Thousands of the north state's rural poor, including residents of the greater Sacramento area, will be able to access medical care in 2012 after more than 30 counties received federal approval and funding to expand their indigent health coverage.

The County Medical Services Program, or CMSP, a group of 34 mostly north state counties, received the green light to cover an additional 30,000 uninsured, low-income adults through Path2Health, a new indigent care program that launched Jan. 1.

Created as a prelude to federal health reform, Path2Health provides free health coverage for medically necessary services to uninsured adults in the 34-county network who are at or below 100 percent of the poverty line – about $10,890 for a single person – and who do not qualify for Medi-Cal.

It is one of a number of low-income health programs, or LIHPs, across the state that will "build a foundation for when health reform takes over" in 2014, said Lee Kemper, executive director of CMSP's governing board.

"We're starting to make it possible to make people eligible now," Kemper said. "This is basically a network that will be a bridge leading to new coverage. This will make it possible for counties to implement health reform early."

The federal government will match each dollar the 34 counties spend on Path2Health, but officials did not know how much that would be. CMSP will serve 90,000 low-income adults by the end of 2013, Kemper said.

Under the Affordable Care Act, low-income adults covered by LIHPs such as Path2Health will transition to either Medi-Cal or the state's Health Benefit Exchange in 2014.

The LIHPs go further than the indigent care programs that counties have long run under Medi-Cal. The LIHPs are managed-care plans with established health benefits and guidelines on coverage and access to basic and specialty care.

Rural administrators in CMSP say the federal matching dollars will help their counties – El Dorado, Nevada, Sutter and Yuba among them – to extend care to more of their neediest residents.

"With this additional funding, quite a number of our poor will receive care and have a good primary medical home," said Jim Ellsworth, executive director of El Dorado Community Health Center in Placerville, which serves about half of the county's 2,800 residents enrolled in Plan2Health through CMSP.

"It's an opportunity to prepare for health reform in 2014 and help people who have fallen through the safety net," said Nevada County executive officer Richard Haffey. "People with no health plan, their only option is to go to the emergency room. In many ways, it's a preventative situation."

More than 45 of California's 58 counties now participate in LIHPs, including 10 large, urban counties that launched their own programs in July, enrolling more than 225,000 Californians, said Anthony Wright, executive director of consumer health advocacy group Health Access California.

A number of remaining counties, including Sacramento and Placer, are working to launch LIHPs later this year to complement their existing indigent care programs. Yolo County will join CMSP and its Path2Health program later this year, Kemper said.

Wright said as many as 500,000 Californians could ultimately obtain coverage through LIHPs by 2014, when they roll into the federal coverage.

"This is a big deal – it's a huge benefit not only for folks who will get care, but for the health-care system and counties," Wright said.

For the poor who need care, low- income health programs such as Path2Health are the difference between trips to the emergency room for basic care and having a medical home base for primary and specialty care, disease management and preventive care.

For recession-battered rural counties charged with providing care to their low- income residents, the federal matching funds pump money into health systems as more residents are feeling financial pain.

In tough times, more people are seeking out CMSP's services, said Kemper, who has seen its enrollment balloon from about 42,000 to about 63,000 people during the recession, draining all but $20 million of CMSP's $250 million rainy-day reserve in the process.

Kemper said not only will the federal dollars shore up CMSP's depleted fund, but the money will help grow the program and is "important to continuing coverage in general."

"These rural areas have been hard-hit," Kemper said. "There's a lot of need."

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