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Casey Christie / The Californian

Kern Medical Center CEO Paul Hensler.

Local health care advocates had a message for state politicians Monday: Keep your hands off money given to counties for indigent health care.

Standing outside Kern Medical Center holding purple and white signs with slogans including "Forward on Healthcare" and "The time is NOW," the group of health care reform proponents and hospital administrators said many people still won't have coverage after the major provisions of the Affordable Care Act roll out next year and thus it would be harmful for the state to take back funding counties use to cover them.

"It's critically important that the counties retain funds to provide care to these safety net individuals," county hospital CEO Paul Hensler said.

The local worries sprung from suggestion at the state level that legislators could reallocate some money directed to counties under 1991 realignment for indigent health care to help cover the state's cost for administering Medi-Cal expansion to those people under the Care Act.

A February report by the state Legislative Analyst's Office recommended redirecting part of the funding "to reflect this shift in responsibility."

While there is no specific provision or legislation on the table to move the funding, Hensler said the news conference was held to get ahead of the issue.

"We'll continue to have quite a segment of the population that will not be eligible (for) or able to pay for care under the Affordable Care Act," he said.

The fear is that those people -- including illegal immigrants and people who still can't afford premiums after subsidies -- will continue to need medical care despite the fact that counties would have less money to pay for it if funds are shifted, Hensler said.

The amount the county receives annually from realignment fluctuates, but Hensler said it is about $16 million a year and KMC receives the majority of that money. KMC has other sources of funding, including federal money, to support indigent care, but Hensler said those safety net resources also will be declining.

Regina Kane, a Kern County Mental Health Department nurse and president of SEIU 521 Kern County Chapter, urged Gov. Jerry Brown and local representatives in Sacramento to "protect and strengthen" the safety net.

"It's a tragic and twisted proposal taking the realignment money and putting it into the Medi-Cal expansion under the Affordable Care Act. It would not only hurt individuals but it would hurt our community," Kane said.

Messages left with Brown's press office Monday were not returned.

During the press conference, Hensler also recommended the state move forward to expand Medi-Cal on Jan. 1, or at least set a new target date "so that those of us involved in the planning for the expansion can realistically plan."

There's been some question as to when California will expand Medi-Cal, Hensler said.

California legislators are considering bills that would extend Medi-Cal coverage to people with incomes that are less than 138 percent of the federal poverty level. Under health care reform legislation, the federal government would pay 100 percent of the costs for these newly eligible individuals for three years and then gradually reduce the share it pays to 90 percent.

"It would seem to me job one is get the money into the state; then we can argue about how to divvy it up, but to just not receive it I think would be a real travesty," Hensler said.

Hospital staff said they would also like a chance to continue the Kern Medical Center Health Plan, a low income health program designed to bridge people into Medi-Cal coverage. Hensler said as things stand now, the program would end on Jan. 1, and enrollees would go into Medi-Cal managed care programs.

Jacey Cooper, executive director of managed care at KMC, said the plan has shown that it can provide well coordinated care for people with multiple, complex illnessess and other issues.

"We've reduced our cost by 43 percent from 2007 to current. I just think that shows that you can take someone who's historically been treated in the ER for episodic care, provide them a primary care doctor, focus on prevention, primary care, and it really does reduce cost," she said.