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'Medi-Cal Under Fire'

December 30, 1987

On Monday, December 14, 1987, the Los Angeles Times' editorial, "Medi-Cal Under Fire," grimly described the sad state of our once laudable Medi-Cal Program, with particular reference to the plight of the obstetrical services covered (or not covered) by the program. The Times pointed out that current rates of reimbursement are approximately 50% of prevailing fees which severely limits access of the needy to the care they so badly need. This is, of course, not only in the area of obstetrics but in all specialties of medical care. What is importantly noted is the fact that for every dollar spent by the state, the federal government provides the same in matching funds. Also noted, is that if access is denied, "postponing timely care is to invite medical complications that ultimately cost far more to treat. That is most measurable in denying prenatal care, with resultant premature births and costly neonatal services." It is not uncommon for one such infant to require costs of $500,000 or more.

On the heels of this revealing editorial comes the unbelievable story reported on the front page of The Times (Part I, Dec. 18). In it we learn that the state is trying to recover millions of Medi-Cal dollars from the very hospitals that attempt, often at a loss, to take care of the state's needy. The total funds sought approximate $100 million, or less than 2% of the funds spent on this program in the past four years. This small percentage, however, has huge financial impact on the hospitals delivering care to the needy, and may cause some to close their doors.

The director of the state's Medi-Cal program, John Rodriguez, states "We want to make sure that Medi-Cal is paying just for the nursery care and not any costs beyond that." What is implied is that the baby magically appears without the attendance of the mother in the hospital and that if the mother should happen to be needed to participate in the delivery of her baby, there is no reason for the state to be responsible for payment for her care--an amount previously described as woefully inadequate in the Times editorial.

The fact is that the mothers from across the border are here and their labor isn't going to stop because the state wishes it so. Their children will be born in homes, cars, police cars and parking lots. These children will suffer greatly increased risks and illness, and because they are eligible for Medi-Cal as United States citizens, they will create costs that could exceed the thoughts of the wildest imagination. The state should not dictate acceptable levels of care for its residents. This belongs in the hands of the medical specialties involved. For the state to do so only invites disaster for all of us and especially the infant, who as we know, had no choice in the choosing of his or her parents. The witch hunt against all the hospitals in the state that have provided this care must stop.

ANTHONY T. HIRSCH, MD

President, Calif. Chapter 2

American Academy of Pediatrics

Inglewood

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