How Los Angeles County Is Tackling Medical Debt With Public Health Prevention
- Public health officials in Los Angeles County are launching a digital system to screen patients automatically for hospital financial aid, aiming to prevent hundreds of millions of dollars...
- Naman Shah, a physician and epidemiologist at the Los Angeles County Department of Public Health, spends his Tuesdays seeing tuberculosis patients at a small public clinic in the...
- An estimated 100 million adults in the United States hold some form of healthcare debt.
Public health officials in Los Angeles County are launching a digital system to screen patients automatically for hospital financial aid, aiming to prevent hundreds of millions of dollars in medical debt each year, KFF Health News and Tradeoffs reported.
Tackling Medical Debt Upstream in Los Angeles County
Naman Shah, a physician and epidemiologist at the Los Angeles County Department of Public Health, spends his Tuesdays seeing tuberculosis patients at a small public clinic in the San Fernando Valley. Shah compares controlling infections to stopping medical debt, stating We like doing things upstream, meaning before they happen, not after the damage is done.
An estimated 100 million adults in the United States hold some form of healthcare debt. In Los Angeles County, public health officials calculate that roughly 800,000 residents carry medical bills they cannot pay.
The impacts of medical debt were staggering. People end up with credit card debt and then a vicious cycle of high interest rates and poverty. People forgo their prescriptions. People forgo appointments. And then you get into worse health.
Naman Shah
Bulk-Purchasing Software to Expand Presumptive Eligibility
Hospitals typically offer charity care to low-income patients, but applications are cumbersome and information is hard to find. Jared Walker, founder of the nonprofit Dollar For, notes that most people walk out of hospitals without knowing financial assistance exists.
To fix this, hospitals can use presumptive eligibility software that checks patient financial aid status automatically using public information like credit history. Hospitals utilizing these systems have reported up to a 50% increase in financial aid distribution, according to Shah. However, only about 1 in 5 hospitals in Los Angeles County currently use them because smaller facilities find them costly and difficult to implement.
A new partnership is addressing that barrier. The Hospital Association of Southern California agreed to procure a digital presumptive eligibility system through a bulk-purchasing model to lower individual hospital costs. Meanwhile, L.A. Care, a nonprofit Medicaid health plan, committed $2 million to establish the system.
Funding Integration and Future Implementation Challenges
Under a California state law passed last year, all hospitals must initiate presumptive eligibility screening by next July. The county-backed partnership aims to get its shared system running by January, though long-term funding and ultimate participation rates among the county’s 88 acute care hospitals remain uncertain.
Project partners are also working to link the digital screening tool with tax records maintained by the state of California to secure more accurate income data. Shah acknowledges that better hospital screening will not eliminate medical debt entirely, but emphasizes that the public health department could not ignore a crisis affecting more county residents than asthma or tobacco use.