Shocking Health Care Secrets: How a Tiny County Program Transforms Lives for Just 50 San Diegans!

Every year, San Diego County allocates around $1 million to provide health care for a narrow group of individuals who do not qualify for other government health care programs. This funding is part of a legally mandated program accommodating the medically indigent population, a requirement set forth by California state law. However, following the implementation of the Affordable Care Act (ACA) and the expansion of Medi-Cal, California's Medicaid program, many such county programs, including San Diego's, have become largely obsolete.

In 2009, the County Medical Services program served approximately 19,000 individuals. Fast forward to the most recent fiscal year, and that number has plummeted to fewer than 40 active participants, with typically only about two people enrolled at any given time. With recent cuts and new work requirements for Medicaid imposed by Congress, the medically-indigent program is garnering renewed attention.

Labor unions advocating for a countywide sales-tax ballot measure are seeking to channel part of the tax revenue into enhancing funding for County Medical Services. In fact, two Democratic county supervisors are pushing for a comprehensive review of the program to identify potential reforms aimed at improving accessibility. A vote on this proposal is scheduled for the Board of Supervisors meeting this Tuesday.

The proposed ballot measure is expected to generate about $360 million annually, with roughly $4 million earmarked for County Medical Services, according to election documents filed by two county labor unions alongside a coalition of nonprofit leaders.

The campaign is led by SEIU Local 221, the largest labor union representing county workers, in collaboration with the county firefighters’ union and Children First San Diego, a political action committee associated with prominent regional social service providers such as the YMCA of San Diego County and Jewish Family Service of San Diego. Currently, the coalition is gathering signatures to place the tax increase on the ballot, requiring a simple majority vote for passage in November.

According to Crystal Irving, president of SEIU 221, increased funding for County Medical Services is essential to counteract recent federal policy changes. The county estimates that around 75,000 residents will lose their Medi-Cal coverage due to their immigration status, while an additional 327,000 of San Diego's approximately 854,000 Medi-Cal recipients will face new work requirements.

“Providing dedicated funding to the county’s healthcare program of last resort for the uninsured — funding Washington can’t take away and local politicians can’t divert — ensures working families and kids have somewhere to turn when they get sick,” said Irving.

However, transforming County Medical Services into a robust program capable of meeting these needs will require significant changes. Currently, the program is the most restrictive among California's largest counties. To enroll, residents must place a lien on their home, a prerequisite that does not exist in other large counties. Additionally, income limits for San Diego's program are considerably lower than those in places like San Francisco, Los Angeles, and Sacramento. Enrollment is also limited strictly to U.S. citizens, a criterion not imposed by other counties.

“With all of these restrictions, the question then becomes: Why even have it in the first place if nobody can access it and you put so many restrictions on it?” questioned Ana Alvarez, an organizer with Health Access California.

The supervisors’ proposal for a program review specifically requests that county staff draft recommendations for eliminating the lien requirement and reforming income limits, though it does not address potential changes to citizenship requirements. “San Diego must explore every tool to keep hospitals open and emergency care available,” stated Supervisor Terra Lawson-Remer. “That means taking a hard look at solutions like reforming the CMS, changing the criteria and building a safety net that works when Washington walks away.”

In a separate initiative, Supervisor Monica Montgomery Steppe has proposed establishing primary care clinics to assist those losing health insurance amid federal cuts and stricter eligibility. Known as the Safety Net Bridge Program, this initiative would serve as an immediate response while reforming County Medical Services remains a longer-term goal.

Understanding County Medical Services

County Medical Services functions differently than a formal health insurance program like Medi-Cal, covering participants’ healthcare on a short-term basis, primarily for one-time medical needs rather than preventive care. According to county Health and Human Services Agency spokesperson Tim McClain, the program encompasses a wide range of medical services, including primary care, dental, vision, emergency medical services, and prescription drugs.

While other counties have public safety-net hospitals that complement similar programs, San Diego operates through contracts with selected long-term care providers. Notably, administrative costs in San Diego’s program accounted for a staggering 79% of total spending in the last fiscal year, reflecting a stark contrast to national averages, where administrative expenses typically comprise around 40% of total healthcare spending.

Throughout the years, the county has averaged $1.1 million in annual spending on the program, with only about $413,000 going to actual patient care. This raises questions about fiscal management, prompting Supervisor Joel Anderson to call on a newly formed fiscal transparency and accountability subcommittee to examine the program's spending.

Comparatively, San Diego’s income limits for program participation are significantly lower than those in other counties, with a maximum of 165% of the federal poverty level – approximately $26,000 per year for a single individual and $53,000 for a family of four. In contrast, programs in counties like San Francisco allow individuals to earn up to 500% of the federal poverty level, and those in Sacramento have limits of 400%. Enrollment numbers also vary widely across counties, with places like Los Angeles County providing care to 500,000 individuals last year through its medically indigent program.

The push for reforms aims not only to enhance the accessibility of County Medical Services but also to establish it as a viable alternative for those unable to enroll in Medi-Cal. As the federal landscape of social safety-net programs evolves, San Diego County faces significant fiscal challenges, projecting a need for $200 million to $300 million annually by 2028 to maintain its current staffing and programs amid these changes.