San Diego County Must Revise Eligibility Rules for Medical Program, Judge Rules
Superior Court Judge Ronald Styn on Friday affirmed a tentative ruling that San Diego County income limits that disqualify low-income residents for last-resort medical care at no cost violate state law, the San Diego Union-Tribune reports (Clark, San Diego Union-Tribune, 11/19).
San Diego County Medical Services provides coverage to county residents whose incomes do not exceed certain levels, currently $802 monthly for an individual or $1,084 monthly for two people, excluding some deductions. Only Orange and San Diego counties in California do not offer cost-sharing options for uninsured residents whose incomes exceed the thresholds (California Healthline, 11/18).
Under the ruling, the county must submit new standards within 60 days that "base eligibility for indigent health care on the individual's ability to pay for such care," Styn ruled. The ruling also requires the county to reimburse patients who were denied coverage under the County Medical Services program because their incomes exceeded the limit.
County Counsel John Sansone on Friday said that the county will revise the program to raise income caps but that the new guidelines will not include a cost-sharing provision for patients. The new income limits will be $1,084 per month for an individual and $1,445 per month for a two-person household.
County officials said higher caps would make 1,800 more residents eligible for the program and cost the county about $6.2 million annually.
The San Diego Board of Supervisors will vote on the proposed limits Dec. 6.
Katie Murphy, lead attorney for the Western Center on Law and Poverty, said raising the income limit is "not what the judge said they were supposed to do." According to Murphy, changes to the eligibility system should include a way for residents making more than the cap to pay a share of the cost, such as a sliding scale based on income.
Murphy said the group "will be right back in court" if the county does not establish a cost-sharing provision (San Diego Union-Tribune, 11/19).
KPBS' "KPBS News" on Friday reported on the ruling. The segment includes comments from Murphy (Goldberg, "KPBS News," KPBS, 11/18). The complete transcript is available online. The complete segment is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.