SACRAMENTO — Gov. Arnold Schwarzenegger's new proposal for financing medical care for the uninsured and poor has led to an unusual rift with state hospital leaders, who fear it could spark the closure of more facilities.
At issue is $2 billion that California has been receiving each year from the federal government. The money has been distributed to public and private hospitals that carry a heavy load of Medicaid and indigent patients.
Of those 133 safety net hospitals, the 57 in Los Angeles County are among the largest and best funded and therefore the most potentially vulnerable to the changes, hospital officials say. Los Angeles County-USC Medical Center received $57 million and Harbor-UCLA Medical Center got $28 million in 2002, the most recent year for which the county has detailed data.
But the Schwarzenegger administration is being forced to transform the way California obtains Medicaid money from Washington as federal officials become less tolerant of the tabulations used by this state and many others to warrant extra money.
With California's Medicaid arrangement expiring at the end of the month, hospitals and healthcare advocates are warning that the replacement solution Schwarzenegger has crafted could place new financial burdens on counties already squeezed by their own fiscal pressures.
The complaints also have resurrected charges that the governor has failed to live up to his campaign promise to wrest more money from Washington as "the Collectinator," his self-applied moniker.
"We don't understand why Gov. Schwarzenegger is siding with the Bush administration, as opposed to California's hospital and healthcare community," said Anthony Wright, executive director of Health Access California, an Oakland-based advocacy group. "We fear that this not only shifts the risk and responsibility to the counties, but could lead to a ratcheting down of local healthcare services up to and including the closure of public hospitals."
Though the federal government generally gives $1 for each dollar that state government spends to treat the poor, many states -- including California -- have devised creative, though legal, accounting techniques that have allowed them to leverage even more money from Washington.
In New Hampshire, one of the more successful states at this, lawmakers often refer to those efforts as "Mediscam."
Some states have used the additional money to shore up budget deficits or on areas not related to healthcare, such as transportation.
