April 20, 2016
Felix Gonzalez was pulling a typical 13-year-old stunt earlier this month when he piled a friend from his Woodland neighborhood onto the back of his bicycle. The boys were gaining speed until their bike tipped over, sending them into a violent skid that sheared the skin from Felix’s right elbow.
What might have been a quick doctor’s visit for other parents turned into a strained discussion for the Gonzalez family. Was the elbow bleeding enough to require stitches? Would it get infected without medical attention? Felix, an undocumented teen, doesn’t have insurance that covers visits to the local emergency room. Parents Gabriela and Victor Gonzalez, Mexican immigrants accustomed to raising four boys on a tight budget, made a run to Walmart for bandages and ointment and hoped the gash would heal on its own.
Starting May 1, Felix and roughly 170,000 other undocumented children in California will have more options during such crises. They’ll gain access to not just emergency coverage but also dental care, checkups, mental health treatment and other vital services following an unprecedented Medi-Cal expansion that provides full coverage to all low-income children in the state, regardless of immigration status.
Home to more immigrants than any other state, California will be the largest in the nation to cover undocumented low-income children, joining Washington, Illinois, New York, Massachusetts and Washington, D.C. The expansion, effective next month, was approved by Gov. Jerry Brown in the October 2015 state budget.
That effort is a major step in meeting the larger challenge of insuring the state’s 2.4 million undocumented immigrants mostly left out of California’s health reform push. With county health departments and now Covered California taking steps to cover the population, local advocates and community clinic counselors are trying to match eligible families with affordable coverage options that will give them access to the same preventive services as their neighbors.
California’s undocumented immigrants are now excluded from purchasing plans under the federal Affordable Care Act and have access only to select Medi-Cal programs for limited populations, such as women with cervical or breast cancer and minors seeking substance-abuse treatment. Those who aren’t insured by employers get their health care through a patchwork of county services, safety-net clinics and emergency department visits. Others choose to go without screenings and shots and allow treatable conditions such as diabetes to become life-threatening.
“There is a sentiment that we need to move toward more and more coverage,” said Sarah de Guia, executive director of the Pan-Ethnic Health Network, an Oakland-based nonprofit group that has been on the front lines of health advocacy for immigrants. “To have people not being able to access health care services as we move toward expansion just doesn’t make sense.”
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Gabriela and Victor Gonzalez, both farmworkers, moved to Woodland from Michoacán, Mexico, in 2007 to give Felix, then 5, a better life near more of his extended family. They’ve had three more sons since then – all U.S. citizens on comprehensive Medi-Cal – but their oldest still lacks a Social Security number, making him ineligible for full coverage until now.
Felix does have a Kaiser Permanente plan that only covers him at Kaiser facilities, the nearest of which is in Davis. In May, Gabriela will enroll him in the same, lower-priced plan as his brothers so that she can take them all to a nearby community clinic for routine primary and dental care free of charge.
“For me to get health care is a big step,” Felix said. “Now my mom won’t have to worry about going to Davis. I don’t like it when she’s so stressed.”
The 38-year-old woman has been fatigued and short of breath lately – symptoms the clinic staff worries might signal a heart problem. She’s had to shell out nearly $500 in out-of-pocket medical expenses this month to pay for imaging and consultations not covered by restricted Medi-Cal, the bare-bones plan that is often the only option for California’s undocumented adults.
About a quarter of the 3.8 million Californians under 65 who remain uninsured are not eligible for coverage due to their citizenship status, according to a March 2016 report from the California Health Care Foundation. Immigrants in California make up 6 percent of the population and 10 percent of the workforce, according to the think tank Pew Research Center.
The Medi-Cal expansion for undocumented children is exclusively state-funded and is expected to cost the state Department of Health Care Services about $132 million annually. A 2015 study from the Public Policy Institute of California concluded that about half of the state’s undocumented immigrants have incomes low enough to qualify for Medi-Cal.
With the stalling of recent legislation seeking to expand Medi-Cal to income-eligible adult immigrants, other efforts are in the works to get more people covered. Earlier this month, Covered California announced that it would seek a federal waiver to allow undocumented people of all ages to buy insurance with their own money. Nearly 50 California counties are also offering, or planning to offer, limited coverage to undocumented families. That’s up from just seven at the beginning of 2015, according to a California Healthline report.
However, those options don’t cover preventive care, lab work, dental care or specialty services, said Betzabel Estudillo, health policy coordinator for the California Immigrant Policy Center. Estudillo, now a U.S. citizen living and working in Los Angeles, migrated from Mexico and remained undocumented until 2012. As a child she was enrolled in a county health program, but that ended when she turned 19, she said. She didn’t get covered again until she attended UCLA several years later.
“My whole childhood I had sporadic health care,” she said. “I just remember going to the county hospitals and the county clinics. I thought, ‘That’s what you do. That’s how you go to the doctor.’ ”
Betzabel Estudillo, health policy coordinator for the California Immigrant Policy Center, formerly undocumented
Estudillo’s story is a common one in undocumented and mixed-immigration-status families, where language barriers, paperwork and fear of deportation dissuade many from seeking out coverage. Even when children are eligible for state and county health programs, parents may not inquire about those options for fear of being asked about citizenship status, said Cecilia Velasquez, enrollment coordinator at La Familia Counseling Center in Sacramento.
Dexsi Reyes Lara, a 25-year-old Honduran immigrant who has been living in California for five years, said she moved quickly to learn more about her health care options when she became pregnant with her daughter Yoselin, now 7 months old. She was able to enroll in a Medi-Cal pregnancy program that covered all of her health needs while she carried Yoselin, now a plump and giggly baby with large brown eyes and thick black hair.
But once Yoselin was born, Reyes Lara was removed from that program and lost her insurance coverage, she said. Since Yoselin is a U.S. citizen, she receives all the care she needs through full-scope Medi-Cal, but her mother is back to relying on the emergency room.
Last December, Reyes Lara brought her brother Jose Reyes Lara, 17 and her sister Merary Reyes Lara, 14, to Sacramento so they could get an education. They learned that their restricted Medi-Cal plans didn’t cover the vaccinations required to enter the school system. The family hopes that with the Medi-Cal expansion, the teenagers will be able to get their shots and other basic services.
To qualify, children must be under age 19 and belong to a family defined by the state as low income. Children who are already enrolled in restricted-scope Medi-Cal – about 120,000 in California – will be able to transition to a full-scope plan without filling out a new application.
“I want them to have better doctors and better dental care,” Dexsi Reyes Lara said. “Imagine if they were to get sick? Or even have a bad cold? We can’t see a doctor. It’s very expensive.”
Joe Guzzardi, spokesman for the immigration reform group Californians for Population Stabilization, called the health care expansion another draw for illegal immigrants who will further stretch California’s limited resources and deepen its financial deficits.
“We’re having a hard time sustaining decent quality of life throughout the state,” he said. “What the governor should be thinking about doing is better providing for the people who are already here legally, before he goes out to create entitlement programs to incentivize illegal immigrants.”
Gabriela Gonzalez said she’s looking forward to getting Felix on Medi-Cal so he won’t have to live with the same medical uncertainties she faces.
“This month has been really hard; it’s been really tight,” she said in tears while rubbing Felix’s back.
She’s waiting for an appointment at a Sutter clinic in Davis to undergo an MRI for her heart. She said she’s not only anxious about the test results but the hit of the procedure’s out-of-pocket costs on her already strained household budget.
“We’ve noticed a difference with the other three,” she said about her sons who are citizens. “They have access to everything, and the service is better. I’m looking forward to having them all get the same thing.”