Reducing Safety Net Bad Fiscal, Moral Choice, Advocates Say

Proposed cuts in several areas of California’s safety net — kids’ coverage, dental services and in-home care programs — have generated considerable attention and opposition in recent battles over the state’s overextended budget.  But those aren’t the only areas affected.

Other parts of the net also are threatened. Health advocates say cuts to programs for farm workers and rural underserved populations, along with reductions in adult day health programs, could have lasting human and financial repercussions.

Gov. Arnold Schwarzenegger (R) has proposed eliminating four programs providing primary care for migrant workers and other low-income Californians in underserved parts of the state. Cutting those four programs — Expanded Access to Primary Care, Seasonal Agricultural and Migratory Workers, Rural Health Services Development and Indian Health — would save about $48.8 million in this year’s budget.

The governor’s plan to eliminate adult day health care programs for about 36,000 frail seniors and those with Alzheimer’s disease would save about $117 million annually.

The deep cuts to health programs come in response to a projection from the state Legislative Analyst’s Office that the state budget deficit had increased by more than $2.8 billion in April and May to a gap of $24.3 billion for fiscal year 2009-2010. The Schwarzenegger administration plans to make up most of that gap by cutting state programs and is trying to avoid establishing new revenue sources with new or higher taxes.

Ana Matosantos, chief deputy budget director for the governor, said that the state has limited options for cutting spending and that although some of the proposed cuts — such as eliminating Healthy Families — will cause the state to lose matching federal funds, she defended the governor’s cuts as the best course for the state.

Health advocates say initial savings from health cuts eventually will evaporate as people begin to fall through the safety net and land in more expensive parts of the health care system — such as long-term care facilities and hospital emergency departments.

“And that doesn’t even take into account the human cost,” said Michael Sullivan, CEO of Golden Valley Health Centers, which has clinics in Stanislaus and Merced counties.

“The ironic part is that the governor is proposing to eliminate these programs right when they’re needed the most,” Sullivan said. “People are losing jobs and health coverage in this recession and it’s not slowing down. It’s not like they or their injuries or illnesses are going to disappear. They’re still going to need care and if the clinics that provide health care for them can’t do it — they’ll go somewhere else.”

Central Valley Clinics Rely on State Programs

Of the four rural programs slated for elimination, the 20-year-old Expanded Access to Primary Care is most crucial in the Central Valley, according to Sullivan.

“EAPC is a grant program for all community health centers in the state and I know for our situation in the Central Valley, it’s probably the most important,” Sullivan said. “That and the migrant workers program go a long way in targeting specific groups in our region. We refer to both of them collectively as farm worker programs because in our area, that’s who qualifies.” 

The expanded access program, created in 1989, is designed to provide access to primary and preventive health care to medically underserved areas and populations. People at or below 200% of the federal poverty level who do not have third-party health or dental coverage are eligible.

The Seasonal Agricultural and Migratory Workers Program, established in 1983, provides financial and technical assistance to primary care clinics serving farm workers and coordinates related federal programs and other state and voluntary agencies.

What Happened to Spirit of Reform?

“It was only about a year and a half ago the governor and everybody else up in Sacramento was talking about health reform and providing coverage for everybody,” Sullivan said.

“I know things have changed — the whole country’s in a recession and the state is $24 billion in the hole, but this is a complete reversal of what was being talked about 18 months ago,” Sullivan said.

Sullivan and many health advocates argue that the governor and policymakers should not treat all state programs equally when it comes to making budget cuts.

“It doesn’t make sense either financially or morally for the state to be cutting programs and institutions that are helping people get through this crisis,” Sullivan said.

Senior Center Officials Agree

Naomi Fuchs, CEO of Southwest Community Health Center in Santa Rosa, said the governor’s proposal to eliminate day programs for seniors will ultimately cost the state much more money than keeping the centers open.

“It just doesn’t make sense from a business standpoint to eliminate adult day health care funding. It makes no sense from a humane standpoint, either,” Fuchs said.

Like other health centers that provide day services for the elderly and Alzheimer’s patients across the state, Southwest Community Health Center allows frail elderly and disabled Sonoma County seniors to remain living at home. Fuchs and other senior advocates say cutting day care funding will eventually — and quickly in some cases — result in seniors being institutionalized.

“The needs of these fragile adults are not going to evaporate simply because Medi-Cal no longer covers this program,” Fuchs said. “What will happen is these people will no longer be able to spend part of their day in a program like ours and the rest of their time at home. Instead they’ll be institutionalized or their caregivers are going to have to give up their jobs. It’s a bad outcome all around, including financially or the state.”

The day centers provide about six hours of care and treatment for about $150 per patient per day, Fuchs estimates. An average day in a senior-care institution costs about $600 — four-times as much — she said.

Adult day centers offer registered nursing services, speech therapy, physical and occupational therapy, psychological consultations, and other medical and social services. Social workers, often working through the centers, help coordinate seniors’ care all with the goal of keeping elderly living at home as long as possible.

The majority of those cared for in these programs — about 80% — depend on Medi-Cal for health care. Without adult day health care, senior advocates predict many will deteriorate quickly and have to move into a nursing home at a much higher cost to taxpayers.

Legislators working on a compromise may end up preserving the program but with a higher bar to qualify and fewer services offered, according to some industry sources.

Lydia Missaelides, executive director of the California Association for Adult Day Services, said eliminating state funding would be a disaster for every California community. 

“Those who are served by these programs are poor, frail and in ill health.  Families and caregivers turn to the professionals of adult day health care to provide a level of community-based care which not even well-to-do families can easily provide on their own. These families and caregivers rely on the state and those who lead the state and they are being abandoned,” Missaelides said in a statement responding to the governor’s proposal.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.