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Lien Rule Scares Some Away From County Medical Services

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Aired 4/19/09

There are up to 600,00 uninsured people in San Diego County. But only a tiny fraction are seeking county medical services - an option of last resort for the working poor. Critics blame the low numbers on what they call the county's burdensome application process, including a requirement that makes some feel like they have to choose between having a roof over their heads and getting crucial medical treatment. KPBS Reporter Amita Sharma has more.

Four years ago, Kim Cormier began experiencing what she thought were panic attacks. Her mother and father had both just died and she felt overwhelmed.

"I knew something was desperately wrong when I'd come from the shower and I was blacking out almost because I couldn't get enough air and so I went to the hospital and they diagnosed me with congestive heart failure," said Cormier.

Until April of last year, she got treatment under the county's medical plan for the poor. But when she went to re-enroll, she was given a form that required a description of her property. Cormier says she didn't have her reading glasses but signed the paper anyway. When she later read the document,  she realized she had given San Diego County approval to place a lien on her home.

"I was horrified. I was completely and absolutely horrified. I called being tricked into signing it because she acted like I was horrified because if I had known what it was at the time I wouldn't have signed it," she said.

Cormier says she was frightened. So she cancelled her county medical services.

"I'm not going to sign a blank check to anybody. That's what I feel like.  I only net about $750 a month and because I own my house that probably the only way I can live if I had to make a mortgage or rent payment, I'd be out of luck," said Cormier.

The county implemented the lien policy in 2008. The county medical services manual says people in Cormier's situation would be exempt from a lien against their primary residence and a car. But she says the county still requires applicants to give their approval for a lien.

"I don't know how it can make sense to anybody," she said.

All five county supervisors declined comment. The county's lawyers, chief administrative officer and the head of the Health and Human Services Department also refused to talk to KPBS about the lien policy.

Public health experts say the lien requirement for medical services is a way of ensuring that uninsured patients at least pay their share of costs.

"It's been used pretty widely," said Dylan Roby.

Dylan Roby is an assistant professor for the UCLA Center on Health Policy Research. He says Idaho has a similar rule for indigent care as does Tulare County, even Medicaid.

"….if a Medicaid patient has a home and they receive long-term care services, when they are deceased, the state can sell their house and reclaim whatever their long-term care costs were and put it back into the state coffers so they're not losing too much money," he said.

That could be a benefit for the county. But Roby says there may also be drawbacks if the lien requirement makes people turn away from county medical services and delay treatment until they have no choice but to go to the ER shifting the costs to the hospital.

There may also be other reasons why poor people are discouraged from accessing county medical services at one of several clinics like this one in El Cajon.

A court has ordered the county to allow people with incomes of  up to $1,400 a month into the program. In the last half of 2008,  423 people applied. About half were approved. Katie Murphy of the Los Angeles-based Western Center on Poverty and Law says for a county the size of San Diego, the numbers should be much higher.  Applicants are required to produce birth certificates, rent, gas and grocery receipts and bank account statements -- all within 10 days.

"Basically, they have to put on a case about what they pay for basic expenses and they have to do that in a very short timeframe. Why is that so tough to do? Well, it's tough to do because in large part, these are often sick people. Sometimes, they're still in the hospital. And they're given just 10 days to put on a very big production of evidence," said Murphy.

Murphy says she's working with county officials to streamline the process. She has not asked the county to rescind the lien requirement because it IS legal. As to whether it's moral, she says that's up to society to decide.

Amita Sharma, KPBS News.

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