Proposed $1.1 billion Medi-Cal cut would hit poor, elderly hardest

Elizabeth Fernandez, Chronicle Staff Writer
http://www.sfgate.com

For 10 years, Sylvia Martir has lived with HIV. A few years ago she learned she had cancer. Then diabetes. Now she’s wondering how she’ll pay for critical medical care if the governor’s proposed budget cuts are implemented.

Every week Martir, an Oakland resident who lives on $736 a month in government assistance, sees a therapist. She takes anti-depression medications and occasionally sees a dentist. These services are paid by the state, but under the governor’s budget plan, they would be eliminated to Medi-Cal recipients like Martir.

“If I have to pay medical bills, I won’t be able to buy food or pay my rent,” said Martir, 50.

Aiming to slash $1.1 billion from Medi-Cal, Gov. Arnold Schwarzenegger presented a budget plan Thursday that would reduce reimbursement to providers – such as doctors and community clinics – by 10 percent, and cut podiatry, hearing and vision services to adults, among other proposed cuts. Additionally, as part of a proposed $11 million cut in state funding of AIDS programs, certain medications would no longer be covered.

Outraged, many health care experts said that essential services are on the cutting block, critically affecting millions of people, especially poor, older adults and the disabled. The state has 6.6 million people receiving Medi-Cal, nearly 774,000 in the Bay Area.

“These cuts affect people’s access to care and quality of care,” said Anne Donnelly of Project Inform, a nonprofit that advocates for people with HIV.

In San Francisco, 10 community clinics – where Medi-Cal is the backbone of financial support – provide care to 70,000 patients a year.

“These cuts would be devastating to our clinics,” said Dick Hodgson, vice president of policy and planning with the San Francisco Community Clinic Consortium. “Many of our patients are (far) below the poverty level.”

Overall, the budget cuts could cost San Francisco $5 million during the next fiscal year, according to a preliminary estimate by Greg Sass, chief financial officer of the Department of Public Health.

If the city decides to cover the tab for HIV/AIDS medications, for example, the cost would be “potentially significant,” he said. “The average cost of anti-psychotic medications is $3,000 a year per person. The proposed cuts would really affect our clinics and San Francisco General Hospital.”

One of those clinics – North East Medical Services – treats 35,000 people a year, said Dr. Kenneth Tai, who specializes in internal medicine and pediatrics at the Stockton Street facility. “Patients will probably have to pay out of pocket for some services, they won’t be able to afford it, and as a result they won’t be able to get the medical care they need,” he said.

One of the biggest items in the proposed Medi-Cal reduction is the suggested elimination of dental care for adults – that would include cleaning, exams, root canals, restorative care, crowns and fillings. The state would save $115 million, but, according to Samuel H. Gruenbaum, chief executive of Western Dental Services, California’s largest Denti-Cal provider, the cutback “will result in fewer children as well as adults getting dental care, costs will be incurred in emergency rooms where people will go.”

Many adult day home programs that serve some of California’s most frail and poorest senior citizens would also be affected.

“The majority of our clients are in their 70s, 80s, 90s,” said Cynthia Davis, executive director of North and South of Market Adult Day Health – her four centers in San Francisco serve 360 people a week. “People with chronic physical and mental disabilities can’t put their medical needs on hold.”

A client of Mission Creek Day Health, Tressie Lavender turns 66 next week. For a birthday present, she’s hoping to have her teeth fixed. One of her bottom teeth recently fell out – she repaired it with Krazy Glue.

“What is wrong with the governor?” said the Western Addition resident. “How can he cut people away from dentists?”
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