SAN FRANCISCO — Counties must continue to provide essential medical care to residents who cannot afford to pay for it themselves, the California Supreme Court held Monday.
An appeals court had ruled that Sacramento County had the right to reduce or even eliminate health care for some low-income residents. Under Sacramento County's proposal, poor residents who receive general assistance or who do not qualify for other welfare programs would have been eligible only for free emergency medical care.
But the high court, in a unanimous decision written by Chief Justice Ronald M. George, said state law requires counties to "provide for the protection, care and assistance of all the needy and distressed people of this state, and to administer appropriate aid and services promptly and humanely."
Neither Sacramento nor any other county has actually implemented the sorts of cutbacks that were at issue in the case. But advocates for the poor were widely predicting that the cuts would have become common had Sacramento prevailed.
"If the decision had gone the other way," said Richard A. Rothschild, director of litigation for the Western Center on Law & Poverty, "hundreds of thousands of people would have been denied health care" whenever a county wanted to save money. Rothschild represented aid recipients in Sacramento who challenged the county's plans to reduce benefits.
The ruling "reaffirmed that there really is a health care safety net for poor people," he said.
The impact of Sacramento's proposal would have fallen on poor and disabled residents who do not qualify for Medi-Cal and certain other government programs, Rothschild said. The medical services at issue are "between the routine and emergency," and would include medication for heart disease, he said.
Sacramento County sought the cost-cutting measures in 1992 and 1993 when bad economic times cut heavily into county revenues. The county initially tried to limit free health care just to people receiving general assistance. That move would have ended services for about 15,000 of the so-called working poor. A trial court blocked that measure.
The county then argued that it could provide a cash grant of $40 for medical care to general assistance recipients and eliminate free medical care. Courts again blocked the county.
