County to End Health Care for Poor in 11 Days : Indigent: State’s last-minute offer of a $9-million loan to keep program going is rejected.

San Diego County rejected the state’s eleventh-hour offer Friday of a loan to save the county’s indigent health care program, and formal notices that the program will end March 19 were sent out shortly afterward.

The development leaves thousands of medically indigent San Diego County residents in the middle of a county-state standoff over who has the responsibility to pay their hospital and doctor bills.

No discussions between the state and the county are scheduled, but local community clinic directors, hospital administrators and others plan to meet Monday to discuss how to cope with the end of the program. Meanwhile, legal aide attorneys are preparing a lawsuit against the county on behalf of patients covered by the program that could be filed as early as Monday.

“We are extremely disappointed that the state continues to ignore its obligation to this program statewide,” said David E. Janssen, assistant chief administrative officer for the county.

But, in a letter received in San Diego at about 4 p.m.--one hour before the deadline set by the county--the state’s director of finance, Thomas W. Hayes, laid the problem back on the county’s doorstep.

“The responsibility for providing indigent health care . . . is the county’s; while we recognize the problems associated with the levels of funding available from the state, the county has broad authority to adjust eligibility, benefit, provider payment levels to bring the program within available resources,” Hayes wrote.

The county has no authority whatsoever to hand this responsibility for its County Medical Services program, know as CMS, back to the state, Hayes emphasized.

He said the administration would be willing to ask the Legislature to approve $12.9 million in funding for San Diego County. Of that, $3.9 million would be reimbursement for funds it did not receive last fiscal year, and $9 million would be an interest-bearing loan.

That loan is the equivalent of the amount the county is owed by cities, schools and other taxing districts for collecting their property taxes. However, the money is in limbo because schools are suing to overturn the new law under which the levies were to be made.

The Board of Supervisors voted Tuesday to end the CMS program unless there was a firm guarantee of money by 5 p.m. Friday, noted Supervisor Susan Golding.

“A loan is not assurance of money. It’s a loan against resources the county doesn’t have,” Golding said. “I feel that what should happen is that the state should guarantee the loan, (so that) if the lawsuit is lost, the state would make the county whole.”

Supervisors’ Chairman John MacDonald said county officials indeed had asked that the loan be interest-free and that the state indemnify the county for it, but to no avail. County officials made several trips to Sacramento over the last week.

“We took the extra effort to try and it just didn’t work out,” MacDonald said.

But the loan offer was seen as potential salvation for CMS by the chairman of the board of the San Diego Council of Community Clinics. The clinics treat about 12,000 people for life-threatening medical problems under the CMS program.

“We feel that people’s lives are very, very important, and they’re worth the county considering very seriously the matter of the $9-million loan,” said Roberta L. Feinberg. “There are lives at stake here, and we would hope the county would look carefully at the state’s proposal.”

Overall, about 25,000 people every year receive treatment for life-threatening or disabling medical conditions under the CMS program.

Often called the working poor, these patients have no health insurance and incomes too high to qualify for Medi-Cal, but too low to pay for their own medical care. There are about 600,000 people in San Diego County with no health insurance.

As CMS heads for oblivion after March 19, Feinberg emphasized, community clinics will continue to care for CMS patients while asking them to pay small, sliding-scale fees for care. A typical doctor’s visit costs about $25, she said.

And hospitals are planning their 1991-92 budgets to take into account the loss of $30 million in CMS and state tobacco-tax funding for caring for the medically indigent, said James Lott, executive director of the hospitals’ trade group.

“Some of them will be making decisions about service capacity and about modifications to their delivery system,” he said.

This could include downgrading their emergency rooms so that ambulance traffic would bypass them, or eliminating participation in the countywide trauma system.

The Legal Aid Society of San Diego also is preparing to file a lawsuit over termination of CMS. If patients sue the county, Golding said, the county would then sue the state--and let the courts decide just who is responsible for caring for those people.