Good Intentions Choked by Red Tape : Why should federal rules have the effect of denying the poor mobile health care?

Mobile vans already are delivering health care to poor neighborhoods in Southern California through such projects as the Watts Health Foundation’s mobile units for prenatal screenings and treatment for the sick homeless; St. Jude Hospital and Rehabilitation Center in Orange County runs a pediatric van. St. Jude’s now also wants to create a “mom-mobile” to offer free prenatal exams to indigent women who may not have access to transportation or child care. Unfortunately, the good intentions are being choked by red tape.

The hospital plans to outfit a van with medical equipment and send an obstetrician and nurse to low-income neighborhoods. There’s wide support for the idea, even from the people who say it can’t be done now. The catch is that while services such as the Watts prenatal program are funded through other means, St. Jude’s wants authorization for Medi-Cal reimbursement to run its “mom-mobile.” To do that, Washington must reinterpret bureaucratic language so that the program can fulfill its promise and serve as a model.

Under existing guidelines, Medi-Cal money cannot be made available for the van because that would amount to providing off-site hospital services, which are not authorized at present. This is an absurdity, given the need for such care among a segment of the population that has a difficult time getting to a hospital. And proper and early prenatal care for poor people, as a way of ensuring healthy mothers and babies, increasingly has become a national concern.

The regional administrator of the U.S. Health Care Financing Administration apparently agrees, and has vowed to push either for a reinterpretation of the regulations or for a change in the rules. A decision that would allow the “mom-mobile” to start up its engine is expected this month. Clearly, the finding ought to come down on the side of this much-needed service.

The Fullerton hospital already has nine of its 12 obstetricians signed up to take turn in the vans. Orange County officials were so impressed with the idea that last summer they gave St. Jude’s $250,000 from the new state tax on tobacco to start the project. State Medi-Cal officials have been interested enough to say that other California hospitals could be considered for similar vans.

But the problem remains with narrowly drawn federal regulations. A lot--including a future generation about to enter the world with the strike of poverty against it--is riding on an administrative guideline that ought to be changed.