County HMO Program for Poor Called Disaster : Health: Thousands are not getting care because they never received membership cards or don’t know how to use them, critics charge. Officials say the plan is carefully designed to reach those in the welfare system.

More than 100,000 general relief recipients, most of them homeless, were put into a Los Angeles County-run, corporate-style health maintenance organization called the Community Health Plan on Sept. 1, and critics say results so far have been disastrous.

Bernardine Pregerson, chairwoman of the county Public Health Commission, called the county HMO program “ludicrous.” Pregerson made the charge Thursday after hearing critics outline some of the problems being encountered as the county tries to corral general relief recipients, about 64% of whom are homeless, into its managed care program.

Among the problems detailed at the commission meeting were complaints that thousands of membership cards were returned because the relief recipients were no longer at their last address, that prescriptions were not being filled for sick patients because they lacked membership cards and that many homeless people had not been able to figure out how to get care under the system even when they had the cards.

The program was designed in part to meet pressure from Sacramento and Washington to develop health care delivery systems for the poor based on managed care programs that have proved successful in the private sector. With the state and federal governments moving to enroll more and more Americans, particularly the poor, in managed care plans, the county’s program may foreshadow future efforts.

But the action forcing the mandatory enrollment of general relief recipients in the HMO was taken in part to justify a countywide reduction of monthly welfare grants from $293 to $212 per person. County officials placed the value of membership in the HMO at $73 a month. In effect, welfare recipients were being forced to buy their own health coverage through reduced benefits.

The supervisors achieved the resulting $70 million in savings by taking a small HMO they had established during the mid-1980s for Medi-Cal recipients and part-time county employees and expanding it from 14,000 enrollees to nearly 120,000 virtually overnight.

Dr. Shirley Fannin, director of the county’s communicable disease program, told members of the commission that the fledgling HMO plan is the worst public health program she had ever seen conceived. Fannin said it would be impossible for any health program to succeed with the kind of growth experienced by the county’s Community Health Plan.

“Under no circumstance, private, public . . . can this be accomplished. It is physically and fiscally impossible,” said the veteran public health official. “All you are doing is creating hostilities, and angers and insecurities.”

Other county officials, however, said the criticism was unjustified.

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Toni Saenz Yaffee, the assistant director of the Department of Health Services, said health officials were using the same distribution system to get relief recipients their cards as the Department of Public Social Services uses to distribute the welfare checks and payments.

“If they are getting their checks, they should also be getting the cards,” Yaffee said. She also said that even if a member doesn’t have a card, their name should be in the county’s computer system, which would enable them to get care.

She conceded, however, that there were problems, such as membership cards that were sent to wrong addresses and difficulty in finding an adequate number of primary care physicians. Though no new physicians were added to handle the expansion of the HMO, county officials insist that they can provide adequate care for the new HMO members by reassigning doctors from the thousands who now staff county health facilities.

The HMO is operating out of some of the county’s six large hospitals and more than 40 regional health centers and clinics. The county is also negotiating with private hospitals to handle some of the new caseload.

“We had to add this population rather rapidly, and it was an extraordinarily large population. Some of the problems we are encountering are historic to this population. They are transient, they do move around,” she said.

Virginia Collins, an assistant county administrative officer who helped create the program, said widespread complaints were a surprise to her. “I don’t know why they say it is not working. I know of no problems. If they can get their checks, they can get their cards and the packet of information,” she said.

The reduction in the welfare benefits created one of the problems now bedeviling the program, critics say. At $212 a month, advocates for the poor say general relief recipients no longer could afford to keep regular rooms--and regular addresses--at Skid Row hotels, where rents for a single room run around $260 a month. Welfare workers say many general relief recipients must now live a week or so every month on the street, in abandoned buildings or at shelters when their money runs out.

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Attorney Susan Fogel, with the Legal Aid Foundation of Los Angeles, told Public Health Commission members that “overwhelming numbers of general relief recipients have not received any information about the Community Health Plan.”

She gave the commission results of an informal survey by one shelter showing that of 57 general relief recipients who came to the shelter between Oct. 1 and Oct. 7, 40 had not received their membership cards.

Further, she said, “Clients report that they receive conflicting and confusing information when they do try to access the health system.”

Fogel also said some recipients are being turned away from health care if they don’t have a health card, so they aren’t even getting the county’s traditional charity care.

“The county has a legal obligation under state law to provide for indigent care. One of our deep concerns is that law is being flagrantly violated by turning away people who don’t have the card,” she said.

Marjorie Sa’adah, director of Homeless Health Care Los Angeles who works with the homeless on a daily basis, told commission members that “I have yet to find a general relief recipient who is adequately informed about her or his new-found comprehensive health benefits.”

She cited what she said were unfounded rumors that some general relief recipients were selling their cards. “If that is true, it is not all bad news, because the story implies that the general relief recipient actually received a CHP card, which we have found to be a rare exception,” she said.