California County News

LAO Reviews Pilot Program in San Bernardino County; Alternative Treatment for ISTs

In response to long waitlists at state hospitals, the Department of Mental Health began a pilot program in San Bernardino County so that those deemed incompetent to stand trial (IST) could be treated in county jails as opposed to state hospitals for treatment. The wait list for such a transfer to state hospitals is often between 200 and 300 individuals a month, hence the creation of the pilot program. Many IST commitments are forced to remain in a county jail before transfer due to staffing and physical space at state hospitals.

In an update, the non-partisan Legislative Analyst’s Office has released a report on the pilot program and has concluded that it provides greater flexibility, reduces costs, and those deemed incompetent to stand trial (IST) have been restored to competency in a shorter amount of time than state hospitals. Overall, treatment at the county level reduced waitlists and was more cost-efficient.

The LAO estimates that counties spend a combined annual total of at least $3.5 million to hold IST commitments in their jails beyond the 35-day period while they wait for a state hospital bed to become available. During the pilot program, the report notes that “San Bernardino County estimates that it has been able to achieve net savings of more than $5,000 for each IST commitment.”

The report concludes:

“We find the pilot program provides less incentive for potential malingerers, has greater flexibility to hold down costs, and is able to restore ISTs to competency in a shorter amount of time than the state hospitals. Additionally, the number of referrals from courts into IST treatment has decreased, possibly because treatment in a county jail is less appealing to defendants who may use a claim of incompetency as a defense strategy to keep out of prison.”

The LAO also advocates that the pilot should be extended into other counties. You can read the full report here. In addition, the LAO released the following video about its report:

Oops: Patient Privacy Breach in Contra Costa as County Warns Patients

Back in 2010, a report to the Contra Costa County Board of Supervisors mistakenly included the names of thousands of patients who owed money to the county’s health department. The county only just realized the public document included the names, thereby violating patient privacy rights since it was posted online. In response, the names have now been redacted and notices were mailed out to the patients; notably, no medical information was published in the report. The list was generated by the former department of Office of Revenue Collection and consists of patients who were relieved of medical debt last year by county supervisors. The county reports the following:

“The disclosure came to light last week, and was immediately reported to the California Department of Public Health, and an internal investigation was launched. […] The County Administrator’s Office and Health Services have reviewed their processes to ensure this won’t happen in the future, and remains fully committed to upholding patient privacy.”

Notably, the County Office of Revenue Collection, which was formerly used by Contra Costa Health Services to collect delinquent hospital accounts, has been dissolved and no longer exists.

You can read the county’s letter to patients here.

Discount Prescription Card Program Helps Counties and Residents Save Money

Seventeen counties in the state of California have approved a discount prescription card program known as Coast2Coast Rx, and the California State Association of Counties (CSAC) has also endorsed the program. The endorsement stems from the fact that the program saves consumers money and contributes $1.25 for each prescription filled to participating county programs. For instance, in Amador and Alameda counties, such funds support meals-on-wheels and health programs. The card is available with no restrictions on age, income status, or existing health conditions. For instance, success with the program has been seen in San Diego County, as Supervisor Greg Cox commented, “Since San Diego County launched the program in June, more than 27,000 prescriptions have been filled and that has saved San Diegans more than $750,000. The Coast2Coast card will help create revenues to support vital county programs and services, while saving money for county residents.”

In San Diego County alone, nearly 7,400 residents have used the card since its launch in June for savings of almost $1 million. The Board of Supervisors approved the program unanimously and it is primarily of most help to those who are uninsured or elderly. The Tribune notes:

“Financial Marketing Concepts, the private firm, obtains discounts of 75 to 80 percent on many drugs and services by buying in bulk. It pays a royalty of $1.35 per filled prescription to the county and still makes a profit because of its negotiated discounts.”

You can find out more here.

RAND Study Says Counties Face Serious Strains in Local Services due to Realignment

We relayed recently that county projections were off when it came to predicting the number of state prisoners that would land in county jails under realignment. Counties are not only scrambling to find extra room for the flood of extra inmates, but the draw on resources could put a strain on county services, according to a new report from the RAND Corp. In a study entitled, “Understanding the Public Health Implications of Prisoner Reentry in California,” the organization argues that local health care and social services programs could suffer under realignment due to the extra demand in resources from local agencies that are already struggling with difficult budgets. The study cautions that counties are ill-equipped to meet the rehabilitative and health care needs of additional inmates at the local level because released prisoners have a high level of health care needs, such as mental health care and alcohol and drug treatment. In addition, if inmates are returned to communities with high poverty and low levels of education, local services are likely to be only further strained. Here are some highlights from the report:

• About two-thirds of California inmates reported having a drug abuse or dependence problem, but only 22 percent of those inmates reported receiving treatment since admission to prison. More than half of California inmates reported a recent mental health problem, with about half of those reporting receiving treatment in prison
• Reentry disproportionately impacts 11 counties statewide and that, within counties, parolees tend to cluster in certain communities and neighborhoods. Such clustering has implications for linking to and providing health care services to this population and for considering how to effectively target reentry resources
• California’s new Public Safety Realignment Plan represents an almost tectonic shift in the state’s criminal justice system that will have a number of implications for thinking about how to meet the health care and rehabilitative needs of the reentry population.
• Public safety realignment presents some challenges, such as the fact that traditional mechanisms for linking ex-prisoners to health care and social services—e.g., parole officers, PACT meetings— will change dramatically for individuals placed on county-level postrelease community supervision and for low-level offenders who will serve their time in county jail.

