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How Will Reform Affect County Programs for the Indigent?

The safety net below California’s safety net is showing signs of stress.  National health reform may help by expanding Medicaid, but that is not scheduled to arrive until 2014. Medi-Cal is California’s Medicaid program.

County programs mandated by the state to provide health services to low-income, indigent California adults who don’t qualify for Medi- Cal or other programs are reeling from back-to-back punches delivered by a punishing recession: More medically indigent adults — MIAs — are seeking help and there’s less money to provide it.

County Medical Services Programs get most of their funding from vehicle license fees and county taxes. Both of those sources are running low.

National health reform may sew up some of the holes, or it could be the beginning of the end for the CMSP safety net.

CMSPs were established in 1983 when California law transferred responsibility for providing health care services to indigent adults from the state to the counties. CMSPs are divided into two tiers:

Thirty-four mostly rural counties with population below 300,000 belong to a statewide organization that oversees CMSP; and Twenty-four more populous counties manage distinct programs with varying degrees and methods of coverage. Some serve

undocumented immigrants, some don’t. Some contract with private clinics.

Considered coverage of the last resort for adults ages 18 to 64 who have no other insurance, CMSPs find themselves in growing demand, as the number of unemployed and under employed Californians rises. The 34 counties with programs administered by the state serve about 54,000 patients a month, only about 9% of the state’s indigent population. The total number of Californians served in the CMSPs is estimated at about 1.2 million.

We asked experts to predict what might be in store for California’s county programs serving the indigent: How might national reform affect California’s CMSPs? How can California weather the next three-and-a-half years before expanded Medi-Cal arrives?  Should California start bringing this indigent population into Medi-Cal earlier than 2014?

Lee Kemper, executive director of the state agency overseeing rural CMSPs, declined the invitation to contribute, saying — as did several others —  there are too many variables involved, including the state’s pursuit of a federal waiver, which would allow more flexibility and funding for Medi-Cal.

“Frankly, there are so many uncertainties about how the state will go about implementing federal health reform, particularly in the context of the state’s current 1115 federal waiver discussions and the continuing state budget crisis, my comments would not be very insightful as I could simply point to these uncertainties and little else,” Kemper said.

We got responses from: