Court Victory on Care for Poor Called Hollow : Indigent: S.D. experts say ruling that the state illegally shifted care costs to counties won’t mean more funds.

A state court has determined that California regulators illegally transferred costly indigent care programs to the counties in 1982, but local health-care experts doubt that the ruling will generate more funds for indigent care in San Diego County.

In a unanimous decision on Friday, the 1st District Court of Appeal in San Francisco ruled that the state illegally forced counties to assume the burden of providing medical care that previously was included in the Medi-Cal program. State funding for indigent medical care in San Diego County conceivably could jump to $62 million from the current $41 million annually because of the ruling, said Paul B. Simms, deputy director of physical health services.

But “the truth of the matter is that I don’t expect” more money from the state, Simms said. “I don’t expect the state to fill the (funding) commitment mandated by the courts.”

Rather, Simms predicted that state regulators will challenge the ruling because the state Constitution prohibits individuals--in this case, the Alameda County residents who brought the suit--from suing the state. And, even if the Supreme Court upholds the decision, state regulators would face spending barriers set in place by the Gann Initiative, Simms said.

“It’s a great decision, but where’s the money going to come from?” asked James Lott, President of the Hospital Council of San Diego and Imperial Counties. “It really doesn’t mean a hill of beans at this point” because spending limits would prohibit the state from increasing state funding, Lott said.

The likelihood that the ruling will prompt increased state funding for adult indigent care programs is “as likely as the planet reversing its rotation,” said Stephen Shubert, executive director of the San Diego Council of Community Clinics, a coalition of local clinics that provide care for uninsured and under-insured San Diegans.

The county has reduced the quantity of medical care for indigent adults in recent years, largely because of state budget cuts that have occurred since 1982, when the state shifted responsibility for indigent adult medical care from Medi-Cal to county-run programs.

More than a quarter of San Diego’s population is uninsured or under-insured, but state funding is available for just 26,000 people, leaving an estimated 600,000 people “at risk,” Shubert said.

“With $41 million, you have real problems in holding the system together and keeping it working,” said Shubert, who described the potential--but unlikely--$20 million windfall as “a drop in the bucket.”

The budget that Gov. George Deukmejian proposed Jan. 10 will force more cuts in County Medical Services, the program that provides medical care for many indigent adults, Simms said.

“I can’t tell you what cuts we’ll make, but . . . we’ll have major system reductions” should the budget be introduced, Simms said.

Deukmejian’s budget would force county administrators to reduce health program funding by $4 million, Lott said. “CMS is the deep pocket for this county,” Lott said. “But (cuts) would come at a time when we’ve identified an 18% increase in demand” for indigent medical care, Lott said.

CMS responded to previous state budget cuts by tightening up requirements and eliminating care for about 8% of the eligible population.

San Diego County received $41 million for its indigent-care program during the fiscal year that began July 1, 1988, Simms said. Deukmejian’s initial budget for the current fiscal year calls for reducing San Diego’s funding level to $35 million. However, the $41-million level eventually was restored.