The study looked closely at Alameda, Los Angeles, San Diego and Kern counties and used focus groups with former prisoners and their families to get a better understanding of the issues at play. The study’s lead author commented that “Investing in treatment for this population may help offset criminal justice costs later. Moreover, expanding access to primary care may help avoid expensive care such as emergency room visits and preventable hospitalizations for this population."

Read the full report here.

Health Care Survey Gauges Concerns and Healthy Steps of 1,500 Local Governments

The ICMA, along with Cigna Healthcare, conducted a survey of close to 1,500 local governments to get feedback on Employee Health Insurance Programs. Many agencies have implemented major cost savings and reduced absenteeism after establishing on-site health clinics for employees, and obesity, stress management, and fitness are cited as the top three health concerns for employees of local governments. Employee health care costs are ranked as the second most pressing general operating concern for cities and counties, after budgets. The ICMA points out that “despite the financial challenges of providing health insurance benefits to employees, some local governments have taken steps to reduce the cost of premiums by offering incentives to employees who stop smoking, making weight loss programs available, and providing disease management programs.”

For instance, of those surveyed, 43% said their local government offered an obesity/weight management program. And 38% provide a nutrition program. Based on the results, for those who say premium payments are shared between employer and employee, 21% is the average paid by the employee. The following chart shows how current employees’ and retirees’ health insurance is paid for among the survey’s respondents:

As for the impact of federal healthcare reform legislation, 63% percent say they only partially understand the impact of the law and that they need to learn more.

You can read the full survey here.

St Supreme Court Rules Local Govt Bound by Implied Contracts for Healthcare if Clear Promise

In what has been called one of the most important cases in years for public agencies, the California Supreme Court heard arguments on October 3, 2011 in Retired Employees Association of Orange County v. County of Orange. At stake is whether or not local governments can take away retirement health benefits from former public employees who are currently retired. The court issued its ruling and basically sided with the employees, but with the following stipulation: clear evidence is necessary to show that the county promised lifetime health benefits. Ernest Galvan, an attorney for the retirees in the case, commented that “This opinion sets up a seawall around people who have already retired.” Orange County basically wanted to shift higher health insurance premiums to existing retirees as a way to rein in costs. CNBC reports the following background to the case’s beginnings:

“Orange County eliminated a subsidy it had been paying for retiree health benefits, amounting to a cash value of more than $3,000 per year for each of its retirees, according to court documents. The Retired Employees Association of Orange County sued in 2007, arguing that the county violated an implied contract with the retirees. The county disagreed, saying in court filings that an unfunded liability of $400 million is at stake. In its unanimous opinion released on Monday, the California high court said the right to benefits could be implied from a county ordinance or resolution.”

Notably, the high court was not consulted to decide whether or not the county in fact promised lifetime benefits; instead, the case will return to a federal appeals court with the high court’s ruling in mind to decide whether a clear promise was made. The central state-law question that remains in the case is whether retired employees have a contract right to receive the aforementioned benefit. The county is arguing it is not a vested right and that reducing unfunded liabilities is paramount. The Register points out that “The decision on the case could have significant implications for local governments across California, many of which are struggling to get a handle on ever-increasing unfunded liabilities.”

From the perspective of cities and counties, attorneys for local governments posited they were pleased the court established that clear intent must be evident for the creation of a lifetime benefit. The court’s opinion read as follows: “Under California law, a vested right to health benefits for retired county employees can be implied under certain circumstances from a county ordinance or resolution. Whether those circumstances exist in this case is beyond the scope of the question posed to us by the Ninth Circuit.”

Thus, the stipulation about clear intent is allowing Orange County to claim the court handed it the real victory because officials claim there was never a guarantee in regards to the benefit’s terms. Now it is up to a lower court to decide if there is evidence of clear promises. The case could have wide-reaching impacts, as the Bee notes the potential effects on a case in Sacramento County regarding retirees regaining lost health-care subsidies. See here.

You can read the full ruling here.

