San Mateo County Grand Jury
• 2009-2010
“Provision of Indigent Health Care in San Mateo
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 12 findings
F1
San Mateo County has had a structural deficit (expenses exceed revenues) since FY 2006-2007. This deficit is projected to be $87 million for the 2009-2010 fiscal year and is expected to increase to $150 million in 2014-2015.
Related Recommendations (2)
R1
The Grand Jury recommends that the Board of Supervisors:
Address the disparity among (a) the level of health services mandated, (b) its unrealized desire to decrease the Medical Center subsidy from the General Fund necessary to provide the current level of services, and (c) the resultant ballooning of the structural deficit.
R2
The Grand Jury recommends that the Board of Supervisors:
Prior to the 2011-2012 budgetary cycle, consider taking the following actions: a. Fund the current level of mandated health services by making reductions in other County operations, b. Eliminate health services programs and/or serviced populations that are not mandated by, or fully funded by, federal or state monies, including but not limited to: i. full service for undocumented persons, ii. treatment for indigent persons without a medical need iii. services dropped from Medi-Cal coverage in 2009. c. Lower the medically indigent income level from $44,100, which is 200% of the federal and state mandated level of $22,050.
F2
The Medical Center offers patients an integrated continuum of care which provides for comprehensive medical services. Health System Redesign Initiative Improvement Update, November-March, 2009. See Health System Redesign Initiative Implementation Update, November – March, 2009 for details of the accomplishments and milestones of the Initiative. 7
No recommendations for this finding
F3
The Board of Supervisors has recognized the increased demands for health services due to the loss of jobs, lost health insurance and the increase of residents living below the designated poverty level as a result of the recent recession.
No recommendations for this finding
F4
The clinics have a nine-month waiting list of 5,000 patients indicating the current demand for medical services is not being met.
No recommendations for this finding
F5
San Mateo County is one of only two counties among California’s 58 counties that provides long-term care to its elder indigent population.14
No recommendations for this finding
F6
San Mateo County is one of only nine counties in California that provides full health services to undocumented persons. California law requires counties to be the health care provider of last resort only for its documented residents. Thirty-five counties only provide emergency medical services to undocumented adults. 15
Related Recommendations (1)
R2
The Grand Jury recommends that the Board of Supervisors:
Prior to the 2011-2012 budgetary cycle, consider taking the following actions: a. Fund the current level of mandated health services by making reductions in other County operations, b. Eliminate health services programs and/or serviced populations that are not mandated by, or fully funded by, federal or state monies, including but not limited to: i. full service for undocumented persons, ii. treatment for indigent persons without a medical need iii. services dropped from Medi-Cal coverage in 2009. c. Lower the medically indigent income level from $44,100, which is 200% of the federal and state mandated level of $22,050.
F7
Some California counties, such as Alameda, Fresno and Yolo, eliminated Medi-Cal optional services (including dental, speech therapy, psychology, podiatry, optician, optometry, audiology, acupuncture and chiropractic) from their programs when the State stopped covering them in 2009.15
Related Recommendations (1)
R2
The Grand Jury recommends that the Board of Supervisors:
Prior to the 2011-2012 budgetary cycle, consider taking the following actions: a. Fund the current level of mandated health services by making reductions in other County operations, b. Eliminate health services programs and/or serviced populations that are not mandated by, or fully funded by, federal or state monies, including but not limited to: i. full service for undocumented persons, ii. treatment for indigent persons without a medical need iii. services dropped from Medi-Cal coverage in 2009. c. Lower the medically indigent income level from $44,100, which is 200% of the federal and state mandated level of $22,050.
F8
Of the 35 California counties with a Medically Indigent Service Program (MISP), 16 require a medical need for ‘drop-in’ treatment. San Mateo County is not among these 16 counties.15
Related Recommendations (1)
R2
The Grand Jury recommends that the Board of Supervisors:
Prior to the 2011-2012 budgetary cycle, consider taking the following actions: a. Fund the current level of mandated health services by making reductions in other County operations, b. Eliminate health services programs and/or serviced populations that are not mandated by, or fully funded by, federal or state monies, including but not limited to: i. full service for undocumented persons, ii. treatment for indigent persons without a medical need iii. services dropped from Medi-Cal coverage in 2009. c. Lower the medically indigent income level from $44,100, which is 200% of the federal and state mandated level of $22,050.
F9
The Board of Supervisors established the medically indigent income level in the County at 200% of the federal poverty level ($44,100 for a family of four versus the federally mandated amount of $22,050); therefore, services provided by the Medical Center exceed mandated state/federal requirements. All other Bay Area counties, except San Francisco, also set the medically indigent level at 200% of the federal level. San Francisco County sets theirs at 500%.
Related Recommendations (1)
R1
The Grand Jury recommends that the Board of Supervisors:
Address the disparity among (a) the level of health services mandated, (b) its unrealized desire to decrease the Medical Center subsidy from the General Fund necessary to provide the current level of services, and (c) the resultant ballooning of the structural deficit.
F10
San Mateo Medical Center services provided to residents of San Mateo County were at a lower cost per adjusted patient day (APD) than nine comparable hospital facilities in California in 2006.
No recommendations for this finding
F11
Redesign efforts undertaken by the Medical Center have resulted in organizational efficiencies and in savings to the general fund over the last two years.
Related Recommendations (1)
R4
The Grand Jury recommends that the Board of Supervisors:
Ensure that the Medical Center continue its efforts to reduce costs and increase efficiency through the current redesign initiative. 9
F12
The current federal health care legislation will have a significant impact on addressing the issue of health care for the medically uninsured and indigent. It is difficult to determine the actual impact at this time as its implementation in San Mateo County will not begin until 2014. Conclusions The 2009-2010 San Mateo County Civil Grand Jury concludes that:
No recommendations for this finding
Additional Recommendations 1
These recommendations are not explicitly linked to specific findings.
-
R3The Grand Jury recommends that the Board of Supervisors: Work with state and federal legislators to ensure that San Mateo County receives the greatest potential funding possible from both the state and federal levels and that efforts are made to streamline regulations that increase costs or create obstacles to delivering exceptional health care to the residents of San Mateo County.
Conclusions 7
-
CL1 Page 9The Medical Center, clinics, and Burlingame Long Term Care have made and continue to make significant quantitative and qualitative improvements to the service delivery system and to undertake organizational efficiencies that reduce costs.
-
CL2 Page 9The care provided by San Mateo County Health Services is delivered in an effective manner and there appear to be few opportunities to significantly further improve efficient operations.
-
CL3 Page 8There is a disconnect between the level of health services mandated by the Board of Supervisors and the funding available from the County and all other agencies.
-
CL4 Page 8San Mateo County offers health services above and beyond levels available in most California counties. 14 HMA Report to San Mateo County Board of Supervisors, 2008 15 California County Indigent Care Program Profiles, 2009 8
-
CL5 Page 9San Mateo County offers health services to resident populations, including undocumented persons, not covered in all California counties.
-
CL6 Page 9There are continuing and increasing demands on the Medical Center for the provision of health services from the unemployed, uninsured and residents below the poverty level.
-
CL7 Page 9In order to manage health care costs, other counties in California have made policy choices to limit the extent of services provided to indigent residents and undocumented persons. Other counties have also eliminated coverage of services formerly funded by Medi-Cal, including dental, speech therapy, psychology, podiatry, optician, optometry, audiology, acupuncture and chiropractic.
No Responses Found 2
Government entities assigned to respond to this report. No response documents have been linked in our database.
County of San Mateo
Agency
San Mateo County Board of Supervisors
Elected County Office