Saturday, February 06, 2010

San Diego County cheated poor out of medical benefits

R.J. Wingo
Sam Hodgson

R.J. Wingo's $86,000 Bill

February 5, 2010
Voice of San Diego

After a burst appendix left R.J. Wingo with an $86,000 hospital bill, he applied for a county program that pays health care costs for people who can't afford them. He was repeatedly denied, but eventually sued the county and won.

...The emergency appendectomy cost $86,000 -- an unfathomable sum for Wingo. He'd never made more than $30,000 a year, he said.

...He said in court records he barely met his personal expenses each month on his income of $1,286 from Social Security and his pension and had nothing left over to pay for medical coverage.

Wingo applied for County Medical Services, the county's healthcare program for adults who don't qualify for other aid and can't afford their own care.

The county denied him because he made too much to qualify. The bill went unpaid. Collectors dogged Wingo. His credit score dropped. That still bothers a man who said he always paid his bills on time.

Lawyers putting together a class action lawsuit challenging the county's income limits in the program reached out to Wingo to include him in the suit.

They won.

Unlike most California counties, San Diego didn't allow patients to put some of their own money toward coverage to eligible. The courts changed that, too.

The courts ruled the county would have to increase funding for the programs and forced it to raise income limits, saying the county hadn't fulfilled a responsibility handed down by the state to be the residents' last resort for vital care. The county had drawn a bright line -- anyone making more than $802 a month didn't qualify.

The county raised the limits to $1,078 per month for a single person. It concluded that a single person in San Diego could cover rent and utilities for about $497 a month, and spend $60 a month on transportation.

That still didn't help Wingo.

An appeals court ruled the county's income limit was still too restrictive and the county was forced to raise it again. Last year, it was nearly $1,500. For residents earning more than that who can't pay for their own medical care, the county adopted a cost-sharing option.

But the big win hasn't resulted in a flood of new participants.

Even though the number of eligible residents expanded, the county made it harder for them to get into the program...

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