A Community Medical Centers proposal for a low-income health program in Fresno County would improve health care for the poor but would be too costly, a county analysis says.

Community’s proposal, submitted as an alternative to a county plan rejected nearly two months ago by the Board of Supervisors, would place Fresno County at “substantial financial risk and would threaten county services,” according to the analysis.

And with the assessment appearing to sink plans for a Low Income Health Program, the county could be facing a court fight.

Chris Schneider, executive director at Central California Legal Services, said Wednesday [November 16, 2011] he plans to sue Fresno County this week over the board’s Sept. 20 decision ordering the county to withdraw its application to the state for the program.

“We will be suing them for their improper vote … because of the conflict with Supervisor [Judy] Case and her failure to disclose that and her participation in the vote,” he said.

Central Valley Legal Services sent a letter to supervisors Sept. 23 alleging Case’s employment as a weekend administrative director at Saint Agnes Medical Center was a conflict of interest and recommending the county refile its application.

Case has denied any conflict of interest.

County officials agreed to consider Community’s proposal after the board nixed launching the county’s plan for the federally sponsored health program.

The Low Income Health Program will offer dollar-for-dollar matching federal funds for all local spending on indigent services for two years beginning in 2012. It’s a first step toward implementing federal health-care legislation that passed last year but is being appealed to the U.S. Supreme Court. If the legislation stands, thousands of county residents will be enrolled in Medi-Cal, the federal-state insurance program, or in subsidized private insurance plans beginning in 2014.

The county plan had the potential to bring in $50 million in federal funds but would have required changing its 30-year agreement with Community for treating the poor and jail inmates. The supervisors weren’t willing to take that financial risk.

Likewise, county officials expressed concern about Community’s plan, which proposed ending the county contract altogether.

Under the proposal, the county would reclaim control of indigent and jail inmate care and the $20 million now paid to Community to provide that care. The money could be used to secure matching federal funds for the health program. The county would then pay Medi-Cal rates to Community for indigent patients.

But the county maintains that Community’s proposal is not financially feasible, John Navarrette, the county’s administrative officer, said in a Nov. 1 letter to Community.

The county report on the proposal was submitted to supervisors Nov. 4 by Dr. Edward Moreno, the county’s health director.

Moreno’s report said the cost of care for indigent patients is more than the $20 million the county now pays Community, which has claimed it spends four times as much yearly to serve indigent patients.

Community’s proposal would shift those costs to the county, the report said.

Community President and CEO Tim Joslin said the county would get $30 million each year for two years through the federal program. And patient care would be less expensive than the $80 million Community spends now, because patients would be seen in primary-care settings, not emergency rooms, he said.

But the county’s position is clear, he said: “Their priority clearly is a financial one.”

Navarrette said he’s willing to talk to Community about alternatives that involve sharing the financial risk for indigent and inmate care. But Joslin said Community presented all its options.

Supervisor Susan Anderson said she hopes negotiations with Community aren’t over. And she said the county report shouldn’t end the discussion – especially because she has concerns over whether county officials are qualified to do the risk assessment.

Said Anderson: “We need people with industry expertise to do a risk assessment for the county.”