County Freezes Hiring for Health Services

Increasingly pessimistic about the federal government’s willingness to keep Los Angeles County’s public health system solvent, the Board of Supervisors on Tuesday voted to freeze all hiring and contracts in their Department of Health Services should Washington decline to extend its $1-billion waiver of Medicaid rules.

To protests from public employee unions and private clinics that rely on county contracts, the board also took a halting first step in a bureaucratic process that could end in deep cuts to services for the county’s nearly 3 million uninsured residents.

“With the [renewal of the] waiver sailing toward a deadly iceberg, another week has passed,” said Supervisor Mike Antonovich. He said his motions, made in concert with Supervisor Zev Yaroslavsky, were needed to prepare for “rational cuts,” rather than ones made in panic, if the waiver expires June 30.

Last week, the board declared an impasse in its negotiations with the state and federal governments over the extension of the waiver, which saved the county from bankruptcy when it was granted in 1995. The renewal process has been stalled by battling among the three levels of government over which will pay for the waiver services.

County health officials Tuesday were unsure of the financial impact of the board’s decision. But Kathy Ochoa, a health care analyst with the Service Employees International Union Local 660, which represents most county employees, said it was a dangerous move.

“The department is only able to hire its most critically needed positions” under current county budget policy, Ochoa said.

“It’s going to be able to hire less critically needed positions,” replied Yaroslavsky.

“Then more people will go without services,” Ochoa shot back.

The waiver was granted in an effort to shift the county health department’s focus from expensive, hospital-based treatment to cheaper, preventive outpatient care that is more easily accessible to the working poor. To do that, the county entered into contracts with more than 100 local health clinics.

But the supervisors’ moves of the last two weeks have left the future of those contracts, which expire June 30, in limbo. Though some county officials privately suggested that the contracts could be extended on a month-to-month basis, clinic directors said the possibility that they will lose county funding is devastating.

“We need your assurance that these contracts will be extended,” said John Stenzel, executive director of Tarzana Treatment Centers, which runs two clinics. Stenzel said patients and staff are frightened by word of possible cuts.

Elizabeth Forer, executive director of the Venice Free Clinic, said her facility, which serves 9,000 uninsured who would otherwise flood county facilities, will have to cut back 40% if its contract is not extended. “These partnerships are the most cost-effective ways of providing health care you have come up with,” she told supervisors.

The board also asked health officials to prepare for detailed public hearings, which are required before any cuts in health care services. But they moved cautiously toward those potentially explosive hearings, asking only for a report from their staff on how to open them.

“We are in a crisis,” Supervisor Yvonne Brathwaite Burke said. But she urged her colleagues to wait until they find out what form of waiver, if any, they can get by June 30 before announcing cuts, so they will “be based on facts, rather than hysteria.”