Despite the Affordable Care Act, millions of Californians will be left uninsured and have to rely on county health programs, but access will vary by county and in some cases could be reduced, according to a survey of county safety-net programs released Thursday.
As many as 3 million people in the state could remain uninsured next year -- thousands within the central San Joaquin Valley -- according to the report by the Health Access Foundation, a statewide health-care consumer advocacy coalition.
While counties are responsible by law for providing care to the medically indigent, they have wide discretion in providing services, the report shows.
As a result, California has a "highly variable patchwork" of health programs for the uninsured, said Anthony Wright, executive director of Health Access.
The range and type of services, according to the report: Nine counties, including Fresno, provide health care to undocumented immigrant adults and children. A few counties -- Santa Clara, San Francisco and Ventura -- allow people with incomes more than three times the federal poverty level to get care while others, like Fresno, set the income threshold to the poverty level or below. Merced County, for example, requires proof of a medical need for people to be eligible for services and approves care for only a short time.
Counties in the central San Joaquin Valley "tend to provide a thinner safety net than other parts of the state," Wright said. But, the variation in services and eligibility for services is so great statewide, he said: "We intentionally did not try to provide a grade or a direct comparison."
The report, "California's Uneven Safety Net: A Survey of County Health Care," spotlights the variation at a pivotal time for counties, Wright said. In the coming months, counties must decide what services they will provide to people who remain uninsured after Jan. 1. Many now being served by counties will be eligible for Medi-Cal, the state-federal insurance for the low income -- and the state is reallocating money to cover them.
Counties have gotten $1.4 billion for "public health" programs annually from the state, but next year will get $300 million, Wright said. The question is whether that will be enough -- and how counties will allocate the reduced amount, he said.
Fresno County, which has a $30 million contract with Community Medical Centers for the medically indigent, is trying to figure out how much money it will get from the state. The county has estimated that 14,000 indigent Fresno County residents will become eligible for the expanded Medi-Cal coverage next year. But another 6,000 indigent residents will remain without insurance and continue to be the responsibility of the county.
Fresno County public health officials were reviewing the Health Access report Thursday and said they needed time to study it before responding.
In Tulare County, it's unknown how many people will remain uninsured after Jan. 1, but the county expects 4,200 now receiving health care through the county will be enrolled in Medi-Cal.
Tulare started a Low Income Health Program this year to prepare the indigent for the transition to Medi-Cal next year. The county is among 53 counties with Low Income Health Programs. Fresno is one of five -- and the largest county -- that declined to set up a program.
Jason Britt, director of public health for Tulare County, said about 500 people receive services from the county now who are not part of the Low Income Health Program. "We expect most, if not all, to transition to Medi-Cal as well," he said. "What we have left are those individuals who for whatever reason don't fit into any of the new categories (for Medi-Cal coverage)."
Tulare County, which does not provide care to undocumented immigrants, has no plans to add them next year, Britt said.
The Health Access report recommends that counties maintain their medical indigent programs and not scale back services in 2014, and that the state publish information about the county programs on a regular basis.
The report also recommends that California expand Medi-Cal coverage to undocumented immigrants, who are estimated to be about 1 million of the 3 million uninsured after full implementation of the Affordable Care Act.
The Affordable Care Act "brings us very close to getting everybody access to basic care and coverage," Wright said. "The question is, can the state and counties take those final steps?"
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