Cuts loom for L.A. County health programs

With a federal waiver worth $150 million expiring next month, and hundreds of millions more in state and federal funds in limbo, Los Angeles County’s top health officials said Tuesday that they soon may have to begin layoffs and slash the number of patients served by a third to 58%.

“We’re going to have to make significant reductions in services,” said John Schunhoff, interim director of the Los Angeles County Department of Health Services. “It’s hard to imagine we could do that without layoffs.”

The department is facing a deficit of $389 million to $429 million this fiscal year and is still trying to offset last year’s $200-million deficit, Schunhoff said.

At issue now are funds that were expected to come from a federal Medicaid waiver, the federal share of Medicaid and a hospital provider fee levied by the state on private hospitals and matched by Medicaid.

Without those funds, $299 million this fiscal year and about $144 million in payments left over from last fiscal year, Schunhoff said, the department will have to scale back the 730,000 patients served annually.

Losing the funds would mean the county could serve 260,000 to 420,000 fewer patients, he said, cutting both inpatient hospital service and emergency room visits by more than 25% each.

The federal waiver request requires an agreement between state officials and the Centers for Medicare and Medicaid Services, which are in negotiations. Congress is considering whether to allow the federal share of Medicaid to be reduced as expected or to extend the current share before the legislative body adjourns next month. The hospital provider fee, also awaiting approval, would have to be enacted through state legislation before the Legislature adjourns next month.

On Tuesday, the county’s chief executive, William T Fujioka, told supervisors that if the funds are not approved, the effect on health services countywide, from emergency rooms to clinics, would be “catastrophic.”

“We are the linchpin for the trauma system,” he said. “As we go, the whole county goes.”

Fujioka encouraged supervisors to “stand firm” and demand that state and federal leaders approve the money.

But Supervisor Gloria Molina said federal lobbying efforts had proved fruitless.

“I think you’re being overly optimistic,” she told Schunhoff and other department officials Tuesday. She cautioned against “gambling” on receiving the funds and demanded a fuller accounting of how they propose to cover the deficit.

Fujioka and Schunhoff, by unanimous vote, were instructed to report back in 15 days with a detailed assessment of how the department plans to close the deficit if the funds fall through.

“The longer we wait, the deeper the cuts are going to have to be,” said Supervisor Michael D. Antonovich.