One way federal officials are working to implement the new health care law in advance of its 2014 mandates is to offer states and counties money to begin enrolling clients early.

San Diego County took advantage of the effort, securing $50 million in federal funding by agreeing to match it with local money already set aside for indigent health care.

Since then, the county enrolled thousands of clients in the federal Low Income Health Program, which offers a broad range of services to needy people who are not eligible for Medi-Cal.

But in doing so, officials eliminated benefits for people who earn more than 133 percent of the federal poverty level. People earning up to 200 percent of the poverty level had been eligible under a previous program.

At least three-quarters of the 15,305 patients enrolled so far transferred in from other county programs, so the majority of people receiving the new federal benefits are not new patients.

County officials expected to enroll 22,000 by the end of the year.

Critics contend the county has not moved fast enough. The county disagrees.

County spokesman Mike Workman said in an email that the county has done a good job finding and enrolling new patients, assigning extra caseworkers to hospitals, clinics and at welfare offices across the county.

“San Diego County has created multiple pathways for access to this program in a way that ensures program integrity and safeguards the privacy of patients,” he wrote.

County officials would not discuss their implementation of the Low Income Health Program. Workman agreed to respond in writing to questions submitted in advance.

Hannah Gravette of the San Diego Organizing Project, a local charity that tries to match public benefits with poor families, said the county needs to do more outreach.

Gravette said her organization has identified thousands of people who could be eligible for the federal program, but the county will not come to events, churches or other venues to sign them up.

“We need to start working to get our county prepared for 2014 and have some really streamlined systems in place so people can get in quick,” she said.

Unlike other counties, San Diego County does not allow emergency rooms, clinics or community groups to sign patients up for the Low Income Health Program.

In Orange County, hospitals, clinics, private-practice medical homes and some nonprofits are permitted to enroll clients.

Orange County also plans to use mental-health, tobacco-settlement and general fund revenue to pay its share of matching funds.

San Diego County raised matching funds from County Medical Services, the health program of last resort for indigent residents. Then it switched at least 3,000 patients from that program into the federal plan.

Workman called the move a “win-win” because clients who were moved from County Medical Services to the Low Income Health Plan will receive broader services that they did under the county program.

When it joined the federal project, San Diego County county opted to end its participation in the Health Care Coverage Initiative plan, which serves people earning up to 200 percent of the federal poverty level.

Workman said there were 9,405 clients in the Coverage Initiative when it closed June 30. They were all moved into the federal Low Income Health Program, he said.

The 700 or so Coverage Initiative clients who earned between 133 and 200 percent of the federal poverty level were “grandfathered” into the new federal program, Workman said. But new people at that income level won’t be eligible.

“We still spend county dollars on indigent care,” he wrote. “We are trying to leverage our existing resources with federal dollars to provide expanded services to indigent clients.”

Federal officials gave counties wide latitude to figure out how to meet the needs of their communities.

Vikki Wachino, a director with the federal Medicare program, said it is up to counties to decide where to secure their matching funds and where to draw the line on eligibility.

“The county has the choice where it sets the income standards,” she said. “Where they had a limited benefits package previously, they are now providing much broader benefits.”

The decisions made by San Diego County health officials directly affected Deborah Jarmon-Johnson, a University Heights woman who lost her job in June.

Jarmon-Johnson heard about the new federal program through her church. She applied the next day but was denied. The $1,300 unemployment check she gets each month puts her over the 133 percent limit, which is $1,207 a month.

“I’m not poor enough; that’s what it boiled down to,” Jarmon-Johnson said. “I told her I can’t pay my bills. She said ‘If you lose your unemployment, come back and apply.’”

Gary Rotto is director of health policy at the Council of Community Clinics, a network of nonprofit health centers that serves needy families across San Diego County.

He said county health officials have worked diligently to keep providers informed about the program, even if they resist allowing them to enroll patients themselves.

“There’s no perfect outreach program,” Rotto said. “We continue to work with the county to try to improve it. We could always do better.”