The sweeping changes being enacted in federal welfare programs are sparking new moves to weaken or repeal the simple California law that makes counties the provider of last resort for the state's needy.
For more than three decades, the state's 58 counties have had the ultimate responsibility to care for those who cannot or will not care for themselves. Large and small, urban and rural, the counties are required to provide welfare and emergency health care to people with nowhere else to turn.
With the federal government moving to restrict welfare benefits and eliminate them for legal immigrants, the counties fear that unless the Legislature acts quickly, they will be left with the mandate but without the money to pay for it.
"They can't leave the counties stranded," said Victor Pottorff, deputy director of the California State Assn. of Counties. "We do not have the financial resources to meet these obligations."
Pottorff said county leaders plan to meet next week in Sacramento to map their strategy for the closing weeks of this year's legislative session.
Mike Antonovich, chairman of the Los Angeles County Board of Supervisors and a member of the association's executive committee, said he believes the counties will join him in asking Gov. Pete Wilson to call a special legislative session to address the impact of the federal welfare reform bill.
Antonovich wants lawmakers to exempt counties from having to pay welfare benefits to legal immigrants and instead make the sponsors of legal immigrants financially responsible for family members they help bring to the United States.
State lawmakers need to undertake a comprehensive realignment of the entire welfare system, said Frank Mecca, executive director of the county Welfare Directors Assn.
Although the federal government is eliminating its commitment to provide welfare and health care benefits to legal immigrants, Mecca said: "The people don't go away."
There must be a partnership between the state and counties to care for indigent Californians, he added.
What's known as the state's safety net law requires that: "Every county and every city and county shall relieve and support all incompetent, poor, indigent persons, and those incapacitated by age, disease, or accident" who are lawful residents "when such persons are not supported and relieved by their relatives or friends, by their own means, or by state hospitals or other state or private institutions."
As their financial plight has worsened in recent years, counties have had some success in easing that burden.
Portions of the state law requiring counties to pay for general assistance to the poorest of the poor have been eased for counties in serious fiscal distress. Los Angeles County, for example, won approval last March from a state commission to cut general relief payments by 25% to $212 a month.
Other California counties have taken the same approach, including rural Lassen County and urban centers such as Sacramento and Alameda counties.
A law that takes effect in January would also allow counties to restrict general relief payments to three months a year for employable adults.
Talk of repealing the so-called safety net regulation strikes fear in private hospitals and doctors who see a wave of poor patients headed their way.
Dr. Brian Johnston, president of the Los Angeles County Medical Assn., called such efforts "catastrophically shortsighted" and predicted the closure of some private hospitals because they can't afford to treat people who can't pay.
Anti-poverty lawyer Beth Osthimer of the San Fernando Valley Neighborhood Legal Services agreed with doctors that "the Legislature can repeal the law, but the problem doesn't go away. People are still going to be sick and need care, people are still going to be disabled, and people needing the services will still be living in Los Angeles County."
The situation in the county may be tempered somewhat by the commitment of both the state and the county to increase indigent outpatient health care services by 50% over the next five years. That was a key part of the county's application for federal funds last year to bail out its ailing public health system.
Steven Thompson, lobbyist for the California Medical Assn., said he and others are concerned that the federal legislation could breathe new life into efforts to repeal the requirement that counties provide services to the poor. At least three bills have been introduced in the state Legislature to lift the mandate.
Health experts say the mandate is particularly critical in a state with more than 6.5 million residents who don't have health insurance of any kind, including taxpayer-supported Medi-Cal.
The UCLA Center for Health Policy Research estimates that roughly 4 million of the uninsured lack the financial means to pay for their own health care and may have to rely on charity care at county hospitals and clinics or on whatever free services they can find at private hospitals.