HomeMy WebLinkAboutMINUTES - 01131987 - 2.4 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
Adopted this Order on January 13 , 1987 by the following vote:
AYES: Supervisors Powers, Fanden, Schroder, Torlakson, McPeak
NOES: None
ABSENT: None
ABSTAIN: None
SUBJECT: Medi-Cal Position Paper
Mark Finucane, Director of Health Services, presented
the attached position paper on the recent State Department of
Health Services Medi-Cal reductions.
Mr. Finucane advised that a Legislative Task Force had
been convened by Assemblyman Brown and Senator Roberti to review
the Medi-Cal reductions.
Henry L. Clarke, representing the Contra Costa Health
Coalition Board of Directors, noted that the Health Coalition,
which consists of members from all segments of society in the
County, unanimously condemned the reductions. Mr. Clarke extended
the Health Coalition' s support in any campaign to oppose the
reductions.
Supervisor Tom Powers stated that his office had
received offers of support from labor union personnel, the San
Pablo City Council and the Brookside Hospital Board of Directors,
and noted that there should be a coordinated effort to oppose the
reductions. He expressed the need to present some affirmative
steps and requested that the position paper include a statement
urging reform within the system.
Supervisor Sunne McPeak requested that the position
paper include the request that County representatives be included
in the newly established Legislative Task Force.
There being no further discussion, IT IS BY THE BOARD
ORDERED that the position paper on the Medi-Cal reductions as
amended to include support of reform within the system and to
request County representation on the Legislative Task Force is
ADOPTED.
IT IS FURTHER ORDERED that presentation of the position
paper to the County Supervisors Association of California (CSAC)
Board of Directors is AUTHORIZED.
IT IS FURTHER ORDERED that the Health Services Director
is REQUESTED to distribute copies of the position paper to
hospital districts, health care providers and cities, urging their
support.
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MEDI-CAL POSITION PAPER
Once again, those systems which provide health care to the neediest
patients in California have been dealt a severe financial blow. The State
Department of Health Services has announced drastic steps to reduce what they
term a "deficit" in the Medi-Cal program budget. This "deficit" is in fact a
result of unrealistically low projected expenditures for the program which were
used by the Department of Finance in preparing the State 's 1986/87 budget.
Hospitals routinely adjust staffing and other expenditures in response to
utilization. It is difficult, however, to provide adequate health care
services when patient need is constant, or rising, but reimbursement is
arbitrarily manipulated. There is hardly anyone left to whom hospitals may
shift costs when reimbursement falls below the cost of providing services. In
the case of public hospitals, the shortfall must be paid out of local tax reve-
nues. Unfortunately, as is well known, counties cannot increase taxes to cover
these new costs shifted to them by the State.
This time, outpatient services are targeted for the largest reduction. It is
short-sighted to attack the very type of care which can maintain health and
control diseases in their early stages in order to prevent needless suffering
and costly hospitalization. Many counties have found fewer and fewer physicians
willing to provide outpatient services to Medi -Cal recipients; the reimbursement
is simply too low, and the paperwork too daunting. The latest round of cuts
promises to shift yet more patients into public outpatient clinics, which were
underfunded by Medi-Cal even before the proposed 10% reductions.
Reduced access to care will be the inevitable result of these cuts. Longer
waiting periods and reductions in specialty clinics can be expected as public
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hospitals attempt to maintain inpatient and emergency services. Those patients
who currently use public clinics and who have adequate health insurance will
face overcrowding and long waiting times, and will instead use private-sector
physicians. This will eliminate one of the few sources of funding which comes
close to covering actual cost of care.
The latest reductions hit counties already reeling from a $25,000,000 reduction
in the Medically Indigent Adult budget. Perhaps sensing that these patients
have nowhere to go but to county facilities, the Governor restored part of his
initial budget cut and, under intense pressure, may restore the remaining
$25,000,000. It must be pointed out that, just as MIA's are today the respon-
sibility of counties, Medi -Cal is fast becoming a de facto county-only program.
What was once a progressive, innovative program to open the doors of health care
to all who needed it has become a financial burden to public and private provi-
ders alike. Private-sector providers can shift services away from basic care
into more lucrative pursuits, and can refer elsewhere those patients who are
financially unrewarding. Counties, with their legal mandate to serve as safety-
net institutions and their historic willingness to take on patients rejected by
other medical providers, have no room to maneuver.
In order to maintain every citizen's access to required medical care, we recom-
mend the following:
1. An immediate reversal of both the $25,000,000 in MIA cuts and the
recent Medi-Cal reductions.
2. A moratorium on future Medi -Cal reductions pending a comprehensive
review of current reimbursement policy.
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3. An independent study of the true cost of providing care to Medi -Cal
recipients in a broad range of settings, and a revamping of the
Medi-Cal rate structure to reflect the actual cost of care.
4. Recognition, through augmented reimbursement, of the role played by
those institutions whose caseloads include disproportionately large
numbers of Medi-Cal and indigent patients.
5. Assignment by CSAC of the highest priority to health care legislation,
in order to avoid the same desperate conditions which finally forced
education to the top of the agenda.
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