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Golden State, Once a Health Care Innovator, Now Slashes Medi-Cal


• Facing a $20 billion deficit, numerous state-sponsored health care programs could be trimmed or eliminated.

• Dental and vision care, mental health services and speech therapy have already been dropped for 2 million adults in Medi-Cal.

• Gov. Schwarzenegger says he needs federal help to avert deeper cuts in programs.

Virginia Villavert is worried budget cuts will shutter the El Dorado County senior day care center where her 83-year-old mother, who has dementia, spends weekdays. Without it, “I would have to hire somebody to be with her,” said Villavert, a 58-year-old acute care nurse from Shingle Springs.

Wanda Demarest, the county’s senior day services program supervisor, has already ordered layoffs and fee increases for the center, but those may not be enough. She’s not sure the center will be open past June.

“I have about 60 people that are at risk of being institutionalized, or their families are going to have to quit their jobs” to care for them, said Demarest.

Their plight is one example of how the health care system is unraveling in California, a state known for health care innovations. Subscribers to the saying “As California goes, so goes the nation,” might want to pay attention.

It’s the birthplace of the nation’s first health maintenance organization, in 1929, the Ross-Loos Medical Group; home of Kaiser Permanente, the nation’s largest nonprofit health plan, founded in 1945; and laboratory for Healthy San Francisco, offering universal health access since 2007 to that city’s uninsured.

But statewide health care expansions have been crippled by the recession, which has swelled the ranks of the poor, underinsured and uninsured.

Facing a $20 billion deficit, Gov. Arnold Schwarzenegger, R, has asked Washington for relief to avoid additional painful cuts. He insists he needs flexibility to reduce payments to health providers, and to limit benefits and raise copayments in Medi-Cal, the state’s Medicaid program.

Compounding the budget problems, the federal stimulus funds that preserved some programs run out Dec. 31 unless extended by Congress. “The stimulus money has been the difference between shredding of services and not,” said Frank J. Mecca, executive director of the County Welfare Directors Association in Sacramento.

To close last year’s $62 billion gap, dental and vision care, mental health services and speech therapy were dropped for 2 million adults in Medi-Cal. The governor cut funds for community clinics, HIV/AIDS programs, home care for the elderly and disabled, Alzheimer’s day care centers, and lab services for poor and mentally ill patients.

Staff and service reductions at hospitals, clinics and nursing homes added pressure on strained emergency rooms. Five community clinics closed.

“We are the ghost of Christmas future for the rest of the country,” said Anthony Wright, executive director of Health Access in Sacramento, which advocates affordable health care for all Californians. In 10 years, if significant national reform hasn’t occurred, he said, “the rest of the country will look like where California is now—a much greater uninsured population, a crumbling safety net of public programs and providers, and people more concerned that their coverage is not going to be there for them when they need it.”

Advocates for children, the disabled and older people—including Disability Rights California and AARP Foundation Litigation—won reprieves from legislators and the courts in 2009 to temporarily avert some of the most draconian cuts.

Schwarzenegger insists he needs the flexibility to cut Medi-Cal payments to health providers, limit benefits and raise copays. In a letter to the state’s congressional delegation, he warned that national health care reform could cost California an additional $3 billion to $4 billion annually and urged Congress to modify Medicaid rules so California can “live within limited resources.”

A federal judge last year prevented the state from capping the number of days each week when disabled and low-income adults could get care through the California Adult Day Health Care program. Last month she blocked proposed eligibility criteria that would have cut thousands of people from the program. But it still could be targeted later this year for elimination, said Lydia Missaelides, executive director for the California Association for Adult Day Services. “It’s going to hit a significant number of frail elderly. They will be left on their own.”

Jane E. Allen is a Los Angeles-based freelance reporter.

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