Wilson Budget Plan Cuts Counties’ Care Obligations : Aid: Proposal would lift required welfare and health services. Needy would be left without help, critics say.

Gov. Pete Wilson, a former mayor, has said throughout his 18 months in office that the state should not force added burdens onto local governments without also giving them the money to pay for the programs.

Now, in a bold move to help him balance the state budget, Wilson has proposed a dramatic extension of that doctrine of local control. He wants to take money from counties and in turn relieve them of a huge responsibility: their historical obligation as the caretaker of last resort for the sick and poor.

Wilson proposed Friday to repeal two legal pillars that undergird the counties’ commitment to the needy, freeing these 58 arms of the state to decide for themselves what level of care and protection to provide their less fortunate residents.

If they get that freedom, many counties are expected to limit general assistance--the welfare program for those who qualify for no other aid--and to restrict access to medical care by capping health budgets, eliminating some services and charging low-income patients a fee for every visit to the doctor.

“The governor believes that local governments need to have the ability to set priorities and decide for themselves how best to spend their available resources,” said Kassy Perry, Wilson’s deputy communications director.

Wilson’s call for repeal of the mandates goes further than the requests of county supervisors, who have asked that these laws be suspended or modified to give them maximum flexibility. The governor’s stand, though supported by many lawmakers, may be a negotiating position from which he will retreat to middle ground.

But for now, advocates for the disadvantaged are warning that Wilson’s move could leave the poor and the infirm with nowhere to turn. Even without the state’s blessing, they say, the beleaguered counties have allowed gaping holes to appear in the “safety net.” They note that the state will not make the needs of the homeless and sick disappear by removing the responsibility of government to care for them.

Without a minimum obligation, said Democratic Assemblyman Sam Farr of Carmel, some counties might resort to the equivalent of a “Greyhound bus ticket out of town.”

And the anticipated reduction in county health services, others say, could produce a ripple effect, inundating private hospitals with non-paying patients, which would force these facilities to shift the cost to those who do pay or close their emergency rooms.

“People need to remember that the county safety net protects everyone, even those of us who have insurance,” said Maryann O’Sullivan, executive director of Health Access, a coalition of religious, labor and consumer groups.

Wilson’s plan would shift $1 billion of local property tax revenue to the schools and cut 15% from the state health and welfare budget. He has not said how he would make that 15% cut but is reviewing options that include the removal from Medi-Cal rolls of thousands of working poor people whose care under current law would become the responsibility of the counties.

Without relief from state mandates, county officials say, they will lack the flexibility to implement the budget cuts humanely.

“If they end up cutting hundreds of millions out of the county property tax and hundreds of millions out of Medi-Cal, there’s no way to put a reasonable or compassionate spin on it--people will die,” said Karen Coker, a lobbyist for the California State Assn. of Counties.

John Sweeten, director of legislative affairs for San Diego County, said the counties’ primary objective is to make sure they are able to “manage whatever we have left” when the budget deal is done.

“We have to have the ability to move funds from one program to another, to reduce services if necessary, to not only address whatever priorities are most pressing locally but to live with whatever resources are available,” Sweeten said.

The Wilson Administration, with less than two weeks before the start of the fiscal year, is considering dozens of proposals to loosen the state’s grip on the affairs of city and county governments. But Wilson said Friday that he has decided to push for repeal of two fundamental laws that guide every county action on health and welfare issues.

One, known as Section 17000 for its spot in the state Welfare and Institutions Code, makes counties the caretaker of last resort. It requires every county to “relieve and support all incompetent, poor, indigent persons, and those incapacitated by age, disease, or accident,” when these people are “not supported and relieved by their relatives or friends, by their own means, or by state hospitals or other state or private institutions.”

The other law governs health services. Called the Beilenson Act, for then-Assemblyman Anthony C. Beilenson--the state statute requires county boards of supervisors to hold public hearings before reducing health services and prohibits them from making the cuts if the reductions would leave the poor with a lower level of care than that available to patients who can afford to pay for their treatment.

