Welfare Programs

County welfare officers may conduct routine searches of the homes of welfare recipients to combat fraud under a ruling in a California case that the Supreme Court let stand Monday. The justices refused to hear a challenge from the American Civil Liberties Union, which contended that San Diego County's policy of requiring home searches without a warrant violated privacy rights. The 4th Amendment to the Constitution forbids the police to search a residence without a warrant.

For 10 years, Wendy Botwin has struggled to overcome brain damage, balance problems and other disabilities suffered in an automobile accident. Finding doctors willing to provide the specialized care she needs has been just as difficult. More often than she can count, she has been rebuffed. And her experience is far from unusual. She is on Medi-Cal, the state and federal program for poor and disabled people, and studies show that many physicians consider its rates too paltry to accept.

California welfare recipients were the only group targeted for major cuts Tuesday when Gov. Arnold Schwarzenegger presented a $125.6-billion budget that would increase payments to education and transportation by billions of dollars. The election-year proposal was a marked departure from past Schwarzenegger spending plans that called for reductions across the board.

Sena Perez works two jobs, attends a community college in Pasadena and receives a monthly check from CalWORKs, the state's welfare-to-work program. She and her husband, Henry, a landscaper, struggle to support themselves and their four children who range in age from 20 months to 11 years. "Everything goes up every year: rent, food. Nothing stays the same price," Sena Perez said.

With only one kidney, Francisco Villasenor depends on dialysis and a special drug to cleanse impurities from his body. But on Friday, he left the Rite Aid pharmacy in Los Feliz without the drug. He didn't have $179 the drugstore demanded. "How can I pay? I don't have money," said Villasenor, 47, lifting his sagging polo shirt to show the L-shaped scar where surgeons removed his left kidney five years ago when his organs began to fail. Until two weeks ago, he got his medication for free.

Even as the state spends millions of dollars on emergency prescription drug coverage for more than 200,000 elderly, poor and disabled Californians, many of their claims are still being denied, healthcare groups said Tuesday.

The Bush administration's fumbled takeover of prescription drug coverage for the elderly poor and disabled has a klutzy resemblance to its botched relief effort for Hurricane Katrina victims. This disaster has a much lower profile, of course. TV crews have not been following old folks in wheelchairs out pharmacy doors after they've been denied the medicine they need to blunt debilitating pain, or even to stay alive.

The new Medicare prescription drug program was supposed to start humming almost with the flick of a switch. As the Bush administration envisioned it, beginning Jan. 1, millions of Medicare beneficiaries would be able to go to their pharmacists and get hefty discounts on their prescriptions.

When a government program is defined in terms of a void at its core, you know it's trouble. In the case of the new Medicare drug benefit, that void has been evocatively named the "doughnut hole." This is a gap in coverage beginning when the full cost of an enrollee's prescriptions for a year reaches $2,250 (including co-pays, a $250 deductible and the amount the customer's health plan pays for the drugs), and ending when the enrollee's own out-of-pocket expenses reach $3,600.

Social Security has been so overwhelmed helping seniors cope with the new Medicare drug program that other services are starting to suffer, a senior government official said in a candid internal e-mail released Friday. A large backlog of cases is getting worse, and the agency is cutting back on audits that save the government money. "It's not a rosy picture, and the news doesn't get better," Deputy Commissioner for Operations Linda S. McMahon wrote to operations employees.