Fresno Co. plan for low-income funds unravels

By Barbara Anderson / The Fresno Bee

Friday, Sep. 16, 2011 | 10:04 PM

A Fresno County plan to leverage millions of federal dollars to start a health program for low-income people has unraveled, and the Board of Supervisors next week will consider withdrawing its application for the money.

County officials decided the Low Income Health Program carries too much financial risk.

And Community Medical Centers, which currently has a contract with the county to provide medical services for indigents, shares the concern. Community and the county would have to amend their medically indigent contract to accommodate the proposed program, but the parties have been unable to agree to new terms.

Advocates for low-income people said Fresno would be the only county in the state to yank an application for the federal funding and that it would be a mistake.

"This money will allow us to provide health care to thousands of people in Fresno County who currently don't enjoy that right," said Kevin Hamilton, a deputy chief at Clinica Sierra Vista, which provides medical services for the poor.

Several community members and health-care providers gathered at Sierra Vista's clinic in southwest Fresno this week to show support for the proposed program.

In a May report, the county estimated approximately 12,000 low-income people would be enrolled in the Low Income Health Program, beginning in 2012. The two-year program is a first step toward expanded medical coverage under the new federal health-care reform law.

In 2014, the program's enrollees would be moved onto Medi-Cal, the state-federal insurance program for low-income patients.

Fresno County's decision to consider pulling its application came after almost a year of meetings, said Richard Yanes, executive director of Fresno Metro Ministry, a multi-faith organization that advocates for the poor. Yanes was in attendance at the planning sessions.

"The key is we're walking away from a huge pot of money for people who need health-care services," he said.

Insufficient funds

But the county came to a painful conclusion, said Kathleen Grassi, assistant health director for Fresno County. "We don't have sufficient funds to support the [program] for the two-year period."

County health officials had estimated they could obtain $56 million in federal matching funds to run the program for two years. But to receive the federal money, the county would have to commit $18 million yearly in health-realignment funds – money the county receives from sales taxes and vehicle-license fees. Another $10 million in mental health-realignment funds would be added yearly.

But for that plan to work, the county would have to get Community's consent. The local money proposed for the program is now locked up in a 30-year contract the parties signed in 1996.

The contract covers health care for indigents – and people who are undocumented residents. But federal rules for the Low Income Health Program don't allow undocumented residents to be enrolled.

Right now, the county allocates $20 million annually in realignment funds for the indigent and undocumented care. The county proposed leaving $2 million of the $20 million realignment funds for Community to continue serving undocumented residents and use $18 million for the Low Income Health Program.

But Community said that wasn't enough. It estimates it now costs about $80 million a year to provide care for 18,000 people – about one-third of whom are undocumented. The undocumented portion of the care costs about $27 million, said Stephen Walter, senior vice president and chief financial officer at Community Medical Centers.

www.fresnobee.com