The effect of these moves probably would be felt first in the general relief program, which serves people--mostly single men--who do not qualify for the state’s largest welfare program, Aid to Families With Dependent Children or state and federal aid to the aged, blind and disabled. The grants average $300 monthly and are supposed to pay for food, shelter, clothing and transportation.

San Diego County supervisors have tried to place a three-month limit on general assistance welfare payments to able-bodied adults. But a court blocked the move--based on Section 17000--and has scheduled a trial to examine the issue.

Other counties are looking at more modest proposals to restrict their general assistance programs. Some examples:

* Counties on the state’s northern and eastern edges are considering a 30-day waiting period to discourage transients from Oregon and Nevada from crossing the border and applying for general assistance payments.

* Sacramento County wants to offer public housing to general assistance recipients and then deduct the housing subsidy from their cash grant. Other counties have tried to reduce grants for people who live with relatives or friends.

* Some counties want to force general assistance recipients into drug and alcohol treatment programs and work-training projects.

In all these cases, the counties either have been rebuffed by the courts or have concluded that they could not implement these policies without violating a variety of state laws.

The same is true for county-run health service programs, which mainly serve the working poor who do not have insurance but earn too much to be eligible for Medi-Cal. Boards of supervisors, reacting to budget shortages, have tried to reduce health care programs but have run into the Beilenson Act’s requirement that they provide services equivalent to those available to private patients.

Counties complain that the Beilenson Act creates a double standard, requiring them to provide care--such as obstetrics--that the state’s Medi-Cal program, because of a shortage of participating doctors, does not make readily available in many parts of California.

One solution that counties propose is for the state to set a cap on what each county must spend. Once that limit is reached, their obligations under the Beilenson Act would cease and they would be free to ration their services any way they wished.

Another possibility is that as the state eliminates services under Medi-Cal--for dental care, for instance--the counties be allowed to do the same. And if the Beilenson Act and other mandates are relaxed, some counties are prepared to charge fees of perhaps $5 per visit and to place liens on the homes of unemployed, uninsured patients to force them to pay for their care later, if they get a job.

Some Democrats share Wilson’s position that just as the state is seeking relief from requirements imposed by Congress, the Legislature should grant the same consideration to counties.

Senate President Pro Tem David A. Roberti (D-Van Nuys) said last week that he will support repealing the Section 17000 obligation but doubted that a majority of Democrats in his house will go along. Sen. Mike Thompson of St. Helena, architect of a Democratic plan to overhaul the welfare system, said the state should not free counties completely but should “call off the dogs.”

Sen. Diane Watson, a candidate for a seat on the Los Angeles County Board of Supervisors, said she does not trust the local board to provide enough care for the needy. She favors keeping the mandate and raising the cigarette tax to as much as $1 per pack, which she said would raise enough new money for the counties to do an adequate job.

Watson said the poor need general assistance more than ever and added that repealing the Beilenson Act would allow counties to make “back-room reductions” in services without allowing those most affected to protest.

“They’ve not gotten the best use of their funds,” Watson said of Los Angeles County. “I really don’t want to let the counties off the hook.”

But Watson’s views are not representative of the county officials whose ranks she hopes to join, and she is also in the extreme in the Legislature, where a compromise probably will emerge. Ultimately, the state may choose to leave counties with their obligation to the poor while giving them much greater flexibility to deliver services in the best way they see fit.

The counties, said Coker of the counties association, would be satisfied with that result.

Without Section 17000, she said, “it would become a matter of local decision making whether a board would continue to pay for health care, own a county hospital, own a clinic or in any way have any responsibility for health care. That is not what we’re advocating.”

But many Republicans will push for even greater freedom, particularly if the counties are to get broader authority to raise taxes, which Wilson also has proposed.

Republican Sen. Frank Hill of Whittier, a member of the Senate-Assembly conference committee on the budget, said the time has come for the state to trust the counties to do the right thing.

Hill said: “The question is, are we going to just rip off their money and still keep our hands on their throats and tell them what to do? That’s the real issue--can you cut the cord? Can you turn them loose? I say we should get out of the business and give the locals the programs and the revenues and say: ‘Do it.’ ”