Finally, there is some good news for Stanislaus County's financially troubled health services clinics.
On Monday, county officials received word that seven of the health clinics are eligible for higher reimbursements for serving Medi-Cal and Medicare patients.
The clinics, which are a safety net for some of the county's poorest residents, have been running big deficits every year, including $16.6 million projected for 2007-08, and were facing severe cuts if the county couldn't find additional funding.
The federal Centers for Medicare & Medicaid Services approved the clinics as Federally Qualified Health Center "look-alikes" effective Thursday, said Rick Robinson, county chief executive officer.
The designation is expected to give the county Health Services Agency as much as $6.4 million in additional funding each year. The clinics are the pediatric and urgent care centers at the Scenic Drive complex, the Paradise Medical Office and McHenry Medical Office in Modesto, plus the Turlock, Ceres and Hughson medical offices.
"The designation is critical," Robinson said. "It doesn't represent the total solution to our financial shortfall, but it puts us on the right path."
The county still is moving forward with about $6.2 million in service cuts to deal with the deficit projected for this year. An Oct. 16 hearing is set for county supervisors to consider a reduction in urgent care hours from 84 to 36 a week, eliminating clinical laboratory and radi- ology services, and tightening the income eligibility for the medically indigent adult program. If approved, the changes could take effect in December.
The county also has committed $4 million from the general fund to help cover the deficit.
Hoped for earlier start date
County officials had hoped the enhanced Medi-Cal and Medicare reimbursements would be retroactive to the start of the fiscal year in July. But the Health Services Agency still should get an extra $5 million this year, said Mary Ann Lee, the agency's director.
"I would have hated to have seen what we were facing if we didn't get this designation," she said. "This is a real win for the community."
The payments to the county for serving Medi-Cal patients have averaged about $50 an office visit. Now, those payments will be based on the county's costs of providing the medical services, and should be $130 to $140 per visit, Lee said. Part of that includes compensation to the Scenic Faculty Medical Group physicians who see patients in the clinics, Lee said. The clinics also will get higher rates for Medicare patient visits.
With the new designation, the county is tapping into a federal program that funds Community Health Centers, Migrant Health Centers and health care programs for the homeless. The county clinics were given FQHC "look-alike" status, which means they are not eligible for certain types of grants, but receive many of the same benefits as Federally Qualified Health Centers.
Discounts on medications
Beside higher reimbursements, the Health Services Agency can save money on purchasing prescription and non-prescription medications for its pharmacy, Lee said. The discounts can be 50 percent for some of the drugs the county buys.
As of Monday, the county clinics were required to establish a sliding fee scale for uninsured patients whose annual income is within 200 percent of the federal poverty level (up to $27,380 for a family of two; up to $41,300 for a family of four). Depending on income, the fees range from $42 to $140 per visit. Uninsured patients with household incomes above 200 percent of the poverty level are charged $140 a visit.
For the uninsured patients who come to the clinics, Lee said, efforts are made to get them into the state Medi-Cal program or other programs to cover their care. The fees can be deferred for a month while they apply for those programs, she said.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.