Not So Fast, Sacramento

The unanimous decision of the California Court of Appeal on indigent health-care funding is a victory for responsible government as well as for the poor.

State legislators, driven by budget pressures, removed thousands of medically indigent adults from the rolls of Medi-Cal in 1982 and dumped their medical problems on the already-strapped county health departments of the state. Now the court has ordered rectification of that unjust action and correction of the financial disruption it caused.

The Court of Appeal found that the Legislature had violated the Gann constitutional spending limit, which requires that the state fully fund any mandate or program shifted to other government entities. That provision of the Gann initiative was essential in guarding against just this sort of maneuver to evade the budget limits.

It is calculated that the state was paying about $1 billion to provide health services to the affected indigent population through Medi-Cal. Instead of continuing that level of funding when the responsibility was forced on the counties, the state provided only $520 million the first year, an amount that has dwindled in subsequent years even as the case loads have risen.

“The state will be obligated to rectify this tremendous under-funding of medical care for literally hundreds of thousands of people in California,” Lois Salisbury said. She is an attorney with Public Advocates Inc., of San Francisco, which participated in the case.

For Los Angeles County, the county most impacted by poverty in the state, this could bring $150 million to $200 million annually in additional state funding, according to Robert Gates, head of the county Department of Health Services. But all counties will benefit.

“This is a decision that has tremendous fiscal ramifications for the state,” Asher Rubin, the deputy state attorney general who defended the state in the litigation, commented. Yes, indeed. But a correction is long overdue.

The finding confirms what critics long have been saying: that the state government is under-funded. Nothing illustrates better the folly of inadequate funding of public services than medical programs for the indigent. The denial and reduction of services that resulted from the funding cuts made over the last eight years produced no real savings. On the contrary, the denial of primary care and prevention programs only serves to postpone appropriate services until costly interventions are required.