Major changes in public funding of medical care for the poor--including pregnant, undocumented residents--were proposed Wednesday in the county's plan for negotiating new contracts with UCI Medical Center.
Under the plan, approved 4 to 0 by the Board of Supervisors, the county would shift the bulk of obstetrical and newborn-care costs to the state Medi-Cal program over the next three years by having the new mothers file paperwork for their babies, who would be U.S. citizens.
Emergency Health Care
Another target area is emergency medical care. Bob Love, interim director of the county's Health Care Agency, said the county counsel has advised him that the county may not have an obligation to pay medical costs for illegal aliens. He has recommended that the county extend its current contract with the medical center in this area for only one more year, "and determine what our policy should be at that point."
County officials now will begin negotiating new contracts with UCI Medical Center, which treats most of the county's poor. The county now spends $11.8 million a year for indigent care at the medical center, but the chief negotiator would not reveal by how much he hopes to reduce that figure.
"These are my marching orders," Love said, referring to the negotiating strategy. "But I didn't lay all my cards out."
Blow to Medical Center?
The proposed cuts appear to be another blow to the medical center, which is grappling with a deficit totaling $10 million thus far into the fiscal year.
Hospital officials have laid most of the blame for the financial crisis on the heavy load of public-sponsored patients. UCI Medical Center has the highest percentage of poor patients of any university-owned hospital in the nation, and government agencies--federal Medicare, state Medi-Cal and the county--do not pay for full patient costs, officials have said.
Medical center officials were delivered a copy of the county negotiating strategy Wednesday, but acting director Leon Schwartz declined to comment on it.
Asked if the plan for reduced funding might not force the medical center to turn indigent patients away, Love answered, "It's best for them (hospital officials) to respond to that."
The county has two contracts with UCI Medical Center. The first, called Indigent Medical Services, uses largely state Medi-Cal funds for the working poor, primarily low-income residents who have no health insurance or those suffering from catastrophic medical problems. Thirty-one other hospitals also have Indigent Medical Services contracts with the county, but the bulk of the patients go to UCI Medical Center, Love said.
The second contract--held exclusively by UCI Medical Center--affects patients who do not qualify for the indigent program, including pregnant women, jail inmates and undocumented residents. The current contract was negotiated 10 years ago, just before the university took over the former county hospital, and it expires June 30.
Schwartz said Wednesday that the hospital loses money on both contracts, but added that the level of reimbursement is less for the Indigent Medical Services program.
The county will try to renegotiate the Indigent Medical Services contracts with all 32 hospitals at the current level for six to 12 more months, according to the strategy approved Wednesday. Legislation has been proposed to increase state funding, and the contracts would be renegotiated after the funding bill has been voted on, Love pointed out.
But Love said that the county is interested in "spreading around" the indigent patients at hospitals other than UCI Medical Center.
Obligation to Share
"There's a certain obligation (by other hospitals) to accept these patients . . . . If any one hospital gets a high volume of these patients, they're going to go under. The only way the system can work is if there is an equitable distribution somehow."
He said hospitals will be enticed to take indigent patients "if there are sufficient funds. Hospitals are a business, and if there's a way for them to pick up some money for their losses, it's amenable to them."
A major cost for the county at UCI Medical Center has been for obstetrical services, Love said, adding that nearly 90% of that care goes to undocumented residents.
"Since it is not completely clear that the county has any liability for the care of undocumented alien mothers and their newborn, the issue . . . is cost and the degree to which the county wishes to continue its traditional support," Love's report states.
He said a large number of those cases could be underwritten by state Medi-Cal, which covers the care of newborns and their mothers. Babies born in this country are U.S. citizens, eligible for Medi-Cal, and no separate application would be needed for their mothers, who would not have to fear that they would be reported to immigration officials, Love explained.
INS Would Be Removed