Among urban California counties, Sacramento County pays the second-lowest amount to recipients of General Assistance – called the aid program of last resort.

The base amount is $234 a month, minus $40 for medical care and $25 for a bus pass – leaving $169 in cash.

Now the county is being accused of depriving recipients of the medical services they pay for through the County Medically Indigent Services Program.

In a lawsuit filed in Superior Court, Legal Services of Northern California says the county is denying medical care to General Assistance applicants waiting for grant approval, in violation of state law.

What's more, according to Legal Services, the county automatically deducts the $40 for medical services from retroactive grant awards even when recipients could not use the service.

County officials deny any wrongful withholding of medical care and say they're following the law.

Amy Williams, an attorney for Legal Services of Northern California, says she wants the county to change its policies and practices to ensure General Assistance applicants have access to medical care.

"What we have here is a calamity of errors," she said.

Applicants have to wait to get primary medical care until they're approved for General Assistance, a process that can take over a month. Until then, they're eligible for urgent care at the county's Primary Care Clinic at 4600 Broadway.

Muriel N. Johnson, one of the recipients named in the lawsuit, said she went to the clinic because of leg pain. She said she was turned away.

"The receptionists all saw I was in tremendous pain, but they didn't even get a doctor to look at me," she said.

Williams argues that the county doesn't adequately determine what constitutes an urgent need, in part because decisions are made by non-medical personnel.

Applicants should have immediate access to primary care, anyway, because urgent care doesn't cover the "medically necessary" coverage guaranteed under state law, according to the lawsuit.

In its answer filed in Superior Court, the county disagrees with that argument, and also says that receptionists are trained to make the decisions about urgent care needs, and bring in doctors when they're not sure about a request.

In the lawsuit filed Aug. 29, Legal Services includes the cases of four people who were allegedly denied service at county clinics.

They were turned away when they needed medication for high blood pressure and care for an abscessed tooth, a bleeding fibroid and severe pain and – in Johnson's case – severe leg pain, according to the lawsuit.

One of the applicants returned and received care when she demanded a "medical override," at the advice of Legal Services, but others have been denied similar requests, according to the lawsuit.

Those denied medical services, as well as those who were not notified about the availability of medical services, are still charged for them, according to Legal Services.

In another lawsuit filed earlier this year, Legal Services challenges the practice of automatically deducting the charge for medical services not available to recipients.

"You're already screwing them by not giving them the service, and then you're taking the $40 out," Williams said. "What this says to the poor is that there is no safety net."

Kathryn Harwell, a deputy director in the Department of Human Assistance, said the amounts are deducted for medical care because the service is available once people apply. They're notified about the service in documentation they're given when applying, she said.

She said she couldn't comment on specifics in the lawsuits by Legal Services.

The county's average grant to General Assistance recipients was the second lowest among the state's 23 largest counties in June, according to the latest figures from the state Department of Social Services.

Santa Barbara County had the lowest average monthly grant, $152, but it also had far fewer cases than Sacramento County, 479 cases compared to 6,566.

The Sacramento Board of Supervisors reduced the grant by 8 percent in July 2011. Recipients are expected to pay back the grants.

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