Counties Must Pay for Care of the Needy

Counties must continue to provide essential medical care to residents who cannot afford to pay for it themselves, the California Supreme Court held Monday.

An appeals court had ruled that Sacramento County had the right to reduce or even eliminate health care for some low-income residents. Under Sacramento County’s proposal, poor residents who receive general assistance or who do not qualify for other welfare programs would have been eligible only for free emergency medical care.

But the high court, in a unanimous decision written by Chief Justice Ronald M. George, said state law requires counties to “provide for the protection, care and assistance of all the needy and distressed people of this state, and to administer appropriate aid and services promptly and humanely.”

Neither Sacramento nor any other county has actually implemented the sorts of cutbacks that were at issue in the case. But advocates for the poor were widely predicting that the cuts would have become common had Sacramento prevailed.

“If the decision had gone the other way,” said Richard A. Rothschild, director of litigation for the Western Center on Law & Poverty, “hundreds of thousands of people would have been denied health care” whenever a county wanted to save money. Rothschild represented aid recipients in Sacramento who challenged the county’s plans to reduce benefits.

The ruling “reaffirmed that there really is a health care safety net for poor people,” he said.

The impact of Sacramento’s proposal would have fallen on poor and disabled residents who do not qualify for Medi-Cal and certain other government programs, Rothschild said. The medical services at issue are “between the routine and emergency,” and would include medication for heart disease, he said.

Sacramento County sought the cost-cutting measures in 1992 and 1993 when bad economic times cut heavily into county revenues. The county initially tried to limit free health care just to people receiving general assistance. That move would have ended services for about 15,000 of the so-called working poor. A trial court blocked that measure.

The county then argued that it could provide a cash grant of $40 for medical care to general assistance recipients and eliminate free medical care. Courts again blocked the county.

In his opinion, George noted that state law does not require counties to provide the same quality of health care that recipients of private services receive, and counties can determine the formula for providing medical assistance. But the formula must take into account an individual’s financial ability to pay for all or part of essential services, he wrote.

“In determining eligibility for subsistence medical care . . . counties must consider a resident’s financial ability to pay the actual costs of obtaining such care,” George wrote.

Most counties base eligibility for free medical care on state Medi-Cal standards. If an individual’s income is about $600 a month or less, the person is entitled to free care. Individuals with higher incomes pay a portion of their health costs on a sliding scale. These programs have not been challenged.

Michele Bach, supervising deputy counsel for Sacramento County, said the county was not yet sure of the long-term implications of the decision.

The case is Hunt vs. Superior Court, SO 63313.