Aid Proposal Shortchanges Indigent Care, Hospitals Say

Orange County officials are recommending that $1 million be added to the program providing medical care for the indigent, far less than what hospitals are seeking, county workers said Thursday.

Since the county received a special one-time state grant of $6.1 million last month, various components of the county’s health care establishment have been lobbying the Board of Supervisors for the funds.

The Orange County branch of the Hospital Council of Southern California said nearly 80% of the money, or $4.8 million, should go to the indigent medical services program. It said the Legislature intended that counties get that much. The legislation was vetoed by Gov. George Deukmejian.

Switch to Block Grants

But John Sibley of the county administrative office told supervisors’ aides at a meeting Thursday that Deukmejian originally recommended putting $12.5 million more in IMS programs across the state, then later switched to the block grants to allow the counties to spend the money as they wished.

Sibley said that if $12.5 million had been earmarked for IMS programs statewide, Orange County’s share would come to $800,000. But he said he was recommending adding $200,000 to that “in recognition of the positive ongoing partnership between the public and private sector to meet the health needs of the indigent.”

The state turned the IMS programs over to counties 4 years ago but has never fully funded them, health care professionals said. In the fiscal year starting July 1, 1985, the Orange County IMS program received $34.7 million. The next year it got $31.4 million, and this year’s figure is the same.

The Hospital Council estimated that hospitals are reimbursed for less than 40% of their costs for treating medically indigent adults, who often are unemployed or lack health insurance and are ineligible for federal and state welfare programs.

If the $1-million figure for IMS stands up, “I think we would be very upset,” said Jon D. Gilwee, director of the Orange County office of the Hospital Council.

“I don’t think it would be a realistic expectation they would give us the $4.8 million, but we certainly would be expecting quite a bit more than $1 million.”

Concern Expressed

Hospital Council officials have expressed concern that some of the 31 hospitals in the county in the IMS program might drop out because of the low reimbursement rates, but Gilwee said he expected council members to “keep limping along.”

The county administrative office is also recommending that $1.2 million of the state money be allocated to the county Health Care Agency for the host of programs it administers, including prenatal care. Another $1.1 million would go to the Social Services Agency for its programs.

The administrative office also recommended that $200,000 of the grant money go to mental health programs and $90,600 to support foster parents in the county.

Sibley and the supervisors’ aides cautioned that the figures can still be adjusted and that the final decision on how much to put into what programs is up to the supervisors, who are likely to vote next month on how to spend the money.

The administrative office’s initial recommendations would put just over $2.5 million of the state grant in the county’s contingency fund. The fund could be used to help cover raises granted to county employees, pay for unexpected expenses in the months ahead and, the county hopes, provide a base to start budgeting for the fiscal year starting July 1.

Sibley declined to provide specific figures but said before the meeting that “a major portion (of the $6.1 million) will of course go to health care and social services.”

“We want to maintain some amount to go into the contingency fund for future funding” of various county programs, he said. “We are trying to take action that will address the needs of the medical community, maintain existing programs and still maintain some fiscal conservatism.”