Judge Rules Against San Diego County in Indigent Care Case
San Diego Superior Court Judge Ronald Styn on Friday ruled that the county must consider a San Ysidro man's ability to pay for some health care services in evaluating his application for coverage in the County Medical Services health plan, the San Diego Union-Tribune reports. The plaintiff in the case was denied coverage in the health plan because his income exceeds CMS eligibility levels for indigent care.
The decision could be "a blow to the county's policy of setting income limits" for eligibility for coverage by the health plan, according to the Union-Tribune (Roth, San Diego Union-Tribune, 5/7).
Currently, low-income uninsured residents whose monthly incomes do not exceed $802 can receive coverage for emergency care from CMS. Friday's decision precedes an eight-plaintiff class action lawsuit alleging that the plaintiffs were illegally denied medical services because their incomes exceed CMS qualifications (California Healthline, 5/5). A court date has not been set for the class-action case.
Under the ruling, county officials have one week to develop standards to assess the plaintiff's ability to pay "subsistence" medical costs. Styn wrote that the state Supreme Court has made it clear that "a county may not adopt a standard that uses an arbitrary income limit without considering the individual's ability to pay the costs of necessary care."
Plaintiff's attorneys had argued that he could not afford treatments to prevent his health from deteriorating.
Timothy Barry, senior deputy counsel for the county, said that the decision was "very narrowly tailored" and that it applied only to the individual plaintiff's case. Barry added, "We're looking at what the judge has ordered and looking at what we need to do to comply with it."
Plaintiff's attorney Katie Murphy said the decision "bodes well" for plaintiffs in the class-action case, whom she also represents. Murphy said about 1,200 county residents have been denied health care coverage through the county health plan because of income (San Diego Union-Tribune, 5/7).