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Fresno Widens Medical Safety Net for Poor

New America Media, News Report, Annette Fuentes Posted: Mar 16, 2010

More Fresno County residents who are low-income and uninsured will now have a health care safety net when they become ill.

On February 23, the Fresno Board of Supervisors approved a proposal to expand eligibility for the Medically Indigent Services Program (MISP), which provides basic medical care to mostly uninsured single adults who do not qualify for Medi-Cal.

The income eligibility level will almost doublefrom 56 percent of the federal poverty level to 114 percent. The program now serves some 10,000 people, and with the new eligibility rules, an estimated 30,000 more people will be eligible.

The Boards action was prompted by a lawsuit filed on behalf of a Fresno man who was denied enrollment in MISP because his monthly income was $24 more than the eligibility limit. The plaintiff was an epileptic who lost his job as a medical aide at the County Medical Center and with it, his health insurance, and he could not afford his medication.

Abbi Coursolle, a staff attorney at the Western Center on Law & Poverty, which filed the lawsuit, said the Fresno boards action is a step in the right direction, but some elements dont go far enough. Coursolle said that the countys cost-of-living study used data for housing, utilities, food and transportation expenses that were too low. They assume that people can use public transportation 70 percent of time, but its not available in all parts of Fresno County, she said. They assume that the other 30 percent of the time they have access to a car, and thats not realistic.

The MISP is a county-funded program begun in 1983 that is provided throughout California, but each county sets its income-eligibility limits. Counties set the eligibility level by assessing the average cost-of-living for residents, using the federal poverty level (FPL) as the benchmark. Most of Californias counties set eligibility at 200 percent of the FPL, which was $10,830 for one person in 2009. But Fresno has had the lowest eligibility level of any county in the state because the county has not revised its cost-of-living guidelines.

The biggest issue in Fresno is that the income eligibility guidelines have not been adjusted in 14 years, said Norma Forbes, executive director of Fresno Healthy Community Access Program (HCAP), a social services network. There are a large number of people who would be eligible for indigent care. We are seeing a number of people who have lost their jobs, and families that lost insurance. Theres a big growth in those with incomes at 100-150 percent of the federal poverty level.

Forbes said the medically indigent in Fresno include singles without families, many with major medical problems. Her organization was funded by The California Endowment to analyze Fresnos MISP and potential problems with it. But the underlying problem is poverty, said Forbes: particularly in San Joaquin Valley, poverty is the root of all evil.

Just how Fresno County will pay for the potential influx of thousands more residents into the MISP is not clear. The program is funded by two revenue streams--vehicle registration fees and sales tax, both of which have fallen during the recession.

Dr. Edward Moreno, Fresnos health director, stated in an email that the Board of Supervisors did not plan to increase its payment to the County Medical Center, which serves MISP enrollees. The County is paying the medical center nearly $20 million this fiscal year for the MISP health care and inmate medical services. By contract, if the MISP enrollment increases by 10 percent or more, the medical center can request an adjustment.

Forbes said there is another possible funding stream for the medically indigent that her group believes the county could tap. It is the federal state Medicaid waiver program that is intended to expand health care to more low-income people. We think Fresno should apply for these monies, Forbes said.

Related Articles:

Indigent Health Care Program Battered by Recession

Community Protests Evisceration of General Assistance

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