'Don't Quit Medi-Cal' Say Frontline Providers to Immigrant Communities

'Don't Quit Medi-Cal' Say Frontline Providers to Immigrant Communities

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FRESNO, Calif. -- Araceli felt blessed last June, when California launched its Health For All Kids program, allowing children to sign up for full-scope Medi-Cal, the state’s name for Medicaid, the health insurance program for low-income people. That allowed Araceli’s children to gain access to a range of medical, dental and mental health care services, including special therapies that her son who has autism needs.

“It has been a relief not having to pay from our pocket,” says Araceli, 44, who has been living undocumented in Fresno for more than a decade, after she immigrated to the United States with her family from her native Mexico.

Araceli, who did not want her last name to be used, shared her story during an ethnic media briefing jointly hosted by New America Media and Clinica Sierra Vista here, to encourage parents to enroll their kids in Medi-Cal and keep them enrolled in the program, which is largely funded by the state.

Despite the fear triggered in immigrant communities by recent arrests by Immigration and Customs Enforcement (ICE), and the possibility of getting on the agency’s radar through databases offering public services, Araceli said she is willing to keep her children enrolled “until the last minute.”

“I am not going to quit; I owe my kids good health care,” said Araceli, who herself has received family counseling from her son’s school. “I don't know what I would do if I have to go back to Mexico where there is no [good] health [care] or education for my kids.”

As Reyna Villalobos, director of community programs at Clinica Sierra Vista, pointed out, if Congress were to repeal the Affordable Care Act, it would leave close to 120,000 low-income adults without health insurance in Fresno County but also eliminate “close to 6,000 jobs due to the reduction in federal health care spending.”

Clinica Sierra Vista is a federally qualified healthcare clinic that provides health care to low-income and ethnically diverse families in the southern San Joaquin Valley through its 28 clinics in four Central Valley counties. It’s been a safety net for those who have no papers.

“We receive $45 million in federal, state and local contracts, so we rely very heavily on public funding,” said Villalobos, who was among four panelist at the media briefing.

She pointed out that “without the Affordable Care Act (ACA), we wouldn’t have been able to serve 10,000 patients in our behavioral health system.”

If the ACA is repealed, as the Trump administration is threatening to do, she said, there will be a “public health crisis, making people run to the emergency rooms, instead of seeing a primary care doctor.”

Having mental and dental health care is part of the Medi-Cal expansion that has had a huge impact in California: 3.7 million adults have enrolled in it, while 1.2 million purchased subsidized insurance through Covered California, the online marketplace. Because of the ACA, the rate of uninsured residents fell from 17.2 percent in 2013 to 8.6 percent in 2015, according to the UCLA Center for Health Policy Research.

Under SB 75, the legislation known as “Health for All Kids,” an estimated 250,000 children have enrolled in Medi-Cal. Children under 19 can enroll even if they are undocumented, provided they meet all eligibility criteria.

House Republican leaders have said they want to repeal and replace or repair the ACA, but have yet to offer concrete alternatives. They could dramatically alter the Medi-Cal program that vastly expanded under the ACA, making it unaffordable to many.

Disparities for Latinos

“Latinos experience greater disparities in their access to healthcare,” said Jennifer Torres, a licensed psychotherapist in Marriage and Family Therapy, who is the assistant director of Behavioral Health at Clinica Sierra Vista. “Their legal status sometimes prevents them from seeking help, as fear of deportation is very real these days.”

Torres highlighted the fact that there are also language and cultural barriers that keep immigrant families from accessing mental health care. Some “don’t want to be seen as ‘crazy’ as that can threaten” their sense of self-worth, she said, noting that SB 75 allows them to get help in dealing with the many stresses immigrant children experience.

Torres said her clinic has seen an increase in the number of patients, following the implementation of the ACA, but there is a shortage of mental health care professionals who speak Spanish in the Central Valley and want to work in the field.

In the case of dental health, too, there is a shortage of providers in the Central Valley. According to panelist Rhoda Howard-Gonzales, a dental consultant at Central Valley Regional Center, Fresno has 55 dentists for every 100,000 inhabitants, while the average in California is 63.

“The problem is we don’t invest in prevention, which is why California ranks 4th from the bottom in the country when it comes to oral health,” she said.

“Early childhood tooth decay or cavities is more preventable than asthma, and still 71 percent of kids have tooth decay in California. The problem is that families don't learn about basic preventative dental care and we need to start with the moms," she said.

Although Medi-Cal expansion allowed an increase in coverage from 209,000 to 280,000 patients in Fresno in 2016, Howard-Gonzales said that just 25 percent of infants between 0-5 years have visited the dentist, and that only 44 percent of patients return for annual checkups.

“Your information is not going to be shared with ICE”

Within immigrant communities, there is an additional factor that prevents them from seeking help: fear of federal officials.

California Rural Legal Assistance Foundation attorney Bianca Dueñas told the attendees that although it was understandable that undocumented people were afraid to enroll in public programs in the current political climate, “several state and federal laws protect the information you provide in the application forms. There are confidentiality provisions that make it safe to enroll, so your information is not going to be shared with ICE.”

Dueñas also stressed the difference between federal and state laws, noticing that SB 75 is a California law that is likely to exist under the Trump administration.

The attorney gave a thumbnail sketch of how immigrants could protect themselves from ICE, both in public places, as well as in their homes.

“A lot of detentions happen because people don't know their rights,” she said.

Here are some key “know-your-rights” points she outlined:

- In any context or space, you have the right to remain silent. There is no law that requires a person to show an ID or talk to an ICE officer.
- At home: Do not open your door to ICE, unless they show a valid warrant issued by a judge.
- At the workplace: Do not run if ICE officers show up at your workplace. It gives them a reason to suspect you. If they don’t have information about you being undocumented or deportable, they don’t have the right to question anything about you.
- In a public space: Under President Obama, ICE had enacted a policy of sensitive locations: churches, clinics, courtrooms and schools were safe from ICE raids. It is unclear if the Trump administration is going to honor that policy, but ICE officers need a warrant to get access to these places.
- If you are driving: You don’t need to show your driver’s license to ICE agents. However, you should show it to a police officer. Undocumented immigrants in California are entitled to get driver’s licenses, thanks to AB 60. However, AB 60 licenses have a distinguishing mark, so your immigration status will be exposed if it ends up in the hands of an ICE agent. The key is to ask which agency an officer represents before showing him or her any ID.