Steps are still required for the successful adoption of the Affordable Care Act, according to a top health care official with the Los Angeles County Department of Health Services.

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The Department of Health Services is engaging Gov. Jerry Brown’s office on a number of budgetary and policy issues.

“It is still unclear how many many patients are going to be eligible and sign up, and until we know how many sign up, it is difficult to know what the actual costs are to the health care system,” said Anish Mahjan, director of systems planning for Los Angeles County Department of Health Services.

The governor’s May revise of the state budget calls for an immediate reduction of county funding for indigent care in the current fiscal year.

The county’s DHS wants to defer the start date for redirecting county funds until 2016, the first year when the state will have costs related to Medicaid expansion.

“Health reform starts on 2014, and so it makes the most sense to wait and see what the actual costs are,” Mahjan said.

The revision states that all savings would be diverted to the state.

For the DHS to fully benefit, they are asking for savings to be shared on an equal basis between the state and county.

“If we don’t share in the savings, we don’t have the money or resources to make the same kind of investments that other health systems make,” Mahjan said.

Brown is proposing the use of a formula to measure the amount of county savings available for redirection to the state. County savings would be determined by measuring the costs of providing services to patients and the revenues received for those services.

The governor’s formula would also place a cap on the cost growth of county expenditures based on historic trends. The DHS believes this would not reflect the true costs under the ACA.

“Costs increase every year due to inflation, but also due to how well the economy is doing. There shouldn’t be a cap on the costs based on the last few years because we were in a recession,” Mahjan said.

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