Reaching out to the undocumented and uninsured

Since Maria Alfaro and her family came to California from El Salvador eight years ago, getting sick has not been an option.

Alfaro has no health insurance. Neither does her husband, who works in the fields in rural Mecca, about 40 miles east of Palm Springs. Their 16-year-old son is in the same situation. Scraping by on about $1,000 a month, they can’t afford private coverage. And they don’t qualify for most public programs because they are undocumented immigrants.

If they get sick, Alfaro says, “We don’t come to the doctor. We just try to do what we can to get better at home.”

That might soon change. Alfaro last month connected with Lucy Moreno, a community health outreach worker, or promotora, who travels the countryside helping people apply for medical assistance.

Moreno told Alfaro about Riverside County’s medically indigent services program, which provides basic preventive and emergency care for the poor, regardless of their immigration status. Excluded from the subsidized insurance that will come if the federal health overhaul takes effect, undocumented immigrants will be eligible for limited services provided by the counties, which will remain the health care providers of last resort.

“It would be so much less a burden on our family,” Alfaro told Moreno in their meeting. “But I don’t know how to get into the program.”

Moreno sits down with moms like Alfaro all the time, going to trailer parks, churches and food distribution sites to reach families in need. She helps them fill out the paperwork, tells them where to send it, then follows up a few weeks later to smooth out any problems and get patients an appointment at one of a handful of clinics that accept the program’s payment: in this case, the Clinicas de Salud Del Pueblo in Mecca.

The promotoras program run by the nonprofit Project Access in the eastern Coachella Valley is in the final weeks of a six-month, $25,000 grant from Kaiser Permanente.

Kaiser and other private health systems that run hospitals with emergency rooms could benefit from the work of the promotoras. As more low-income people are enrolled in public programs, fewer will wind up in emergency rooms with bills they cannot afford to pay.

Moreno said she and the rest of her six-person team have signed up about 300 families since January. Now they are following up with each family to see if they are enrolled and have found a family doctor and dentist.

“About 45 percent of the community in the eastern Coachella Valley need this help and probably qualify for some type of program or another. That’s thousands of people,” Moreno says.

The promotoras say they’re battling a simple lack of knowledge.

“Many people don’t know they qualify,” Moreno said. “They don’t have a Social Security number, so they don’t apply. There is a fear factor and a stigma. They’re afraid of not qualifying. They don’t want to admit how many people are living in the home. They are afraid to give out their address. So they wait and end up in the emergency rooms.

“We’re trying to change that mindset. We’re talking to them about prevention, about the importance of going to the doctor or dentist before a crisis.”

Moreno says she also has to convince people that applying for the program won’t label them a “public charge” in the eyes of the law, so it won’t count against them when they apply for citizenship.

The promotoras work hard to establish a rapport with the families. They listen and communicate in a culturally sensitive way because they come from the same communities.

“We know exactly how to talk to them and break through those barriers,” Moreno said. “You really have to gain their trust. If you don’t gain their trust, you can’t go in the door. Once you gain it, then the word starts to spread, and it’s all word of mouth. The marketing takes care of itself because once you get one person hooked up and they’re happy, there are 10 others right behind them.”

Many families are surprised that they can see a doctor in the Mecca clinic. Many falsely believe that they have to travel 60 miles to the county hospital in Moreno Valley to get care.

Moreno says the promotoras take a more personal approach, something the overloaded case workers at the Department of Public Social Services don’t have time to do.

“We go to your home, we go to your trailer, or to your next door neighbor’s house. We go to community fairs and do it there,” Moreno said.

The idea is to guide people through the process, then give them the tools to go out and help themselves down the line. The program is designed not only to reduce suffering among families like the Alfaros, but it also cuts down on those very costly emergency room visits.

Along the way, the promotoras help solve other problems.

“As you help them fill out the application, you get to know these people. They start talking to you about their lives,” Moreno said.

“They don’t have food in their cupboards, their brother’s been sent to the hospital somewhere, their son been has hurt. There are all kinds of issues that appear. And we can provide some assistance with referrals and follow-up.”

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