Thursday, January 13, 2010 | The more than 400,000 residents of Orange County who depend on the county for services from doctor visits to daycare will have to pay more for those services or lose them altogether if Gov. Jerry Brown’s proposed state budget cuts become reality.

In general, said Dr. Michael Riley, director of the county Social Services Agency, planned cuts in state assistance, including health, “really hit the most vulnerable … the ones who have suffered the most through this Great Recession.”

Leaders of the Social Services Agency, the county Health Care Agency and the county-run CalOptima health insurance program — the government agencies that deal with health and welfare issues — are scrambling to assess the potential effects the governor’s planned cuts.

“Our concern,” said David L. Riley, director of the Health Care Agency, “is in any of these state actions, are we going to be left holding the bag?”

The big question for CalOptima executives, said Yunkyung Kim, director of government affairs for the agency, is how much flexibility they will have to reject or change cuts in services if Brown’s proposed budget is approved by the state Legislature and voters.

While CalOptima provides insurance, the Health Care Agency manages everything from flu shots to restaurant inspections to environmental hazards and disaster preparedness.

Social Services administers food stamp programs, welfare, work training, services for the disabled and for abused and neglected children, and and in-home care for the elderly.

The proposed cuts to these programs are part of an overall austerity plan unveiled by Brown on Monday that aims to eliminate a $25.4 billion state budget shortfall. He is also proposing major cuts to higher education, pay cuts for state employees and the elimination of redevelopment agencies.

To raise more revenue, Brown has proposed extending $9 billion in temporary sales and income and vehicle tax increases. The voters must approve the tax extensions, and Brown is expected to ask the Legislature for a special election in June.

If lawmakers refuse to set the special election or voters reject a continuation of the taxes, local health, social service and other cuts could go even deeper.

Under Brown’s proposal, families and individuals receiving state-financed medical care will have to make co-payments of $5 for doctor visits, $3 to $5 for prescriptions, $50 for emergency room visits, and $100 a day for hospital inpatient stays.

Kim said she’s not sure what that will mean for those enrolled in CalOptima. “Do we have to do it [impose the co-payments] or do we have some flexibility with the reduced payment that we get [from the state]?”

Similarly, the governor’s budget would limit doctor and clinic visits to 10 a year, and drug prescriptions would be capped at six a year. The state also would quit paying for over-the-counter cough medicine. But CalOptima isn’t certain yet if it could use its state allocations in ways that mean those cuts don’t apply or are modified.

One area where Kim said they already know there is no flexibility is the Healthy Families program for children. Those children no longer would get free eye exams and glasses, under the planned budget.

“We do have to make cuts” and “not stick our heads in the sand,” said Social Service’s Michael Riley. He added: “This is a difficult task the governor has.”

Those on government aid programs, under the proposal, are likely to see cuts in financial assistance and in-home supportive service for children and adults with disabilities. Eligibility requirements for those programs have become more stringent in the past several years, and Brown’s budget would make them even tighter.

After-school day care for 11- and 12-year-olds from low-income families would be eliminated. Welfare grants, already at 1989 levels, would be cut another 13 percent, according to agency spokeswoman Terry Lynn Fisher.

The Health Care Agency’s David Riley said he’s concerned with issues such as possible increased health care costs if nonviolent adult prisoners and minors are transferred from state prisons to county facilities.

And, he wondered, if the Legislature or voters reject Brown’s proposal, “What’s the plan B?”

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