Editor's note: San Juan County officials are considering many options to reduce an anticipated $6 million budget deficit. The Daily Times is examining some of those options — including tax hikes and layoffs — and the anticipated impacts in a three-part series. This third installment looks at proposed program cuts.
FARMINGTON — One way for San Juan County commissioners to reduce a more than $6 million deficit is to gut a state-mandated fund that helps uninsured residents pay for health care. If they cut it down to the bare minimum, it would support only cremations and burials.
"They better make sure they have the funds in there," said Jolene Schneider, Four Winds Recovery Center director, adding that proposed social service cuts will create a need for burials.
If Four Winds loses county funds, its detox center — the only one within about 50 miles — will likely close, she said.
"We're headed in that direction anyway," she said. "The hope is to make it through the fiscal year."
Senate Bill 268, passed in the last legislative session, requires that counties pay one-twelfth of 1 percent of their gross receipts to a fund known as the Safety Net Care Pool.
San Juan County's payment is about $3 million, and with another approximately $3 million worth of obligations, that creates the $6.04 million deficit in the county's health care assistance program.
The health care program and the safety net pool are similar. The county's program partially reimburses community health care providers for delivering uninsured care, and it also helps uninsured residents pay for care. But commissioners recently cut the program's reimbursements nearly in half to cope with the anticipated deficit, severely impacting many providers. The statewide safety net pool uses county payments to help hospitals pay for uninsured care. That pool could provide about $800,000 to the San Juan Regional Medical Center.
But without county payments, the medical center would lose an estimated $2.2 million that pays for ambulance services, according to county documents. Efforts to reach hospital officials for comment on that proposed cut were unsuccessful.
Presbyterian Medical Services would lose an estimated $309,173, which supports Totah Behavioral Health, Northwest New Mexico Hospice & Home Care, San Juan Home Health and Farmington Community Health Center's medical and dental services, according to county documents.
Childhaven would lose an estimated $20,500 that supports its emergency shelter and a projected 500 nights of care in its children's shelter, according to county documents.
The Alternative Sentencing Division would lose an estimated $965,434 that pays for its DWI and drug treatment programs, according to county documents.
And Four Winds could lose about $250,000, according to county documents.
If those programs are ended or significantly limited, emergency room visits would rise, more people would go to jail, and shoplifting, vandalism and loitering would increase, Schneider said. And health officials say care such as that offered by detox centers is more cost-effective than care delivered in emergency rooms.
"There's probably not as much awareness as there should be that if these services are eliminated, costs will go up elsewhere," she said.
The detox center has served about 4,100 people in a year, she said. Without the center, officers would have to deliver drunk people to the emergency room and the Adult Detention Center.
Eric Ketcham — the hospital's emergency room, emergency medical services and correction health division director — said more drunk people would spend more time in the ER.
"In the long run, we'd have to build a larger emergency department to accommodate that," he said. "In the short term, we would have to get used to having more beds in the hallways."
According to documents Schneider provided to The Daily Times, the ER is about seven times more expensive per day than a detox center.
Tom Havel, detention center administrator, said the jail has 1,094 beds and held 715 people on Wednesday. The jail wouldn't fill if the detox center closed, but it could be a problem, he said.
According to the documents Schneider provided, jail is about 13 times more expensive per day than a treatment center, another service Four Winds provides that would be greatly reduced
Drunk people are always a concern in jail, Havel said. They are more susceptible to kidney failure, high-blood pressure and diabetes, he said. And the hospital would incur this cost, he said, as it renders care.
"If they close, the hospital's going to get them one way or the other," he said.