LOS ANGELES COUNTY: Supervisors Trek to Washington for Ask For Extension of Medicaid Waiver

      The Los Angeles County Board of Supervisors traveled to Washington yesterday to lobby for an extension of the Medicaid waiver that allows "the county to collect $225 million a year for outpatient care." While the waiver does not expire until June 2000, supervisors nonetheless feel the situation is dire, as its "loss could be devastating." Rene Santiago, who heads the Medicaid Demonstration Project funded by the waiver, said, "It could wipe out all ambulatory care for the county (Greene, Inland Valley Daily Bulletin, 5/5). The Los Angeles Times reports that the county Department of Health Services would face a $300 million shortfall without the waiver. "It's a huge issue for us and the future of the health care system in Los Angeles," said Supervisor Don Knabe. The project was instituted in 1995 when the county's system was on the verge of collapse, complete with a promise by the county that the money would be used to covert its system from a hospital-based to an outpatient-based system. The venture has been successful in increasing the number of outpatient clinics from 45 to 149, decreasing hospital beds in the budget by 28%, inappropriate emergency room use by 27% and the average number of hospitals beds in use by 24%. Also, the program reduced the work force by 15%, or 4,300 positions. However, the county is still "more than $200 million short of its savings goal" and 900,000 fewer patients than expected utilize the outpatient clinics.

Predictions, Please
      An HCFA official said the standards used to determine whether the agency would grant such a waiver extension "are whether the local government working under a waiver has maintained quality access to care and not spent more federal money than it would have without an exemption." Supervisor Zev Yaroslavsky said, "I'm optimistic that we will have a waiver extension. If we don't then we turn the clock back to where we were in 1995, which saw the health care system of Los Angeles teetering on the brink. And nobody wants to go back to that." Supervisor Gloria Molina added, "If I were making a judgement on the waiver, I would probably say to the county, 'Why would I give you an extension if you haven't achieved your goals?' But the reality is that we need this extension desperately in order to keep the system operating" (Riccardi/Simon, 5/6).