Judge Tells San Diego County To Restructure Health Care Program
On Thursday, a superior court judge tentatively ruled that a San Diego County program that covers medical care for about 21,000 chronically ill, low-income patients is invalid, raising the possibility that the county will have to rewrite eligibility rules for the program again, the San Diego Union-Tribune reports.
The county rewrote eligibility rules for the program, called County Medical Services, in December 2007 after an April 2007 ruling by the 4th District Court of Appeals that ordered the county to expand eligibility for the program.
County residents are eligible for no-cost care under the program if their incomes do not exceed 135% of the federal poverty level, while residents whose incomes fall between 135% and 165% of the poverty level are subject to copayments (Clark, San Diego Union-Tribune, 3/28).
Patients whose incomes exceed 165% of the federal poverty level are excluded from the program but can file for hardship exemptions. However, only one of the 41 county residents who filed for hardship exemptions was offered coverage (California Healthline, 3/6).
The Western Center on Law and Poverty in Los Angeles, which filed a class-action lawsuit against San Diego County, said the county violated state law by using arbitrary income caps that excluded too many county residents.
Judge Ronald Styn's decision said:
- The program's income limit for free care and the copayment formula for individuals who exceed the limit lack an "evidentiary basis"; and
- The county's hardship waiver policy has no legal justification.
Styn will hear arguments today before finalizing the decision (San Diego Union-Tribune, 3/28).
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