Just as Amelia Carranza and her husband finished up at the doctor’s office, their 12-month-old began to lose patience and soon was crying. Big sister, meanwhile, sat nearby at a desk, quietly coloring.
Carranza and her family were at the AltaMed Medical Group’s clinic in Garden Grove to enroll their older child in the state’s public insurance program, Medi-Cal. Along with the health insurance exchange, Medi-Cal remains a key avenue to coverage for lower-income people such as Carranza and her husband Jose, who requested that his last name not be used because he is undocumented.
It was Jose’s idea to enroll their 4-year-old in Medi-Cal. (Their younger child already had Medi-Cal coverage). But filling out the application gave him pause, remembers Carranza, who works alongside her husband as a cleaner. Not yet a legal resident of the U.S., Jose was uncomfortable providing personal information to the government.
Families such as theirs, in which some members lack legal residency, have been hesitant to enroll eligible members in the health insurance options available under the Affordable Care Act, according to enrollment specialists and civil rights organizations.
“On a daily basis we encounter mixed-status families,” said Juana Rodriguez, manager of community relations for Orange County at AltaMed. “Their main question is, ‘How is my information going to be used?’”
On Nov. 15, the new enrollment period will again put the issue of mixed status in the forefront.
Dreading the knock on the door
While undocumented residents are largely excluded from federal health reform, many have children who are eligible. An estimated 4.5 million children were born in the U.S. to undocumented parents. California has one of the highest concentrations of mixed-status families in the nation.
These families fear providing personal information to federal authorities, according to Yadira Gomez, senior case manager at Share Our Selves Community Health Center in Costa Mesa.
Enrollment forms “are asking for tons of information, including Social Security (Numbers), family size and income. They (applicants) just feel they don’t need to share that information,” Gomez said. “They feel like someone is going to knock on the door and deport them.”
“Eventually,” she said, “we do sign them up. We have to take extra time and educate clients.”
Enrollment specialists remind mixed-status families of a few things. For one, documentation of legal residency or citizenship is only required of family members seeking the coverage, not the people who are applying on their behalf or other family members.
Further, the information provided on the forms is not used by immigration authorities, according to the application itself as well as federal officials, as stated in a memo from U.S. Immigration and Customs Enforcement.
Another reason mixed-status families are hesitant to enroll in coverage is they fear that receiving a public benefit will be counted against them in their petitions for legal residency. Immigration officials can reject a green card applicant if they determine he or she is a “public charge” that is, dependent on government benefits for subsistence.
But enrollment in Medi-Cal or the health purchasing exchange does not generally make someone a public charge, according to Covered California, which administers the exchange under the Affordable Care Act. Covered California materials say that enrollment “will not affect your immigration status, chance of becoming a lawful permanent resident, or becoming a naturalized citizen.”
Exceptions are if someone receives long-term care in a nursing home or other facility paid for by the government or he or she does not tell the truth on the application.
Despite these public pledges, families continue to worry about appearing dependent, even though they are often working long hours and seeking to legalize their status, Gomez said.
“That’s where we have to spend more time, especially when the family is trying to obtain a green card. They are afraid to ask for any type of help,” she said.
In some cases, people who lack full legal residency but have temporary status can apply for coverage, though levels of access vary. For example, young people exempt from deportation under the Deferred Action for Childhood Arrivals program can participate in Medi-Cal if they qualify, but they can’t enroll in the health exchange.
A study this year from University of California researchers estimated that 80 percent of 150,000 young people with deferred status are likely eligible for Medi-Cal – the question is whether they will apply.
But even signing up for deferred status feels like too big of a risk for one undocumented 21-year-old at UC Irvine, who said that she and her family “don’t want any problems. We try to stay as hidden as possible.”
The computer science major, who asked not to be named, said she qualifies for the program and would have benefited from Medi-Cal in the last couple years, when she went without a dentist and doctor.
“DACA is a really good option, and I would like to get it. But I am afraid that one day they’re going to say, ‘All of these people – get them out,’” she said. The program was enacted by the Obama Administration, not by legislation, and thus could end at any time.
This fall, the student gained coverage through UC Irvine after years of trying to stay healthy through tooth-brushing and avoidance of strenuous physical activity that might lead to injury.
Another issue related to mixed-status families is that some parents don’t feel comfortable getting coverage for some but not all of their children, depending on who was born where.
“One challenge we face was, ‘Do I give some kids access and have others not have it?’” according to Joseph Villela, senior policy advocate at the Coalition for Humane Immigrant Rights of Los Angeles.
Raquel, a second-year UC Irvine student who did not want her last name published, was born in the U.S. and grew up going to regular doctor and dental checkups through her Medi-Cal policy. But her two younger sisters do not have legal status and only receive health care in emergencies.
“We had all grown up here so it seemed so unfair,” she said.
Year two of enrollment
On the eve of a second year of ACA sign-ups, Villela hopes that this time, Covered California will go further to assure prospective enrollees that they will not be penalized for participating in a government program when applying for legal residency.
“The biggest concern is the public charge issue: ‘Will it affect my ability to legalize my status?’” Villela said.
Other concerns about deportation and giving personal information to the government are expected to continue to loom large during the next enrollment period. AltaMed, a network of numerous nonprofit clinics in L.A. and Orange counties, will attempt to allay some of these fears in 2015, using a $750,000 grant from Covered California to assist in signing up eligible residents.
Community relations manager Juana Rodriguez of AltaMed said the plan is to reach mixed families by staging enrollment events in community centers and trusted neighborhood locales. As with last year, enrollment specialists will work at tables in large tents that foster confidentiality and discreet conversations, she said.
Even in an era of aggressive deportation, she said, “Fear should not be a barrier to getting care.”