Judge Rules That State Must Fund CMS : Health: It’s unclear whether Superior Court’s ruling on the county program for the poor and uninsured is binding on Sacramento.

In a move that delighted county officials, a San Diego Superior Court judge ruled Tuesday that the state is financially responsible for a beleaguered county-run program, County Medical Services, that serves the poor and uninsured.

Judge Michael Greer ruled that the state will have to fund the program and reimburse the county for past CMS services. The program was almost terminated by the county this spring for lack of money.

“It is yet another court ruling that validates what this county has been saying all along--that the state should stop sending programs to local communities and requiring them to fund them without sending money,” said County Supervisor Susan Golding.

At issue is whether the state should reimburse the county for the $41-million-a year program and how much.

For the fiscal year 1989 to 1990, the county claimed that the state owed it $5.4 million for medical care. The state, in turn, paid all but $1.5 million, disputing the county’s interpretation of the law. The amount owed for the current fiscal year has not yet been determined but could be $7 to $9 million, said Diane Bardsley, chief deputy county counsel.

The lawyers representing the state, however, questioned whether the judge had the jurisdictional authority to rule against the state.

“What we’ve got here is an end-run attempt,” said Richard T. Waldow, a deputy attorney general.

In a hearing scheduled for next month, Greer said he will try to determine how much money the state owes the county. Greer also said he will study whether he has the power to force the state to pay.

“Normally, a judge can’t tell the state Legislature to appropriate money, but there are exceptions,” said Valerie Tehan, deputy county counsel.

County officials have suggested two funds--the State Mandate Fund and the Health Care Deposit Fund--that could be tapped to pay San Diego County, Tehan said.

“We’ve told the state . . . that they have a responsibility to this indigent population, and they can’t shirk this responsibility any longer,” Tehan said.

There is some concern among county officials, however, that the new state budget contains language that may penalize San Diego County for filing a suit against the state.

“We are studying that to see how that would affect our relationship with the state budget,” said County Supervisor John MacDonald. “Right now, we are going to go forward.”

Some attorneys predicted that the state will appeal Greer’s decision.

Waldow, the state’s lawyer, criticized Greer’s efforts to set up a hearing in July, asking, “Why are we in this helter-skelter rush?”

Greer shot back that he was eager to get the case moving on behalf of the patients whose medical plans may have been stalled by CMS’ piecemeal funding.

“There’s urgency to the person who goes in for cancer treatment and wants a plan, and the doctor can’t give a plan” because it’s not yet known if CMS will shut down, Greer said.

“You have to recognize that medical care is not something you do like going to the grocery store--it requires planning. You can’t plan with the economic situation the way it is.”

Waldow, based in Los Angeles, also tried to placate Greer, advising him that the state would probably pass legislation to allow counties to get more money by expanding their revenue-generating abilities. But Greer, saying it was irrelevant, dismissed this possibility. “I’ve had too much experience dealing with Sacramento.”

Until this year, when state money ran out, the state funded the CMS program. But this year, the state paid only $19.8 million of the program’s $41-million budget, and the state’s funding ran out last December.

This left the county, already facing funding problems in other programs, to scramble and put together makeshift funding. The quick-fix, however, quickly burned up more money than the county could afford.

In March, formal notices were sent to CMS’ 25,000 patients--a move that caused patients, employees and lawyers to rally. About 26% of San Diego County’s population, or 400,000, doesn’t have health insurance and is eligible to use CMS, said Paul Simms, deputy director of physical services for the county’s Department of Health Services.

Legal Aid lawyers, representing the poor, sued the county when it announced its intention to close CMS. In that suit, a Superior Court judge issued an injunction keeping CMS open.

Escalating the legal battle, the county filed a cross-complaint against the state saying the program was the state’s responsibility. In April, Superior Court Judge Harrison Hollywood issued a temporary order that expires June 30, saying the state should pay for CMS and asking the county and state to hammer out a solution. But a quick fix was not found.

On Monday, the Board of Supervisors authorized funds to keep CMS operating for another 60 days, carrying it to the end of August.