Health Funds: Now the Hard Part

The drama of Los Angeles County’s health care scare deserves the attention of every county taxpayer now and for years to come. The good news for the millions of residents who lack private health insurance is that Washington has granted a five-year extension of the waiver of Medicaid reimbursement rules. This means the county can continue to get federal funding for medical care delivered at outpatient clinics. Normally, the county is reimbursed only for hospital-based care.

Now the difficult work begins for county health officials and, particularly, for the county supervisors, who must set a proper leadership tone. They were rescued from the brink of county bankruptcy in 1995 and have now been given another reprieve, but the ride ends by 2005. The waiver cannot be renewed again, and the county faces financial penalties if it fails again to meet goals set in 1995.

The county, in dealing with one of its challenges, will have to redouble its efforts to shift from acute or critical care at county hospitals to cheaper preventive care at the clinics. The county is lucky to have another five years to wean itself from the $1 billion in federal bailout money that’s kept its budget balanced since 1995. This time around, county health programs have even more help, with $900 million from Washington and $300 million from the state. The county itself has to pitch in $400 million more for health care than it now spends.

Perhaps the county’s most important goal is to achieve Federally Qualified Health Center status within the next five years. That’s a program originally designed 10 years ago to help individual community-based clinics get full reimbursements for the care they provide. Contra Costa and San Mateo are among the counties that have gained similar status, but no other jurisdiction’s program is of a size that approaches Los Angeles County’s.

Now’s the time for the supervisors to set their agenda. They have spent far too much time arguing about staffing and beds at various county hospitals, with County-USC the most glaring case in point. The clinics deserve much more attention.

The county will receive funds based not on days of hospital stays but rather on a per-case basis. That means it won’t lose money if a patient is well enough to leave ahead of schedule.

Since the congressional mandate for states to pay full-cost reimbursement through the Federally Qualified Health Center program runs out in 2005, the California congressional delegation has a key role to play in the funding. Even if the county meets its difficult goals, it will still require an extension of the program. So county officials can bask in the glow of the new agreement for a few days, but then it’s back to work.