CA Report Covers Reactions to the Rollout of Heatlh Care Reforms in Conservative Counties

The California Report has filed a report on how the rollout of health care reforms are being perceived in conservative counties, as officials have voted to accept federal health dollars to provide coverage to those in need when many residents claim they are ideologically opposed to Obmacare. Poor, childless adults are among those who were sorely lacking coverage. Early expansion of Obamacare has been adopted by all California counties (other than Fresno), but it is been reported that residents of conservative counties are unaware of the link between such coverage and Obamacare. The CA Reports that Kern County Supervisor Ray Watson is not a fan of the federal health care law but acknowledged that the uninsured need some basic level of care.

Listen to the full report here:

Childhood Obesity Rates Vary Greatly by County; Imperial Has Rate of Nearly 50%

There has been a slight decline in childhood obesity rates in California, but when faced with the figures from 2010, an unavoidable conclusion remains: the state has a sizeable problem on its hands when it comes to the long-term health of residents, not to mention the high costs associated with obesity, and there is a long ways to go if the problem is to be fixed. The UCLA Center for Health Policy Research and the California Center for Public Health Advocacy have released a new report that shows last year 38 percent of children statewide were obese or overweight. This is only a 1.1% decline from five years ago, but a decline nevertheless. If the state and local governments don’t continue to tackle the issue head on, healthcare costs are likely to grow, as last year the state spent $21 billion in public and private money on costs related to obesity. In a state that struggles with its budget every year, the toll on the financial health of the state from obesity is worth considering. Notably, obesity rates for children varied greatly between counties. The LA Times reports:

“More than half of the counties saw their obesity rates climb between 2005 and 2010. Imperial County had the highest obesity rate at 47% and Marin County had the lowest at 25%. The biggest increase — 16% — occurred in Del Norte County. […] Los Angeles County also has made childhood obesity a priority and recently received a $10-million grant to work on the issue. Fielding said some of the money is going toward physical education training for teachers and on getting schools and preschools to provide more fresh fruits and vegetables. The county also is working on developing policies to make streets more pedestrian-friendly so children can get more exercise, he said.”

The Times has created an interactive map that can be viewed here to see the childhood obesity rates for each county, based on the report’s findings.

Here are the top 5 counties with the worst childhood obesity percentages in the state:
1. Imperial: 46.9%
2. Colusa: 45.7%
3. Del Norte: 45.2%
4. Monterey: 44.6%
5. Madera: 44.1%

Here are the counties with the best percentages:
Marin: 24.9%
El Dorado: 25.7%
Placer: 25.8%
Trinity: 26.7%
Nevada: 27.2%

CalPERS Report Says it has Saved the State $1.2 Billion In Health Care Costs

In a letter accompanying a report to Joint Legislative Budget Committee Chairman Mark Leno, CalPERS is claiming that it has saved the state $1.2 billion in health care costs since 2008. The information was included in a report that the pension fund is required to provide the Committee regarding CalPERS 2012 health rate premiums and one-time savings. Overall, more than $587 million has been saved for the State’s General and Special Funds. Notably, CalPERS is the largest buyer of public employee health benefits in California, and the second largest purchaser in the nation after the federal government. The pension fund credits changes in pharmacy co-pays as one of the reasons for the savings, as well as health care cost savings by negotiating premium rate increases. Savings for 2011 alone were just over $78 million.

In a letter to the Legislature, CalPERS Chief Executive Officer Anne Stausboll, wrote the following:

“Each year, the (CalPERS) Board of Administration carefully considers specific strategies that will reduce the premium costs by extracting costs from the system on a long-term basis, and strategies that will result in one-time savings. We will continue to pursue robust rate negotiations and partner with our health plans to minimize future rate increases and ensure CalPERS members have access to affordable, quality health care.”

You can read the pension fund’s full letter to Leno and the report that accompanies it here.

City Pressures Riverside County to Open Ambulance Contract to Competitive Bidding

Riverside County has a long-held contract with the emergency medical services company American Medical Response. While the group’s contract is up for renewal, many residents and officials are urging supervisors to open up a competitive bid process as opposed to merely renewing the contract. Murrieta city officials in particular turned up to a recent meeting to pressure the county into a competitive bid process for the local ambulance services. City officials argued that the competition would spark better care as well as potential cost savings. Murrieta Councilman Alan Long commented, “You have absolutely nothing to lose by putting it out to bid, but the residents have everything to gain. I plead with you: Don’t renew the status quo.” According to other local government officials, Riverside County’s system is 20 years behind other counties. Supervisor Bob Buster acknowledged there was room for improvement and that better coordination was needed. Buster stated:

“Right now we have a system that does not distinguish the real trauma calls from those that are less severe. We are glad to see our partners here, because it is going to take coordination. This system here has to work at its best when we have a major disaster such as an earthquake. We are going to begin talking about this today, talking about where we are."

There was no vote taken at the workshop and supervisors did express some reservations; however, Supervisor Jeff Stone stated “"I don’t have any heartburn from putting this out to bid...to see what we can get.” AMR pointed to its long commitment to the county and noted it has strived to improve over the years. Murrieta officials contend those improvements aren’t apparent in their neck of the woods. Discussion is expected to continue about the competitive bid process.