Judge Leaves County in Limbo on Funding of CMS : Health Care: Court refuses to order transfer of state money to finance County Medical Services for the poor.

A Superior Court judge refused Tuesday to order the specific transfer of $9 million from the state to San Diego County to provide health care for the medically indigent.

Although an injunction that orders the state to pay for the program remained in effect, the actual mechanism for doing so was not settled at the hearing before Judge Harrison Hollywood.

Acting on a suit by patients of the County Medical Services program, Hollywood in March prohibited the county from shutting CMS. Since then, the county has been running the program at a deficit, and has considered other budget cuts to compensate.

“The board will have to probably consider at least putting the program cuts back on if we’re not going to move any closer to some resolution of the matter,” said Diane Bardsley, chief of litigation for the county counsel’s office.

She was referring to closures of parks and the county’s community mental health program that county administrators have proposed to pay for the CMS extension Hollywood ordered.

Bardsley said that, contrary to the judge’s instructions last week, the state had made no effort to cooperate with the county in establishing a payment plan.

But Hollywood said that, if he forced a payment order on the state, it would trigger an appeal and the county’s situation would be “worsened, not bettered.”

As Bardsley tried to protest, Hollywood cut her off, saying: “The nicest thing about sitting up here is that I never lose an argument. I lose an argument to my wife, to my kids, to my dog when she wants to go for a walk. But I never lose one when I’m sitting up here.”

With that, Hollywood said he would send the county and the state to a mediator over the next week to try to work out the details of how the money will be paid.

The development preserves the status quo, at least until the next hearing, at 3 p.m. April 25.

Under the March order from Hollywood, the county is prohibited from shutting down CMS, even though it ran out of budgeted money Dec. 24. A preliminary injunction ordering the state to pay for the extension, issued last week, also remains in effect.

CMS provides health care of last resort to the working poor, people who do not qualify for Medi-Cal but have incomes too low to pay for medical care. Of the 25,000 people served by the program annually, many have chronic diseases such as diabetes or high blood pressure, or have been in traumatic accidents.

CMS reimburses doctors and hospitals for caring for these people, at reduced rates. The state’s contribution to the $41-million program was cut this fiscal year to about $19 million.

David E. Jannsen, deputy chief administrative officer for the county, said the program cuts to pay for CMS would not go on the Board of Supervisors agenda next week.

If no state payment plan emerges next week, however, the cuts may be considered April 30, he said.