More L.A. County patients could get free care

Hospitals run by Los Angeles County could provide free care to more of their cash-strapped patients under a new proposal aimed at expanding medical bill relief.

County health officials said the proposed changes, which also include deeper discounts for other eligible patients, could ultimately benefit thousands of people in the county but are unlikely to have a significant impact on hospital finances.

The move comes amid ongoing concerns across California that residents are postponing or forgoing medical care due to the cost, despite government efforts to expand access to charitable care and ensure patients are aware of financial assistance.

Under the proposed rules, free care would be available to eligible LA County residents with incomes less than 200% of the federal poverty line, or $60,000 for a family of four under current guidelines. The existing limit is 138% of the poverty line, which equates to $41,400 for a family of four.

The revised rules would too Reducing fees for patients who are eligible for reduced county care – residents who make up 400% of the federal poverty line or less – although the county has not yet determined exactly what those reduced amounts would look like.

And the proposed rules would expand the program to cover patients who are “underinsured” or have health insurance, including through state-funded programs that require patients to pay some costs suffering financial hardship.

These changes could benefit Medi-Cal beneficiaries who don’t have “the free or free version of Medi-Cal,” as well as Medicare beneficiaries who don’t also have Medi-Cal, said Shari Doi, director of patient access for LA County Department of Health Services, which presented the proposed changes at a county meeting on Wednesday.

The changes must be reviewed by legal aid groups under a consent decree issued decades ago when the “solvency plan” was drawn up — the result of a class-action lawsuit filed by people who had sought medical care from the county.

“The district is moving in the right direction with these program improvements,” said David Kane, senior counsel for the Western Center on Law and Poverty, which was one of the groups involved in the lawsuit.

In LA County, people earning less than 200% of the state poverty line “certainly cannot afford high medical expenses — or even what other people consider modest medical expenses.” Providing them with free care “is definitely the right thing to do because those are the people who need it the most.”

Still, Kane argued that LA County could go further to guarantee free care. He pointed out that the Alameda health care system in the San Francisco Bay Area, for example, offers “full charity coverage” to families earning 350% or less of the federal poverty line.

The county Department of Health Services previously warned that not paying Medicare co-payments could put hospitals at risk of being booted out of federal programs.

Last year, in response to questions from The Times, she cited a federal warning that said that while medical providers could waive a Medicare co-payment based on an individual patient’s financial difficulties, such an exception “must not be used routinely” and ” Except in such exceptional cases, a good faith attempt must be made to collect deductibles and co-payments.”

However, the federal agency that oversees Medicare has also stated that if a hospital can document that a Medicare patient is destitute or is facing medical expenses that could push them into poverty, the hospital “then assumes no collection expense for.” can do without the patient”.

Other safety-net hospitals have reported offering free or discounted care to Medicare beneficiaries: For example, last fiscal year, Zuckerberg San Francisco General Hospital reported more than $3 million in charitable care for Medicare beneficiaries, according to a report submitted to the state.

That same year, LA County-USC Medical Center in Los Angeles reported none.

Health Department officials said that although they had not made any upfront charity provision in such cases, they estimated that they only collected 10% of the medical debt sent to Medicare or Medi-Cal patients and that the rest was ultimately written off unsuccessful attempts to collect the invoice.

In a memo outlining the proposed changes, Health Services Director Dr. Christina Ghaly said the move would allow “certain historically excluded populations to receive relief” from the costs as long as the changes comply with the law. Treating the unpaid fees as charity rather than “bad debt” – money that is likely to ever be collected – is unlikely to significantly impact revenue, Ghaly wrote.

The proposed changes come shortly after the California Department of Health and Human Services began charging LA County-operated hospitals for not prominently displaying their charitable nursing policies on their website, a key requirement of a California law that went into effect last year.

There was a link to the financial aid policy on the website, but state inspectors wrote that it was only found after “scrolling all the way down the webpage” for billing after looking at a list of hospitals in the county system and theirs billing contacts had been followed.

The state also found that hospitals operated by the county health department had failed to ensure patients were referred in writing to an organization that offers free help in obtaining and maintaining health insurance, as required by law.

In response, the County Department of Health Services told state investigators it had updated the back of hospital bills and made an additional release in hospitals to accommodate the Health Consumer Alliance website. The department also said it moved the link to its financial assistance policy up on its website.

The Department of Health said in a statement its hospitals were not fined for these “relatively minor issues” which were “addressed immediately”. The county said it had long previously worked to revise its financial aid rules “to both expand eligibility and make the program more generous.”