Report: Ax help for illegals

San Mateo County should consider axing health programs for illegal immigrants, indigent patients without a medical need and health care for anyone who makes more than the federal and state poverty levels, according to a civil grand jury report which found a disconnect between mandated services and the money available for them.

The state requires counties to provide care to the poor and uninsured but the guidelines are broad, particularly when it comes to the undocumented population. San Mateo County provides more than the minimum, leaving local funds to make up the difference and creating a larger eligibility pool. Approximately 76,000 patients were treated at least once during 2008 at either the San Mateo Medical Center and its clinics and approximately 5,000 people are waiting up to nine months to be seen.

San Mateo County is one of only nine counties that offers the same services, regardless of residency status. The county is also one of two that provides long-term care for its elder indigent population and does not require indigent patients have a medical need for drop in treatment.

The civil grand jury suggested that before the next fiscal year, the Board of Supervisors look at eliminating programs for which the county isn't fully reimbursed. This would include care for the undocumented, drop-in treatment for the indigent and anyone whose Medi-Cal services were dropped in 2009.

The jury also recommended dropping the medically indigent income level from $44,100 which is 200 percent of the $22,050 level used by the state and federal government. All other Bay Area counties aside from San Francisco set the bar at 200 percent.

In San Mateo County, 6.9 percent of residents live below the poverty line and 7.6 percent are uninsured, according to 2009 statistics provided by the grand jury.

The grand jury report did not indicate how much money could be saved by implementing the recommendations.

The Health System referred all inquiries about the recommendations back to county executives because they are policy decisions, said spokeswoman Robyn Thaw.

The Board of Supervisors "obviously has a long-standing support for indigent care" and "believe preventative care is important," said county spokesman Marshall Wilson.

For example, the county's Blue Ribbon Task Force on Adult Health Care Coverage Expansion worked since 2006 to offer heath care coverage to more uninsured adults but stopped after passage of the federal health care legislation in April.

Wilson conceded not having a detailed response from county leaders because the report will require a formal response within 90 days.

The San Mateo Medical Center, which perpetually runs a significant deficit, has done well to identity cost-cutting methods but funding programs beyond the minimum is too great a strain on the bottom line, the grand jury concluded.

San Mateo County currently has an $87 million structural deficit in its general fund and could see it hit $150 million by 2015 without intervention.

Funding the hospital is one of the large factors in play for the deficit which the county is trying to fix.

In 2008, the Board of Supervisors decided its contribution to the hospital would drop to $50 million from the previous year's $72 million subsidy. By the following February, though, the policy was changed to only a 10 percent drop with the caveat the medical center absorb 35 percent of salary and benefit increases.

In 2008, the county also redesigned its Health System which saved $7.75 million.