County Agrees on Free Medical Care Plan for the Poor

Los Angeles County has agreed to stop charging low-income residents for medical services because they may be entitled to free health care at county clinics and hospitals.

In settling a class-action lawsuit, the county agreed to inform all patients, either in writing or over the telephone, that they may be eligible for free or reduced-cost medical care.

The agreement also requires the Department of Health Services to send letters to about 450,000 people who have outstanding county medical bills, informing them that they can retroactively qualify for the plan.

Most of these patients were seen in outpatient clinics and have bills of several hundred dollars each.

400 People on Refund List

About 400 people are already on a list to receive refunds, subject to confirmation of their eligibility by county officials. Officials had no estimate of the total amount of money that might be refunded.

The settlement, approved by the Board of Supervisors this week, will be submitted to a Superior Court judge for final approval in January.

“I am delighted that we reached a settlement,” said Bruce G. Iwasaki, an attorney with the Legal Aid Foundation of Los Angeles, one of five public-interest law groups that initiated the suit in August, 1985.

“This means that people with limited incomes will not put off getting needed health care because they don’t have the money to pay for it,” he said.

In addition to the written and telephone notices, the settlement requires the county to place conspicuous signs advertising the “ability-to-pay” plan at its six hospitals, 47 health centers and two rehabilitation centers.

The county began to implement these notification provisions of the settlement this summer, according to Gary Wells, deputy director of finance for the Department of Health Services.

“The county felt the settlement was preferable to protracted court proceedings,” Wells said.

Will Monitor Terms

Under the agreement, the county will also increase the number of employees available to determine patient eligibility for reduced fees. In addition, it will pay for independent monitors to police its adherence to the settlement’s terms.

The county provided between $150 million and $200 million in free or reduced-cost care to about 200,000 people between July, 1985, and June, 1986, Wells said. Much of this was for hospitalized patients; both sides agreed that the county has done a better job of providing financial assistance to these patients.

Under a 1982 state law, counties must provide care to medically indigent adults--the so-called working poor--based on a sliding scale that offers free care to the poorest. Such patients typically do not have private health insurance and do not quality for other government insurance benefits, such as Medicare, the federal program for the elderly and the disabled, or Medi-Cal, the state program for the poor.

The suit charged that county employees were incorrectly telling the poor that they had to pay $20 and $30 fees before receiving care, including patients with life-threatening illnesses, and often not telling them at all about the “ability-to-pay” plan.

Denied Care

In some cases, detailed in court papers and at 1984 legislative hearings, patients who could not pay these fees were denied care; in other instances they received bills for hundreds of dollars or more.

Those who qualify for free clinic care under the county program include a family of four with a monthly income of $1,201 or less, or an individual with a monthly income of $801 or less. For free hospital care, those eligible include a family of four with a monthly income of less than $996 and an individual with a monthly income of less than $546.

The county also has a low-cost clinic care plan for patients who pay their entire bill in advance or within seven days of treatment. Current charges are $25 for a visit to a public health center, $35 for county hospital outpatient clinics and $40 to be seen at Rancho Los Amigos Medical Center, a rehabilitation facility. Patients who pay later are billed the full cost of clinic services.

In addition to the Legal Aid Foundation of Los Angeles, the other law groups filing the suit were the American Civil Liberties Union, the National Health Law Program, the Western Center on Law and Poverty and the San Fernando Valley Neighborhood Legal Services.