto Bee

Thursday, Feb. 04, 2010

Legal group challenges policy requiring patients' prepayment

Stanislaus County is reconsidering the cost-sharing and income eligibility policies in the indigent adult health program after an advocacy group threatened legal action last week.

Deputy County Counsel Dean Wright said Wednesday that the county health clinics are not requiring program participants to pay in advance to see their doctors if they cannot afford the fees. The decision took effect Monday.

"We will ask for payment but won't require it prior to providing service," Wright said. "We have concluded that is the way the law requires us to proceed."

The county may review its September board decision that sharply increased patient co-payments and tightened eligibility rules for the program serving about 6,000 adults in Stanislaus County. The services are for poor and insured adults who don't qualify for other government programs.

The county hasn't backed off the cost-sharing policy and is billing patients for their share of medical costs; it just won't require payment in advance, Wright said.

An attorney with the nonprofit Western Center on Law & Poverty, which declared the policies unlawful, said it was too early to claim victory in the dispute. The Los Angeles-based group has filed lawsuits on behalf of patients in other California counties that restricted access to indigent health programs.

"I certainly hope they are taking a close look at the policies and they do what the law requires," said Abbi Coursolle, a staff attorney for the center. The center has given the county until Feb. 12 to commit to revising the policies.

In September, county supervisors voted to raise the co-pays for about 2,650 program participants, reduce dental benefits and exclude people from the health program if they have more than $2,000 in assets.
The county is dealing with a $1 million revenue shortfall in the program's $14.1 million budget and a surge in applications from people who've lost jobs during the recession.

Under the cost-sharing policy, patients whose co-pays were as low as $3 are expected to pay up to $574 a month if they need medical care. Others with more income are seeing co-pays as high as $1,205 a month.

Critics said the policy, affecting those with incomes of more than $600 a month, served to exclude everyone from the program except the "poorest of the poor" county residents. The health clinics started requiring them to pay a $140 fee before seeing a health care provider.

In a Jan. 26 letter, the Western Center on Law & Poverty said the policies violate a state law requiring the county to provide indigent health care, and the group threatened to "file the appropriate legal action."

Coursolle wrote that the county adopted the fees without considering whether patients had the ability to pay. In addition, the program does not consider hardship applications from people who exceed the program's income cap of $1,806 a month, her letter said.

The center is representing Leslie Cook of Hughson, 41, who has lung disease and uses a home oxygen unit to help her breathe when she sleeps. The policy requires her to pay the first $355 each month for doctor visits, medication and tests.

After receiving the letter, county legal staff reviewed the state Welfare & Institutions Code and concluded that the clinics must provide service without requiring advance payment from people who are unable to pay, Wright said.

"We are working with (the law center)," Wright said. "One of their primary goals was to make sure their client was able to see the physician without interruption over the payment issue."

Wright and Coursolle would not disclose details of the talks between the county and law center.

Cook was able to visit the county's Hughson clinic this week without paying in advance. On Tuesday, another patient outside the county clinic on Scenic Drive in Modesto said he was told he's no longer eligible for services.

"I think it's ridiculous," said David Norton of Modesto, referring to the cost- sharing policy. "People can't afford to pay that. If people are coming here, they are hurting."

Norton said he has no income and didn't understand why he is out of the program.

As counties have tried to save money by cutting indigent health care, the law center has filed lawsuits in San Diego, Fresno, San Francisco and Sacramento counties. In some cases, courts have required counties to analyze the cost of housing, utilities and other living expenses before establishing health care fees for the poor.

Homero Mejia, lead organizer for Congregations Building Community in Stanislaus County, a group that supports health care reform, said the county disregarded the health care needs of vulnerable residents.

"They know these people are not going to be able to pay those fees," he said. "They weren't acting in the best interest of those community members."